New Research Highlights Pair Team's Novel Approach to Improving Medicaid: Better Engagement, Lower Costs and Improved Health Outcomes

Peer-reviewed study of Pair Team's unique model demonstrates increased outpatient engagement, reduced emergency and hospital utilization, and improved health outcomes

SAN FRANCISCO, Sept. 29, 2025 /PRNewswire/ -- Pair Team, a tech-enabled medical group reimagining care for Medicaid and Medicare beneficiaries, today announced the publication of its first peer-reviewed study in the Journal of General Internal Medicine (JGIM).

The study evaluated Pair Team's AI-enabled, community-integrated model, which blends medical, behavioral, and social care for some of the country's most medically and socially complex Medicaid members. The model serves people with high rates of homelessness, serious mental illness, and chronic disease, and demonstrates strong patient engagement and significant reductions in avoidable emergency and inpatient utilization.

"Patients with the greatest medical, behavioral, and social challenges too often fall through the cracks of the system," said Neil Batlivala, CEO and Founder of Pair Team. "This study shows that when you combine integrated care teams, deep community partnerships, and AI-enabled technology, it's possible to engage some of the hardest to reach individuals and put them on an upward life trajectory."

The retrospective cohort study examined outcomes for 568 adults enrolled for at least one year in California's ECM program with Pair Team between July 2022 and August 2023. Participants were disproportionately affected by homelessness, serious mental illness, substance use disorder and chronic conditions such as diabetes and hypertension.

Key Findings

• High patient engagement: Patients averaged 3.3 contacts per month with Pair Team care teams—which include community health workers, behavioral health specialists, registered nurses (RNs), and nurse practitioners (NPs). More than 94% of patients were reached within days of a hospital or ED discharge.
• Improved access to care: Following enrollment, HbA1c testing rates more than doubled (52.7% vs. 22.3%), and the share of patients with documented blood pressure readings increased from 74.3% to 81.7%. Outpatient visits increased by 21%.
• Reduced emergency care: Emergency department visits declined by 52% and hospitalizations dropped by 26%.
• Better behavioral health outcomes: Average PHQ-9 scores for depression improved by 4 points.

"These results demonstrate that care models built for the realities of patients' lives — where housing, food security, and behavioral health are addressed alongside medical needs—can deliver measurable improvements," said Dr. Nate Favini, Chief Medical and Strategy Officer at Pair Team. "We are encouraged by the findings and believe this approach can be replicated to reduce costs and improve outcomes in Medicaid programs nationwide."

The paper highlights three key ingredients that set the Pair Team Model apart from prior approaches to high-need, high-cost patients:

• Pair Team's community health worker-led program partners directly with community-based organizations, such as shelters and food pantries, and pays them directly for the services they provide to patients
• Pair Team directly employs a team of nurses and nurse practitioners to bridge the gap between patient needs and primary care availability in the community
• Arc, Pair Team's AI-enabled software platform, coordinates care across the medical and social care ecosystem and drives quality as the model scales

By partnering with community-based organizations and equipping care teams with technology that scales high-touch support, Pair Team delivers proactive, whole-person care to some of the nation's most vulnerable patients, ultimately improving outcomes, reducing avoidable utilization, and strengthening the sustainability of Medicaid programs nationwide.

The full article, "A Novel Intervention for Medicaid Beneficiaries with Complex Needs," is available in the Journal of General Internal Medicine here.

About Pair Team

Pair Team is a public benefit company reimagining Medicaid and Medicare as a connected care ecosystem: team-guided, AI-enabled, and built for real lives. Pair Team closes gaps, bridges problems, and connects people with care that's proactive, personal, and built around the whole person.

Pair Team helps people overcome medical, behavioral health, and social barriers through coordinated, whole-person care. Pair Team's model blends empathy, AI and local partnerships so that more people can reach their full potential.

Media Contact

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Interdependence Public Relations
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SOURCE Pair Team