Changes in Service Use Following the Introduction of AI-Enabled Prior Authorization in Medicare.

AI-enabled prior authorization under the Center for Medicare & Medicaid Innovation WISeR model is assessed for its impact on Medicare recipients’ medical service use using Epic Cosmos data.

• Why it matters: Prior authorization can change access and utilization, but the specific effects of AI-enabled requirements on Medicare service use are not well quantified.
• What they did: The study analyzes Epic Cosmos data to evaluate changes in medical service use by Medicare recipients after implementation of AI-enabled prior authorization requirements under the WISeR model.
• The result: The analysis is designed to quantify how service use changed following the AI-enabled prior authorization implementation in this Medicare setting.