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In this episode, CMMI Director Abe Sutton shares his unique journey from the private sector back to government service and reveals how he's rapidly transforming Medicare through innovative payment models. Sutton discusses the newly launched WISER (Wasteful and Inappropriate Service Reduction) model, which leverages AI technology to reduce fraud and waste in Medicare, and the upcoming ASM (Ambulatory Specialty Model) targeting heart failure and lower back pain. The conversation explores CMMI's 2025 strategy focused on evidence-based prevention, patient empowerment, and choice and competition, while addressing how emerging technologies like generative AI are creating unprecedented opportunities to streamline healthcare administration and improve patient outcomes. Sutton also reveals how he spent four years during his "off season" developing a comprehensive roadmap for healthcare innovation that he's now implementing at warp speed.

Links:
WISeR (Wasteful and Inappropriate Service Reduction) model: https://www.cms.gov/priorities/innova...
ASM (Ambulatory Specialty Model): https://www.cms.gov/priorities/innova...
CMMI's 2025 Strategy Focus: https://www.cms.gov/priorities/innova...

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Timestamps:
00:00:00 - Introduction and Welcome
00:00:37 - Why Leave Private Sector for Government Service
00:09:16 - AI and Technology's Impact on Healthcare Innovation
00:17:49 - WISER Model Introduction and Goals
00:30:45 - Food Policy and Making America Healthy Again
00:34:08 - ASM Model for Heart Failure and Lower Back Pain
00:38:31 - Four Years of Preparation During "Off Season"