What to Know About Medicare’s New WISeR Model: Aiming for Smarter Spending, Not Less Care

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced the launch of a pilot program designed to reduce wasteful and inappropriate services in Original Medicare. Known as the WISeR Model (Wasteful and Inappropriate Service Reduction), the program seeks to improve efficiency in health care delivery, not cut back necessary care.

While the name of the program has raised questions among Medicare beneficiaries and health care providers, it’s important to understand what the WISeR model is, how it works, and who it affects as well as who it doesn’t.

What Is the WISeR Model?

According to the Centers for Medicare & Medicaid Services, the WISeR Model will test "whether aligned financial incentives and expanded prior authorization can reduce provision of services that national experts have determined are likely to be wasteful or inappropriate."

This effort is led by CMS’s Innovation Center, which was created to explore new approaches to delivering care and improving Medicare’s sustainability for future generations.

Under the WISeR Model, health care providers, not patients, are the focus. Providers who choose to participate will be part of a five-year test to reduce the use of services that national guidelines suggest offer limited clinical value. This includes certain imaging tests, surgical procedures, and prescription medications.

What Services Might Be Affected?

CMS has stated that the model will focus on services that "clinical guidelines and professional societies have identified as likely to be unnecessary or duplicative." These decisions are not being made arbitrarily; they’re backed by national medical recommendations and evidence-based research.

It's worth noting that prior authorization may be expanded for some services under the WISeR Model. That means a provider may need to get advance approval before delivering certain treatments or services. However, CMS emphasizes that the goal is not to delay care, but to make sure it's appropriate and effective.

Who Will Be Affected?

WISeR is not a national rollout. It will begin in only seven states: Delaware, Louisiana, New Jersey, New Mexico, Pennsylvania, Texas, and Washington, and even within those states, only providers who voluntarily participate will be involved.

Medicare beneficiaries do not need to opt in, and the model does not change Medicare benefits or eligibility. According to CMS, over 30 million Americans are enrolled in Original Medicare, and this pilot is expected to affect only a small subset of those individuals.

Why This Matters without Causing Alarm

Efforts like WISeR are part of CMS’s broader push to ensure Medicare dollars are spent wisely, especially as the population ages and demand on the program increases. The model is designed to help identify inefficiencies in care, not limit medically necessary treatment.

If you or a loved one is enrolled in Original Medicare, there is nothing you need to do. You’ll continue to access care the same way you always have. If your provider participates in the WISeR Model, they are responsible for managing any changes in prior authorization or service delivery.

Final Thoughts

The WISeR Model is still in its early stages, and CMS will continue to evaluate its impact before making any long-term decisions. For Medicare beneficiaries, the most important takeaway is this: your benefits remain unchanged, and this program is focused on improving care delivery, not cutting access.