内容来源：https://techcrunch.com/2026/05/12/medicares-new-payment-model-is-built-for-ai-and-most-of-the-tech-world-has-no-idea/

内容总结：

硅谷忽视的群体，成了联邦医疗AI试验的主角

一家名为Pair Team的医疗健康公司，在长达七年的时间里，始终服务于硅谷主流科技圈几乎从未听闻、也长期忽视的患者群体。然而就在上个月，这家公司因一项联邦计划被推至聚光灯下。

4月30日，Pair Team宣布入选美国联邦医疗保险与医疗补助服务中心（CMS）发起的ACCESS计划，成为150家试点机构之一。这项为期十年的项目将于7月5日正式启动，旨在测试AI驱动型医疗模式在联邦层面的规模化应用。

“政府正在为传统监管行业中的AI创新开辟‘泳道’。”Pair Team创始人Neil Batlivala表示，“在医疗这样受严格监管的行业，以往从未有过‘最佳方案胜出’的机制。”

ACCESS计划全称为“以有效、可扩展方案推动慢性病护理”，其核心创新在于支付模式改革。传统Medicare按医生接诊时间付费，无法覆盖AI健康监测、用药提醒、住房协调等非诊疗环节。而ACCESS采用按健康结果付费——只有当患者达到降压、减痛等可测量健康目标时，机构才能获得全额拨款。覆盖病种包括糖尿病、高血压、慢性肾病、肥胖、抑郁及焦虑症。

“这是支付模式的转型，以前根本做不到。”Batlivala强调。

首批入选机构涵盖AI问诊初创公司、虚拟营养治疗服务商、可穿戴设备厂商（如Whoop）等。但Batlivala对部分参与者持保留态度：“我很看好可穿戴设备，但对于一位面临食品短缺的老年人，我不确定Whoop能帮上多大忙。”

Pair Team成立于2019年，精准锁定“慢性病+住房不稳+食品短缺+交通不便”的多重困境患者——美国约三分之一人口处在这种处境。其核心理念是：不解决患者生活的全貌，就无法改善健康结果。目前公司拥有约850名临床专业人员，运营着加州最大的社区健康工作队伍，营收已达九位数（亿美元级），累计融资约3000万美元，投资方包括Kleiner Perkins、Kraft Ventures和Next Ventures。

公司模式有同行评审证据支撑。发表在《全科内科杂志》上的研究显示，Pair Team的社区整合模式对高比例无家可归、严重精神疾病、慢性病的Medicaid会员产生了显著效果：急诊和住院可避免使用率大幅下降。Batlivala称，在其护理下，四分之一的住院和二分之一的急诊其实本来可以避免。

但长期以来，纯人工团队限制了扩张速度与成本效率。约九个月前，Pair Team部署了语音AI助手Flora作为主要患者交互界面。Flora可24小时值守，处理问诊、协调转诊、进行随访。第一个改变Batlivala想法的电话，来自一位67岁、住在车里的女性患者，她同时患有创伤后应激障碍和充血性心力衰竭。她与Flora交谈了一个多小时。“既令人难以置信，又让人感到悲哀，”Batlivala说，“Flora可能是她几周来唯一倾诉的对象。”如今，与Flora长达一小时的对话已成为常态。“这就是陪伴的价值，事实证明，这本身就是一种干预。”

ACCESS计划的设计者同样是前创业者出身：CMS创新中心主任Abe Sutton曾任职医疗风投基金，首席AI与技术官Jacob Shiff曾是医疗创始人。两人均在特朗普政府时期加入CMS，其创业背景体现在计划设计中：结果导向支付、直接面向患者注册、鼓励竞争。

风险同样存在。参与机构需将极度敏感的患者数据（关于住房、疾病、精神健康的私密对话）输入有数据泄露前科的联邦基础设施。财务风险也不容忽视：美国国会预算办公室2023年分析显示，CMS创新中心在首个十年内反而使联邦支出增加54亿美元。此外，CMS支付的每人每月费用低于许多机构预期，只有实现大部分患者交互自动化的组织才能实现盈利。

就此，Batlivala认为这是故意设计。“如果要建立真正激励AI使用的模式，报销标准必须设低。只有运营精简、以AI为先的机构，经济账才可能算得过来。”

Pair Team目前合作渠道可触达约50万潜在患者，目标是在三年内扩大到100万。

医疗健康领域投资者正密切关注。今年一季度，数字健康融资额创下疫情以来同期新高，AI公司占据主要份额。而ACCESS计划本身，至今仍鲜少出现在主流视线之外。

中文翻译：

尼尔·巴特利瓦拉花了七年时间打造了一家医疗保健公司，这家公司在科技行业几乎无人知晓，服务的人群也是硅谷绝大多数企业所忽视的。但就在上个月，他的工作让他置身于一个更宏大的事件核心。

他的公司Pair Team于4月30日宣布，已被纳入美国联邦医疗保险（Medicare）的ACCESS项目——这是美国医疗保险和医疗补助服务中心（CMS）挑选的150个试点机构之一，旨在测试人工智能驱动的医疗护理如何在联邦层面大规模推广。该项目将于7月5日正式启动。

