Understanding the CMS Access Model

Medicare patients with multiple chronic conditions — like diabetes, heart disease, or depression — often struggle to get consistent, coordinated care. They may have several doctors who don't talk to each other, miss follow-ups, or fall through the cracks between appointments. ACCESS was created to fund a better model: one where a dedicated care team actively stays in touch with patients, coordinates between providers, and addresses social factors like transportation and food access that affect health outcomes.

The ACCESS Model launches on July 5, 2026. It is a multi-year CMS Innovation Center model. Participating organizations commit to the model for its full performance period.

The ACCESS Model involves three groups working together: ACOs and health systems that take on responsibility for patient outcomes, primary care providers who continue directing patient care, and care management partners like Pair Team who deliver the day-to-day coordination and support. Medicare beneficiaries with qualifying chronic conditions are the patients at the center of the model.

Pair Team is an ACCESS-approved care management partner that delivers the between-visit support ACCESS is designed to fund — medication check-ins, appointment coordination, social needs navigation, and clinical escalation when needed — through Flora, our 24/7 AI health advocate, backed by a team of nurses and care managers. For patients: Your existing doctors stay in place. Pair Team fills the gaps between appointments, and for eligible Medicare patients, it's covered — many pay $0 out of pocket. For ACOs and providers: Pair Team plugs into your existing care team as an extension, not a replacement — handling the between-visit touchpoints you can't staff at volume and sharing updates across your provider network. For payers: Pair Team's model targets the utilization patterns ACCESS is designed to reduce. Patients in our model see 52% fewer ED visits and 26% fewer hospitalizations (Journal of General Internal Medicine, 2025).

No. You keep your existing doctors and care team. Pair Team works alongside them, not instead of them. We coordinate with your providers so your care is better connected — but your doctor stays your doctor.

Once you are enrolled, you will be connected with Flora — Pair Team's AI health advocate, available 24 hours a day, 7 days a week by phone or text. Flora can help you find a ride to your next appointment, answer questions about your medications, connect you to food or housing support, and coordinate between your different care providers. You can reach Flora by phone or text anytime — no app required.

Flora is Pair Team's AI health advocate and care coordinator. She is available 24 hours a day, 7 days a week by phone call or text, and is your first call when you need help — whether that is a question about your medications, help getting to an appointment, or anything else related to your care. Flora works with your clinical care team to make sure nothing falls through the cracks.

Signing up is simple and takes just a few minutes. You can check your eligibility and get started at pairteam.com/medicare. If you prefer, you can also call or text Flora directly and she will walk you through the process over the phone.

To be eligible for the ACCESS Model through Pair Team, you generally need to: be enrolled in Original Medicare (Part A and Part B), have one or more qualifying chronic conditions, and live in a service area where Pair Team participates. The fastest way to check is to complete our short eligibility form at pairteam.com/medicare — it takes less than three minutes.

Yes. Pair Team is fully HIPAA compliant and follows all federal privacy rules for your health information. Your information is never sold or shared with anyone outside your care team without your permission.

Absolutely. With your permission, Pair Team can keep a family member or caregiver in the loop and include them in care conversations. Many patients find it helpful to have a trusted person involved.

ACCESS is designed to improve chronic disease control measures, including hemoglobin A1c, blood pressure, and PHQ-9 for depression. These outcomes support stronger performance on key quality benchmarks tied to chronic condition management.

Pair Team is designed to extend your existing care team, not replace it. We integrate with your workflows to close care gaps between visits — handling the high-volume, between-visit touchpoints that are difficult to staff internally. Your care managers retain oversight and direction; Pair Team handles execution at scale.

Pair Team delivers continuous patient engagement through Flora, our 24/7 AI health care coordinator. Patients receive proactive outreach, medication check-ins, appointment reminders, and real-time support for social needs. Engagement data is reported back to your care team so you have visibility without the operational burden.

ACOs working with Pair Team have seen improvements in medication adherence, reduction in avoidable ED utilization, higher chronic condition control rates, and stronger patient engagement scores. We will work with you to establish baselines and track outcomes specific to your population.

We are built to move quickly. Onboarding timelines depend on your ACO's existing infrastructure, but Pair Team can typically begin patient outreach within weeks of agreement execution. We will provide a detailed implementation plan as part of the partnership process.

The first step is a partnership conversation with our ACO team. We will walk through your population, your current infrastructure, and how Pair Team can deliver ACCESS at scale for your organization. Schedule a call at pairteam.com/access-partners.

We provide regular reporting on patient engagement, care gaps addressed, and escalations — in the format that works best for your practice. You will have full visibility into what is happening with your patients between visits, without having to manage it yourself.

Yes, patients go through a brief enrollment process to participate in the ACCESS Model. Pair Team handles outreach and enrollment so the burden does not fall on your practice staff. We can coordinate with your team on how to introduce the program to your patient population.

No. Pair Team's care coordination services are funded through the CMS ACCESS Model — there is no cost to your practice. Participation allows your patients to access services that complement the care you provide, at no charge to them or to you.

Patients can be referred to Pair Team via web portal, phone or recurring data share. Reach out to our provider team and we will walk you through how the program works for your practice and your patients.

Pair Team provides reporting on member engagement, care coordination activities, care gap closures, escalations, and outcomes across your population. Reporting can be customized to align with your operational, clinical, and compliance workflows.

Pair Team is fully HIPAA compliant and maintains enterprise-grade security, privacy, and data governance standards across all member interactions. We execute Business Associate Agreements (BAAs) with all health plan partners and maintain SOC 2 certification, with security documentation available for review during diligence processes.

Pair Team helps health plans improve member engagement, improve quality outcomes, and reduce avoidable utilization through longitudinal, community-based support. Our outcomes, published in peer-reviewed literature (JGIM and JMIR), include 52% reduction in ED visits, 26% reduction in inpatient admissions, $25,000 in annual savings per member, 52% improvement in diabetes control, 57% depression remission, 34% improvement in blood pressure, and 95% of care transitions completed within 7 days of discharge. These outcomes align with health plan priorities across cost control, chronic condition management, HEDIS and Stars performance, and overall member experience, including supporting members through HR1 redeterminations.

Pair Team contracts with health plans to deliver whole-person care management under value-based care arrangements across Medicaid, D-SNP and Medicare Advantage.

Pair Team uses AI to support care coordination, member engagement, and operational efficiency — not to replace clinical judgment. Our workflows are designed with human oversight, escalation pathways, and compliance safeguards to ensure members receive safe, appropriate, and timely support. Clinical decisions remain guided by licensed care teams and established care protocols.