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Amy Turner on Fixing Prior Authorization: Inside CMS’s WISeR Model
EPISODE SUMMARY
Ever feel like you’re playing a game of "Red Light, Green Light" with insurance companies, only the light is always stuck on red? We sat down with a true healthcare game changer, Amy Turner, Deputy Director for Policy at the CMS Innovation Center (CMMI), to talk about how they are trying to fix that.
Amy breaks down the mission of CMMI—lowering costs while boosting quality—and introduces us to the WISeR model. This isn't just bureaucratic talk; it’s a look at how advanced technology and the "Kennedy Pledge" are aiming to turn prior authorizations from a provider nightmare into a streamlined, transparent process—maybe even reaching the "holy grail" of auto-approvals. We also dive into the three pillars of innovation: more preventive care, empowering patients with actionable info, and boosting competition for independent physicians.
KEYWORDS
CMMI, WISeR Model, The Kennedy Pledge, Value-Based Care, Prior Authorization, Medicare
TAKEAWAYS
Sustainability is the Goal: Healthcare costs are outpacing inflation and GDP, yet outcomes aren't keeping up. CMMI's mission is to find the "mother load": reducing costs while improving quality.
The Three Strategic Pillars:
1. Preventive Care: Nipping health issues in the bud before they become serious.
2.Consumer Empowerment: Giving patients digestible, actionable information so they can make informed choices.
3. Choice and Competition: Specifically empowering independent physicians and bringing more options to rural areas.
Prior Auth Modernization: The WISeR model aims to use technology to create consistent, timely decisions. The ultimate goal is to reach a point of auto-approvals based on proven accuracy.
Stewardship of Funds: Everything the Innovation Center does is built on being careful stewards of taxpayer money (Medicare and Medicaid).
CHAPTERS
00:00 Introduction: Inside CMMI and the WISeR Model
07:13 How WISeR Improves Patient Safety
11:03 How WISeR Is Tested and Evaluated
14:34 Where WISeR Is Launching and What It Covers
16:24 How WISeR Uses Technology Responsibly
22:46 Measuring WISeR’s Long-Term Impact
24:29 Conclusion: Staying Updated on WISeR
RESOURCES
Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO
Learn more about WISeR: Visit https://www.cms.gov/priorities/innovation/innovation-models/wiser
Learn More About The Claim Game: Visit practicesol.com/podcast
The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.
Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.
Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.
Get full access to The Claim Game at jeremyzug.substack.com/subscribe
View all episodes
By Jeremy and Kathryn ZugEPISODE SUMMARY
Ever feel like you’re playing a game of "Red Light, Green Light" with insurance companies, only the light is always stuck on red? We sat down with a true healthcare game changer, Amy Turner, Deputy Director for Policy at the CMS Innovation Center (CMMI), to talk about how they are trying to fix that.
Amy breaks down the mission of CMMI—lowering costs while boosting quality—and introduces us to the WISeR model. This isn't just bureaucratic talk; it’s a look at how advanced technology and the "Kennedy Pledge" are aiming to turn prior authorizations from a provider nightmare into a streamlined, transparent process—maybe even reaching the "holy grail" of auto-approvals. We also dive into the three pillars of innovation: more preventive care, empowering patients with actionable info, and boosting competition for independent physicians.
KEYWORDS
CMMI, WISeR Model, The Kennedy Pledge, Value-Based Care, Prior Authorization, Medicare
TAKEAWAYS
Sustainability is the Goal: Healthcare costs are outpacing inflation and GDP, yet outcomes aren't keeping up. CMMI's mission is to find the "mother load": reducing costs while improving quality.
The Three Strategic Pillars:
1. Preventive Care: Nipping health issues in the bud before they become serious.
2.Consumer Empowerment: Giving patients digestible, actionable information so they can make informed choices.
3. Choice and Competition: Specifically empowering independent physicians and bringing more options to rural areas.
Prior Auth Modernization: The WISeR model aims to use technology to create consistent, timely decisions. The ultimate goal is to reach a point of auto-approvals based on proven accuracy.
Stewardship of Funds: Everything the Innovation Center does is built on being careful stewards of taxpayer money (Medicare and Medicaid).
CHAPTERS
00:00 Introduction: Inside CMMI and the WISeR Model
07:13 How WISeR Improves Patient Safety
11:03 How WISeR Is Tested and Evaluated
14:34 Where WISeR Is Launching and What It Covers
16:24 How WISeR Uses Technology Responsibly
22:46 Measuring WISeR’s Long-Term Impact
24:29 Conclusion: Staying Updated on WISeR
RESOURCES
Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO
Learn more about WISeR: Visit https://www.cms.gov/priorities/innovation/innovation-models/wiser
Learn More About The Claim Game: Visit practicesol.com/podcast
The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.
Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.
Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.
Get full access to The Claim Game at jeremyzug.substack.com/subscribe