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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:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
