Is "Make America Healthy Again" the Next Big Opportunity for Physical Therapists?

“Make America Healthy Again,” or “MAHA,” can mean almost anything. To be sure, we have to do something about poor population-level health outcomes (the worst of the wealthy nations) and sky-high spending on healthcare (the highest of the wealthy nations).

I’m watching CMS and the CMS Innovation Center, or CMMI, the most, but if you are following the Budget Reconciliation process on the Hill in Congress, you know there are potentially significant legislative changes coming in Medicaid, for example. Will those changes, if signed into law, “Make America Healthy Again,” or even take us in that direction?

MAHA is being used in a wide range of contexts that include things like tackling fraud, waste, and abuse (FWA) and their impacts on health outcomes, prevention and early detection, empowering Americans with more and more relevant data and advanced technology to support choice and behavior change, and rapidly improving the quality of and integration of data to leverage artificial intelligence and machine learning in more sophisticated ways.

And that just scratches the surface. They are casting a wide net.

On the CMS side, the Innovation Center has been the most vocal on how they are integrating MAHA into their strategic plan for this Administration. The Director of CMMI, Abe Sutton, posted this blog in May, in which he shared his “three interrelated strategic pillars”:

• Promote evidence-based prevention

• Empower people to achieve their health goals

• Drive choice and competition for people

Here’s what Director Sutton says to expect (“future model features”) in the models CMMI puts out during his tenure. Note all bullet points are pulled directly from the blog:

• Directly engage with providers and beneficiaries on disease prevention activities, including collaboration with community-based organizations

• Include waivers to incentivize preventive care

• Offer access to evidence-based alternative medicine

• Evaluate for preventive outcomes, such as days at home for frail beneficiaries

• Increase beneficiary access to information and tools, including mobile-device applications, for disease management and healthy living

• Publish data about providers and services, including cost and quality performance, to support beneficiary decision making

• Issue waivers to support predictable cost-sharing for certain services drugs, or devices

• Expand using advanced shared savings and prospective payments to support independent provider practice participation in models

• Reinvest hospital capacity in outpatient and community-based care by changing certificate-of-need requirements

• Standardize design features, such as quality measures, to reduce administrative burden

  and he goes on to say that model reviews and new model designs could:

• Require that all alternative payment models involve downside risk and that a growing proportion of Medicare and Medicaid beneficiaries are in global downside risk arrangements

• Require that providers bear some of the financial risk and that conveners cannot hold all financial risk

• Reduce the role of state government in rate setting for health care services

• Refine and simplify model benchmarking methodology

• Ensure funds reach those most in need through proper and non-discriminatory provision of funds for health care services

• Prioritize high-value care and services and incentivize reductions of unnecessary utilization

• Ensure all model tests are fiscally sound with a pathway to certification

I see lots of opportunities for PT and OT professionals to share their data-driven ideas based on CMMI’s strategic framework and what they want to achieve. As Director Sutton notes, waivers, benefit enhancements, flexibilities, incentives, greater scope of practice, and so much more can be leveraged via CMMI authority in alternative payment model design. This is relevant.

If you have a chance to read the full blog, let me know what you think! How do you see this impacting our profession and what might we collectively need to do to make sure the scope and skills of therapists are being considered in model opportunities?

High-Level Take on the new WISeR Model

On Friday, June 27th, 2025, CMMI announced its first new model, the WISeR Model, or “Wasteful and Inappropriate Service Reduction.” The participants in the model will be “technology innovators.”

Here’s the gist, although I’ve only read the online summaries and skimmed the RFA. CMMI will only test this in certain states and MACs. They will give contracts to likely one organization per MAC region that with then take risk on spending for a potential reward by adding prior authorization to certain services. This is a brief summary, so details on how they chose what would be included is out of scope. Here’s the link to the RFA if you want to check it out.

They chose services for prior authorization that are commonly overutilized and highly variable with questionable benefit or potential for harm, and for which there are alternative treatments. This issue is a big problem in fee-for-service, but not for managed care. Prior authorization is used much more heavily in programs like Medicare Advantage, as you know. The WISeR Model adds prior authorization or retrospective review for the following services:

From page 20 of the RFA pdf, here are the items and services planned for the Initial Performance Year:

From the announcement:

The model is being called “voluntary,” but that means voluntary for the tech companies to respond to the RFA. An organization will work with the MAC chosen by CMMI (that list is already available, see below), and all the providers and suppliers who are assigned to that MAC will need to have their services pre-authorized where applicable. I’m willing to bet there will be plenty of applications from “tech innovators” like data lake companies.

Here is the Request for Applications, or RFA, if you want. As I mentioned, only “technology innovators” may apply.

In the RFA is this “Prior Authorization Process Flow Chart.” 👇️ 

Here’s the WISeR Fact Sheet

Here’s the WISeR Infographic

Here’s the WISeR Model on the Federal Register

I’ll leave you with this from page 5 of the unpublished version of the pdf, which is what you find when you click on the the Federal Register as of June 30, 2025. This is word for word, and includes what I think is a key takeaway for PTs and the states and jurisdictions where the model will run. PTs, I see opportunity to work with the participating organizations if your state(s) and MAC(s) are selected.

We envision that implementing the review process while leveraging technologies would identify when such services are medically unnecessary, that model participants will support providers and suppliers in navigating beneficiaries towards more clinically appropriate or higher value care when appropriate and will streamline the prior authorization process for providers and suppliers. This model will be tested in select states in select MAC jurisdictions. The selected MAC jurisdictions for WISeR are JH, JL, JF, and J15, and the selected states are New Jersey (JL), Ohio (J15), Oklahoma and Texas (JH), and Arizona and Washington (JF).) Note: bolded text is the authors’ addition

The collaboration between the data/tech companies taking risk and the providers who seek authorization for services will be crucial. What I’m guessing happens is that there’s a precipitous drop in requests for prior authorizations for many of these services. The providers generally know what they can and can’t get authorized based on Medicare Advantage. CMS guidelines are the same, regardless of whether you have Original Medicare or Medicare Advantage. Providers will need to support patients in securing other evidence-based care for the conditions where they are denied prior authorization or for which they choose not to seek prior authorization. PTs—you are an important resource—don’t miss this opportunity to collaborate with the chosen organizations and the providers in the catchment area.

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