AI Meets Medicare: Inside CMS’ WISeR Model With Sanjay Doddamani, MD, MBA
Sanjay Doddamani, MD, MBA, a former senior advisor to the Center for Medicare and Medicaid Innovation, and internist and cardiologist by training, explains how the Wasteful and Inappropriate Service Reduction (WISeR) Model hopes to work, and addresses concerns about delays and denials from revamped prior authorization processes.
On June 27, CMS announced plans for its Wasteful and Inappropriate Service Reduction (WISeR) Model, which will see the Center for Medicare and Medicaid Innovation (CMMI) add artificial intelligence (AI)–powered prior authorization processes—while preserving physician judgment through human oversight—to services it deems of low value and prone to fraud abuse.1,2 These services include skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis.2 WISeR will target these services delivered to patients with traditional Medicare coverage, but even then, the model is only being tested in 6 states to start: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.1