Medicare’s new payment model is built for AI — but most tech companies are missing the boat. Neil Batlivala of Pair Team, a company managing chronic conditions in underserved populations, was recently accepted into ACCESS, a Medicare program testing AI-driven care at federal scale. This marks the first time the government is rewarding health outcomes, not just clinician hours, creating a pathway for AI to drive real impact in healthcare.

This shift opens doors for AI solutions that address the full context of patient lives — from housing to nutrition — but only if you know how to leverage it. Read on to discover how this model can transform your business and unlock measurable ROI through smarter, outcomes-based AI strategies.

The Gap Nobody Talks About: Why AI Is Being Left Behind in Healthcare

Healthcare is lagging in AI adoption, despite the sector’s massive potential for transformation. Most tech companies are ignoring Medicare’s unique needs, particularly the new payment model built to support AI-driven care. Traditional models fail in chronic care because they reward activities, not outcomes — a mismatch for AI tools that monitor patients between visits or coordinate care across systems.

Companies like Pair Team have spent years aligning with Medicare’s goals, yet many in tech remain unaware of how to leverage this shift. As Neil Batlivala notes, the government is creating “swim lanes for AI innovation,” but most players are still stuck in old paradigms. This gap means billions in opportunities are being left on the table — for now.

What Is Medicare’s New Payment Model — And Why It’s a Game-Changer for AI

From activity-based to outcome-based payment

Medicare’s new payment model shifts the focus from how much time is spent on care to how well patients actually improve. Instead of paying for check-ins or procedures, it rewards measurable health outcomes, like lower blood pressure or reduced pain. This change creates a new financial incentive for solutions that deliver real results — something AI is uniquely positioned to do.

How AI fits into the new model

AI can monitor patients continuously, flag issues early, and coordinate care between providers — all without requiring additional time from clinicians. Neil Batlivala of Pair Team notes that AI can manage chronic conditions more effectively by addressing the full context of a patient’s life, including housing, nutrition, and transportation. This is a perfect fit for the outcome-based model.

ACCESS program: The first step in AI-driven care

The ACCESS program, launching July 5, is the first real test of this new model at scale. It includes 150 participants, from AI startups to wearable makers. Pair Team, which has been building toward this for five years, is one of the few companies focused on the complex needs of patients with chronic conditions and social barriers. The program is a critical first step in proving AI’s value in healthcare.

How AI Can Deliver on the New Model — Beyond Just Tech

AI as a care coordinator, not just a diagnostic tool

AI in healthcare is shifting from a diagnostic tool to a care coordinator. This change aligns with Medicare’s new payment model, which rewards outcomes, not activities. Tools like Pair Team’s AI-driven platform go beyond diagnostics by managing care workflows, ensuring patients follow through on treatments and lifestyle changes.

Real-world applications in chronic care

Chronic care management is where AI shines. Pair Team, for example, uses AI to address the full context of a patient’s life, including food insecurity and unstable housing. Their model shows that AI can manage complex, multi-dimensional care needs — a critical requirement for the ACCESS program’s success.

Why AI wins in patient-centric models

Medicare’s new payment model favors AI because it enables personalized, continuous care. Unlike traditional models that pay for time, ACCESS rewards measurable outcomes — and AI is uniquely positioned to deliver these. As Neil Batlivala notes, “You just couldn’t do this before,” but with the right AI tools, it’s now possible to transform how care is delivered and paid for.

Where AI Wins — Practical Steps for Implementation

Step 1: Align AI with measurable outcomes

Medicare’s new payment model rewards outcomes, not activities. Start by mapping AI tools to specific health goals — like blood pressure control or medication adherence. Pair Team’s success shows that AI works best when it directly ties to measurable patient outcomes.

Step 2: Integrate with existing care workflows

AI must fit into current clinical processes, not replace them. Use tools that interface with EHRs and support care teams. Avoid solutions that create friction or duplicate work — integration is key to adoption and effectiveness.

Step 3: Leverage data for continuous improvement

Collect and analyze data from AI interventions to refine care delivery. Pair Team has built its model around continuous feedback loops, ensuring AI adapts to real-world patient needs. This approach drives long-term value and aligns with Medicare’s outcome-based goals.

How to Use AI to Improve Chronic Care and Meet Medicare’s Goals

AI for diabetes and hypertension management

AI can monitor glucose levels, medication adherence, and lifestyle factors in real time for diabetes and hypertension patients. Pair Team’s model shows that integrating AI with community health workers improves outcomes — and aligns with Medicare’s new payment model.

AI in mental health and depression care

AI chatbots and predictive analytics can detect early signs of depression and connect patients with care. This is especially impactful under the ACCESS program, which rewards measurable outcomes like reduced pain or improved mood.

AI in social determinants of health

AI can identify social barriers like food insecurity or housing instability and trigger interventions. Neil Batlivala’s company, Pair Team, has shown that addressing these factors is critical to improving long-term health outcomes — and meeting Medicare’s goals.

Common Misconceptions About AI in Medicare’s New Model

Misconception: AI replaces human care

AI is not a replacement for human care — it’s an enabler. Companies like Pair Team have built models that integrate AI with human clinical professionals to address complex patient needs. As Neil Batlivala said, “You can’t improve health outcomes without addressing the full context of someone’s life.” AI handles routine monitoring and coordination, while humans handle the nuanced, high-touch care.

Misconception: AI is only for tech startups

AI in healthcare is not limited to startups. Established players and startups alike can leverage the Medicare new payment model built for AI. Pair Team, for example, has grown to employ 850 clinical professionals and operates at scale. The ACCESS program is open to a wide range of participants, including startups, wearables, and connected device companies.

Misconception: AI can work without data integration

Data integration is essential for AI to deliver measurable outcomes. Without seamless access to patient data, AI cannot make informed decisions or coordinate care effectively. The Medicare new payment model built for AI assumes that data will be shared and used strategically — a shift that requires both technical and operational alignment.

The Future of AI in Healthcare — What’s Next?

AI as a core part of healthcare infrastructure

The Medicare new payment model built for AI is not just a regulatory shift — it’s a blueprint for the future of healthcare infrastructure. AI will no longer be a niche tool; it will be embedded into the fabric of care delivery, from chronic disease management to real-time patient monitoring.

Companies like Pair Team are already proving that AI can drive measurable outcomes when integrated with human expertise. Their model, which combines AI with a large community health workforce, shows that the most effective solutions address both medical and social determinants of health.

As this model scales, healthcare systems will need to rethink how they allocate resources. AI automation in healthcare will shift from being an add-on to a foundational element of care — and those who adapt will capture the most value.

“The government is creating swim lanes for AI innovation in traditionally regulated industries,” says Neil Batlivala. That’s not just a statement — it’s a call to action for healthcare leaders to build solutions that align with this new reality.

Source: techcrunch.com