AI-Powered Medicare Pilot Program Coming Soon

Texas is one of six states that will participate in a pilot program that uses artificial intelligence to evaluate prior approvals for certain procedures for Medicare patients. Arizona, New Jersey, Ohio, Oklahoma, and Washington were also selected for participation in the six-year program, which starts Jan. 1.

The program, dubbed WISeR (Wasteful and Inappropriate Service Reduction), requires prior approval for more than a dozen medical procedures—including electrical nerve stimulation and epidural steroid injections—that “historically have had a higher risk of waste, fraud and abuse,” according to the Centers for Medicare & Medicaid Services.

AI companies that administer the program will receive a portion of the cost savings associated with each denial, a model the American Hospital Association has characterized as a “perverse incentive.” Human clinicians will review denials, and companies could be penalized if procedures they deny are subsequently appealed and approved.

Massachusetts-based Cohere Health will administer the program in Texas. In a statement, the company said its AI-powered prior authorization platform approves 90% of requested procedures.

Austin-San Antonio Megaregion Primed for Growth

Austin and San Antonio are 75 miles apart and have a combined population of 5.3 million, but the fast-growing cities are expected to become a megaregion with more than 8.3 million people by 2050.

Earlier this year, business leaders and government officials met at Texas State University in San Marcos for the first-ever Austin-San Antonio Megaregional Collaborative. At the summit, attendees highlighted the strengths of each city and discussed challenges to continued growth, like affordable housing, job training, and water and transportation infrastructure.

“This area is going to grow,” said Henry Cisneros, the mayor of San Antonio during the 1980s and a former Housing and Urban Development secretary under President Bill Clinton. “It’s not a question of if. It’s only a question of at what pace and if we’re prepared for it.”

Cisneros, the co-author of the recently published The Austin–San Antonio Megaregion, emphasized the importance of regional coordination.

“Are we going to grow in a planned way with proper support, with some kind of rational transportation system, quality of life, opportunities for training, and a coherent approach?” he asked. “Or is this just going to be eclectic growth that creates traffic congestion, air pollution, and communities at each other’s throats? That’s the choice.”

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➤ Gov. Greg Abbott has called for legislation that would establish an office of Chief State Prosecutor, arguing that some local district attorneys have refused to prosecute certain criminals. “Progressive DAs are literally leading to the murder of Texans,” he posted on social media. (More)

➤ More than 150 Lake Austin property owners successfully petitioned to be removed from the city of Austin’s jurisdiction, claiming they weren’t receiving full services despite paying taxes. (See Details)

➤ NBC’s Friday Night Lights TV series, which was filmed in and around Austin and aired from 2006 to 2011, is credited with revitalizing the Central Texas film industry and boosting the state’s production credentials. Streaming service Peacock is currently working on a series reboot. (More)

➤ San Antonio’s Texas Biomedical Research Institute is home to roughly 450 marmosets that are used for research on human aging and a variety of health conditions. The squirrel-sized monkeys, which “get chunky like we do,” are big fans of mini marshmallows. (See Photos)

➤ Abilene resident Reed Ambrose is the creator of Wispwood, a new board game published by Czech Games Edition. “I’ve always loved creating,” he said. “I just love that I’m able to actually share it with people.” (More)

➤ Austin-based Alpha School plans to open several new Texas Sports Academy schools across the state next year. The private school uses an AI-driven instructional platform that enables students to complete their coursework in two hours each day. (See Details)

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