The debate surrounding CMS’s WISeR model raises an important question: How can we reduce wasteful spending in Medicare without creating new barriers to care?

In an interview with MedCity News, Managing Partner Michael Abrams explained that the controversy stems largely from the model’s reliance on prior authorization. While the tool has been used sparingly in traditional Medicare, it is used extensively in Medicare Advantage – where it faces frequent criticism for delaying care, increasing administrative burdens, and generating denial decisions that are often overturned on appeal.

Building the same flaws that make Medicare Advantage problematic into traditional Medicare would seem a monumental mistake. The WISeR program is out of step with the national experience in healthcare insurance.

Abrams also expressed concern regarding the model’s incentive structure, which allows outside contractors to share in savings generated through reduced spending. He noted that reducing waste, fraud, and unnecessary spending should remain a priority. But the ultimate goal should be better value in healthcare, not more obstacles between patients and the care they need.

Read the full story at medcitynews.com.