Medicare's AI-assisted prior authorization pilot cut use of targeted services, JAMA study finds

WISeR, a six-year pilot launched in January, requires prior authorization in traditional Medicare for a set of services seen as prone to waste and fraud in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, and its contractors are encouraged to use AI in reviews. Researchers from the University of Minnesota and Brown University compared those states with the rest of the country using electronic health records.

Epidural steroid injections, the highest-volume service in the pilot, fell 15% relative to other states, and other targeted services fell about 20%. The effect faded over time: the drop in injections went from about 21% in the first quarter to about 9% in the second. Services that were slated for the pilot but never added showed no decline.

Why it matters: Traditional Medicare has rarely required prior authorization. The authors said the study cannot show whether the care that was not delivered was needed or wasteful, a key question as Medicare weighs whether to continue or expand the model.