“政府正在为传统受监管行业中的AI创新开辟‘泳道’。”几天后他在视频通话中告诉我，“最优的解决方案将胜出，而在医疗保健这样的受监管行业里，过去并非如此。”

ACCESS——“以高效、可扩展方案推进慢性病护理”——是CMS一项为期10年的项目，旨在测试一种新的支付模式：按健康结果付费，而非按必要活动（如一定次数的复诊）付费。像Pair Team这样的参与机构，在管理符合条件的病症时会获得固定的预付款，但只有患者在血糖、疼痛等可衡量的健康指标上达标，才能拿到全款。该模式覆盖糖尿病、高血压、慢性肾病、肥胖、抑郁和焦虑症。

这种支付结构才是真正的大新闻。

传统的联邦医疗保险按临床医生接诊时间报销。没有机制为这样的AI助手付费：它在患者就诊间隙进行监测、致电问候、协调住房转介，或确保患者按时取药。ACCESS首次创建了这一机制。

“这是一次支付模式的变革，”巴特利瓦拉说，“过去你根本做不到。”

首批试点参与者涵盖范围广泛——AI医生初创公司、虚拟营养疗法供应商、联网设备公司以及Whoop这样的可穿戴设备制造商。巴特利瓦拉对其中一些持怀疑态度。

“我是可穿戴设备的忠实粉丝，但对于一个连食物都成问题的老年人来说，我不知道Whoop能有多大作用。”他补充说，至于自己的公司，“我们为此已经准备了五年多。”

Pair Team成立于2019年，目标患者群体很明确：患有慢性病，同时面临住房不稳定、食物短缺或交通不便的人群。约三分之一的美国人属于这一范畴。

该公司的核心理念是：如果不全面了解一个人的生活状况，就无法改善其健康结果。如今，它拥有约850名临床专业人员，运营着据称是加州最大的社区健康工作团队，并且据巴特利瓦拉称，年收入已超过九位数。公司已融资约3000万美元，投资者包括凯鹏华盈、Kraft Ventures和Next Ventures。

该模式已有同行评审的证据支持。一项由Pair Team研究人员共同撰写、经《普通内科杂志》同行评审的研究，评估了Pair Team的社区整合模式——该模式将医疗、行为和社会护理融合在一起，服务于无家可归率、严重精神疾病和慢性病发病率较高的联邦医疗补助（Medicaid）成员——结果显示，患者参与度很高，可避免的急诊和住院率显著降低。巴特利瓦拉称，在Pair Team的护理下，四分之一的门诊和二分之一的急诊本不会发生。

但多年来，提供这种程度的护理需要庞大的人力团队，这限制了扩张的速度和成本。大约九个月前，Pair Team部署了一个名为Flora的语音AI代理，作为面向患者的主要交互界面。Flora全天候在线，负责接诊、协调转介，并进行随访，让患者在临床就诊间隙保持参与。

让他观念转变的第一个电话，来自一位67岁的女性，她住在车里，患有创伤后应激障碍和充血性心力衰竭。她与Flora聊了一个多小时。“这既令人难以置信，又令人沮丧，”巴特利瓦拉告诉我，“Flora可能是她几周来唯一能倾诉处境的人。”如今，与Flora长时间通话已成为常态。“这就是陪伴的意义，”他说，“而事实证明，这本身就是一种干预手段。”

ACCESS项目的设计者本人也是前创业者。该计划由CMS创新中心主任阿贝·萨顿和首席AI与技术官雅各布·希夫共同设计。萨顿此前是医疗保健基金Rubicon Founders的风险投资人，希夫则是医疗保健领域的创始人。两人均在特朗普政府时期加入CMS，他们的创业背景也体现在项目设计中：按结果付费、面向消费者直接招募，以及刻意推动竞争。

风险确实存在。参与者将极其敏感的患者数据——关于住房、疾病和精神疾病的私密对话——输入到有过泄露记录（包括社保号码曝光）的联邦基础设施中。对于ACCESS项目所针对的弱势群体而言，这并非杞人忧天。

财务风险同样存在。CMS创新项目的过往成效参差不齐。2023年国会预算办公室的分析发现，CMS创新中心在其第一个十年间增加了54亿美元的联邦支出，而非产生预期的节余。此外，CMS支付的每位患者每月费用低于许多参与者的预期，这意味着只有那些将大部分患者交互实现自动化的机构，账才算得过来。

对于报销方面的担忧，巴特利瓦拉的回应是：这是特点，而非缺陷。“如果你想建立一个真正激励AI使用的模式，那么报销率就必须低，”他告诉我，“只有当你运营一个精干、以AI为先的机构时，这笔经济账才划算。”

Pair Team表示，目前已建立合作关系，可接触约50万潜在患者，并希望在三年内覆盖100万人。

医疗保健领域的投资者一直密切关注这一切。今年，数字健康领域的融资额达到疫情以来的最高第一季度水平，其中AI公司占据了大部分。但ACCESS项目在医疗科技行业贸易媒体之外几乎并未引起关注。

