Early Feedback on WISeR Raises Questions on Access, Oversight, and Incentives

Early feedback from providers on the WISeR model is highlighting delays in care, rising administrative burden, and new concerns about how decisions are being made. A recent report released by Senator Maria Cantwell, drawing on data from hospitals affiliated with the Washington State Hospital Association, found approval timelines stretching from days to weeks, with procedures taking two to four times longer and care increasingly sequenced around authorization timing rather than clinical need. Findings also highlight inconsistent denials without clear rationale and growing concern about third-party administrators with financial incentives tied to claim denials. Read more here and here.

Why It Matters

While this reflects provider-reported experience from one state, it reinforces a broader concern stakeholders have been raising as tech- and AI-enabled companies move into more traditional care decision spaces. The promise is efficiency and consistency, but early signals suggest that without the right guardrails, these models can introduce new barriers to care, reduce transparency, and create misaligned incentives that work against patient and provider needs. Getting these fundamentals right will be central to whether these models succeed and scale. We expect continued scrutiny, near-term adjustments, and a stronger push for transparency, human oversight, and accountability before broader expansion.

Look for the Helpers: Oregon County Mobile Clinic Restores Access to Care

At the Oscar G. Johnson VA Medical Center, volunteers are playing a hands-on role in supporting veterans, from greeting and escorting patients at the front door to staffing coffee stations, assisting clinical teams, and providing companionship through programs like hospice care. One of the most impactful efforts is the Veterans Transportation Network, where 125 volunteer drivers logged more than 141,000 miles in 2025 to help over 1,300 veterans across Michigan’s Upper Peninsula and northern Wisconsin access care. Together, these contributions, totaling roughly 19,000 hours last year, show how community members are helping bridge access gaps in rural areas and strengthening the day-to-day experience of care for veterans. Read here.

What We Are Reading

Quality Gains in MA Star Ratings Driven by Narrow Set of Measures

A new Health Affairs article finds that gains in Medicare Advantage Star Ratings from 2015–2025 were largely driven by a narrow set of medication management and clinical measures, with limited improvement in access, preventive care, and patient experience metrics. Read here.

State Medicaid Coverage of Certified Nurse Midwives

NASHP’s newest brief highlights how states are structuring Medicaid coverage and reimbursement for certified nurse midwives to expand access to maternity care, with evidence linking midwifery care to fewer interventions and improved maternal and infant outcomes. Read here.

Expanding The GUIDE Model To Include Adults With Intellectual Disability And Dementia

Health Affairs Forefront published an article proposing that expanding CMS’s GUIDE Model to include adults with intellectual and developmental disabilities would help close care gaps in dementia services, improve care coordination, and advance health equity using existing program infrastructure. Read here.