New Jersey Medicare patients will be guinea pigs in a grand experiment that tests the capabilities of using artificial intelligence to decide which medical procedures should be covered by insurance. <\/p>\n
The pilot program, which starts on Jan. 1 and will run through Dec. 31, is being implemented in six states \u2014 New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington.<\/p>\n
The program was first announced in June by Health and Human Services Secretary Robert F. Kennedy Jr.<\/a> and Dr. Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services. They described it as a health insurance breakthrough designed to root out waste and fraud. <\/p>\n \u201cToday, because of President Trump\u2019s leadership we are agreeing to this momentous and monumental accomplishment and we hope to see the dividends of this success story immediately materialize as a better experience for hundreds of millions of American patients,\u201d said Kennedy. <\/p>\n The pilot program aims to revamp the unpopular process known as prior authorization, or pre-authorization, which requires health care providers to get approval from insurers before prescribing certain medications or carrying out certain services.<\/p>\n Prior authorization has long been criticized as unnecessarily burdensome and frustrating by doctors and patients alike. In a nationwide survey<\/a> of 1,000 physicians conducted by the American Medical Association, 24% reported that prior authorization led to an adverse event for a patient. More than nine in 10 reported prior authorization has a negative impact on patient outcomes and delays access to care.<\/p>\n \u201cIt\u2019s the number one complaint not only from patients, but providers, doctors like myself, are continually struggling with this issue,\u201d said Oz, a former talk show host who now runs the CMS, a federal agency within the Department of Health and Human Services. <\/p>\n By outsourcing some of the decision-making process to technology, Oz said he hopes to ease the administrative burden on providers and ensure timely payment for Medicare services.<\/p>\n