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Medicare just quietly launched its biggest AI experiment yet.
Starting January 1, 2026, the WISeR Model (Wasteful and Inappropriate Service Reduction) went live in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
This isn’t another pilot program collecting dust.
It’s CMS using AI and machine learning, paired with human review, to fundamentally reshape how Medicare pays for care.
Think about what this means:
• AI algorithms analyzing millions of claims in real-time
• Machine learning identifying inappropriate services before payment
• Human experts validating AI decisions for clinical accuracy
• Evidence-based care navigation powered by predictive models
This voluntary program targets something massive: the estimated $100+ billion in annual Medicare waste.
But here’s what’s really happening.
CMS is testing whether AI can make payment decisions. Not recommendations. Decisions.
Yes, there’s human oversight. For now.
But if this works? We’re looking at AI becoming the gatekeeper for $900 billion in annual Medicare spending.
The implications are staggering:
✓ Faster claim processing
✓ Reduced administrative burden
✓ More consistent coverage decisions
✓ Data-driven care pathways
But also:
✗ Algorithm bias affecting vulnerable populations
✗ Reduced physician autonomy
✗ Black box decisions providers can’t appeal
✗ Tech companies controlling healthcare access
Six states are the testing ground. If successful, this becomes national.
We’re witnessing the beginning of algorithmic healthcare governance.
The question isn’t whether AI will transform Medicare payments. It’s whether we’re ready for machines to decide what care gets covered.
Are your hospitals prepared for AI-driven payment models?
♻️ Repost if healthcare AI needs human oversight guardrails
👉 Follow me, Jonathan Govette, for real-time updates on healthcare technology and business news. LinkedIn Profile: https://www.linkedin.com/in/jonathangovette/
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Author:
Jonathan Govette is a seasoned healthcare and technology executive with more than two decades of experience building, scaling, and advising digital health companies. He is the Co-Founder and CEO of Oatmeal Health, an AI-driven Lung Cancer Screening and Diagnostics company focused on expanding access to early detection for underrepresented populations, particularly patients served by Federally Qualified Health Centers and value-based health plans.
With a background in engineering, product development, and strategic partnerships, Jonathan has founded and led multiple health technology ventures across clinical care delivery, regulated medical software, and AI-enabled diagnostics. His work sits at the intersection of medicine, technology, and health equity, with a consistent focus on translating complex clinical problems into scalable, real-world solutions.
Jonathan has spent much of his professional life dedicated to improving outcomes for marginalized and underserved communities. He has designed and implemented frameworks that align clinical quality, reimbursement, and technology to sustainably advance health equity at scale. This mission is deeply personal and informs his leadership philosophy and long-term vision for healthcare transformation.
In addition to his operating experience, Jonathan is an author and long-time writer in the healthcare domain, with over 20 years of published work covering digital health, medical innovation, and healthcare systems. He is a frequent mentor to early-stage founders and regularly advises startups on product strategy, partnerships, and go-to-market execution in regulated healthcare environments.
Before entering industry full-time, Jonathan nearly pursued a career in medicine with an early path toward cardiothoracic surgery, an experience that continues to shape his clinical perspective and respect for frontline care delivery.
CEO | Oatmeal Health | AI Lung Cancer Startup | Engineer | Writer | Almost Became a Doctor (Cardiac Thoracic Surgeon) | 3x Health Tech Founder | Startup Mentor | Follow to share what I’ve learned along the way.
