Discussing WISeR and the Merits of Prior Auths with Jeremy Friese

CMS Innovation Center leader Abe Sutton and Chief of Staff Gita Deo recently outlined the center’s new strategy in a Health Affairs Forefront article, and I thought their discussion of the WISeR model as an example of prioritizing high value care was instructive. Take skin substitutes for example:

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This seems like a huge and obvious problem that urgently needs to be solved. But when CMMI first announced WISeR, there was backlash and concern from traditional Medicare participants and advocates. Although it’s long been a utilization management strategy for Medicare Advantage, prior authorization has only been used in traditional, fee-for-service Medicare in a very limited way.

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This represents a significant departure from how things have been done in the past.

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Read the full article here