英文来源：

Neil Batlivala has spent seven years building a healthcare company that most of the tech industry has never heard of and that serves a patient population most of Silicon Valley ignores. But last month, that work put him at the center of something much bigger.
His company, Pair Team, announced on April 30 it had been accepted into ACCESS, a Medicare program — as one of 150 participants chosen by the Centers for Medicare & Medicaid Services to test what AI-driven medical care could look like at federal scale. The program goes live July 5.
“The government is creating swim lanes for AI innovation in traditionally regulated industries,” he told me over a Zoom call a few days later. “The best solution wins, which, in regulated industries like healthcare — that’s not been the case.”
ACCESS — Advancing Chronic Care with Effective, Scalable Solutions — is a 10-year CMS program testing a payment model that rewards health outcomes rather than required activities (like a certain number of check-ins). Participating organizations like Pair Team receive predictable payments for managing qualifying conditions and earn the full amount only when patients meet measurable health goals, like lower blood pressure or reduced pain. It covers diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety.
That payment structure is the real news.
Traditional Medicare reimburses based on time spent with a clinician. There’s no mechanism to pay for an AI agent that monitors a patient between visits, calls to check in, coordinates a housing referral, or makes sure someone picks up their medication. ACCESS creates that mechanism for the first time.
“It’s a payment model transformation,” Batlivala said. “You just couldn’t do this before.”
The first cohort spans a wide range of participants — AI doctor startups, virtual nutrition therapy providers, connected device companies, and wearable makers like Whoop. Batlivala is skeptical of some of them.
"I'm a big fan of wearables, but for a senior who's struggling with food insecurity, I don't know how much Whoop is going to be able to do," he said, adding of his own company, "We've been building toward this for five-plus years now."
Pair Team launched in 2019 with a specific kind of patient in mind: people managing chronic conditions who were also dealing with unstable housing, too little food, or lack of transportation. About a third of Americans fall somewhere in that category.
The company's premise was that you can't improve health outcomes without addressing the full context of someone's life. It now employs roughly 850 clinical professionals, runs what it describes as the largest community health workforce in California, and, per Batlivala, generates revenue above nine figures. It has raised about $30 million, backed by Kleiner Perkins, Kraft Ventures, and Next Ventures.
The model has peer-reviewed evidence behind it. A study, co-authored by Pair Team researchers and peer-reviewed by the Journal of General Internal Medicine, evaluated Pair Team's community-integrated model, which blends medical, behavioral, and social care for Medicaid members with high rates of homelessness, serious mental illness, and chronic disease and it showed strong patient engagement and significant reductions in avoidable emergency and inpatient utilization. Batlivala says one in four hospital visits and one in two ER visits don't happen when a patient is in his company's care.
But for years, delivering that level of care required human teams, which limited how fast and cheaply it could scale. Then, about nine months ago, Pair Team deployed a voice AI agent called Flora as its primary patient-facing interface. Flora is available 24 hours a day, handles intake, coordinates referrals, and does the check-ins that keep patients engaged between clinical visits.
The first call that shifted his thinking was with a 67-year-old woman living out of her car, managing PTSD and congestive heart failure. She spoke with Flora for over an hour. "It was both incredible and depressing," Batlivala told me. "Flora was probably the only 'person' she'd talked to in weeks about her situation." Now, hour-long conversations with Flora are routine. "That's the companionship piece," he said. "And it turns out that is truly an intervention."
The architects of ACCESS are themselves former startup operators. The program was designed by Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, Chief AI and Technology Officer of the CMS Innovation Center. Sutton was previously a venture capitalist at a healthcare fund called Rubicon Founders. Shiff is a former healthcare founder. Both joined CMS under the Trump administration and their startup backgrounds are reflected in the program's design: outcome-based payments, direct-to-consumer enrollment, and a deliberate push for competition.
There are real risks. Participants are feeding extraordinarily sensitive patient data — intimate conversations about housing and diseases and mental illness — into a federal infrastructure with a documented history of breaches, including exposed Social Security numbers. For the vulnerable populations ACCESS is designed to serve, that's not an impractical concern.
There are financial risks, too. The track record of CMS innovation programs is mixed. A 2023 Congressional Budget Office analysis found that the CMS Innovation Center increased federal spending by $5.4 billion during its first decade rather than producing the projected savings. CMS is also paying less per patient per month than many participants anticipated, which means the math only works for organizations that have fully automated most of their patient interactions.
Batlivala's answer to the reimbursement concern is that it's a feature, not a bug. "If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low," he told me. "The economics only work if you're running a lean, AI-first operation."
Pair Team says it right now has partnerships in place that give it access to roughly 500,000 potential patients, and that it wants to reach a million within three years.
Healthcare investors have been watching this closely. Digital health funding hit its highest Q1 total since the pandemic this year, with AI companies capturing the bulk of it. But ACCESS has barely registered outside health tech trade press.