source: techcrunch ai: medicare’s new payment model is built for ai, and most of the tech world has no idea
level: business
a new medicare program called access starts july 5, testing a payment model that pays for health outcomes instead of activities. it covers diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. for the first time, providers can get paid for ai agents that monitor patients between visits, coordinate referrals, or check medication adherence. traditional medicare only reimburses for time with a clinician, so this shift could make ai-first care financially viable.
pair team, a startup focused on low-income patients with chronic conditions, is one of 150 participants. it uses a voice ai agent named flora to handle intake, check-ins, and referrals. the company says one in four hospital visits and one in two er visits are avoided when patients are in its care. the program's designers, former startup operators, built access to encourage competition and direct-to-consumer enrollment, but reimbursement rates are low, forcing participants to automate heavily.
the program carries risks. participants feed sensitive patient data into federal systems with a history of breaches. also, past cms innovation programs increased spending by $5.4 billion without projected savings. still, healthcare investors are watching, as digital health funding hit a post-pandemic high this year, mostly for ai companies. yet access has barely registered outside health tech trade press, even though it could reshape how ai is used in regulated industries.
why it matters: this payment model could make ai-driven care financially sustainable for the first time in medicare, opening a large market for health ai startups.
source: techcrunch ai: medicare’s new payment model is built for ai, and most of the tech world has no idea