The Impact of the WISeR Model in Medicare is Likely to Be Modest in Its First Year

The model would expand the use of prior authorization in traditional Medicare ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­  

The independent source for health policy research, polling, and news. The independent source for health policy research, polling, and news. NEW & NOTEWORTHY KFF Examines a Trump Administration Initiative to Expand the Use of Prior Authorization in Medicare A KFF analysis examines an initiative from the Center for Medicare & Medicaid Innovation (CMMI) to establish new prior authorization requirements in traditional Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) model.   Prior authorization, which is rare in traditional Medicare but widely used by insurers that offer Medicare Advantage plans and private commercial plans, aims to reduce wasteful or inappropriate utilization of health care services and the associated health care spending. But it also can lead to delays and denials of needed care, uncertainty for patients, and administrative costs and hassles for health care providers.   CMMI's WISeR model, launched on January 1, tests the use of technologies, such as artificial intelligence, to review the appropriateness of select Medicare-covered services in six states over a six-year trial period. The new KFF analysis explores the model's potential impact by examining recent spending and utilization trends in traditional Medicare for services selected for prior authorization review.   Findings suggest the impact of the model is likely to be modest in its first year. That is because the services targeted account for a small share of total Part B spending in traditional Medicare, and because the vast majority of service spending and growth the model aims to address is accounted for by a single service category (skin substitutes), which the Centers for Medicare & Medicaid Services has simultaneously targeted with recent changes to payment policy. Read the analysis Related Drew Altman: Why We Are Stuck with Prior Authorization read the column-->  KFF Poll: People View Prior Authorization as Greatest Burden in Navigating the Health System read the findings --> Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024 read the analysis --> Contact: Chris Lee | 202.654.1403 | ChrisL@kff.org  When citing our work, please note our legal name is KFF. We should be cited as KFF, a nonprofit health policy research, polling, and news organization. Our name is no longer the Kaiser Family Foundation.  Did someone forward this to you? Sign up for emails from KFF. This email was sent to albarkahslamet.ssss@blogger.com. Update your email preferences to choose the types of emails you receive. Or, permanently unsubscribe from all future emails. Need assistance? Email subscriptions@kff.org; do not reply to this email. The independent source for health policy research, polling, and news. KFF, 185 Berry Street, Suite 2000, San Francisco, CA 94107