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Landmark AI Mammography Trial and CMS Launches AI Prior Authorization Pilot

AI in HealthcareIndustry
Landmark AI Mammography Trial and CMS Launches AI Prior Authorization Pilot

New large randomized trial to test AI in mammography screening, while CMS launches a multi-state pilot using AI for Medicare prior authorizations.

Key Details

  • 1CMS will pilot AI for prior authorization in Medicare claims across six states from 2025-2031 under the WISeR program.
  • 2WISeR aims to reduce waste, fraud, and inappropriate services using AI to expedite decision-making.
  • 3The PRISM trial, led by UCLA and UC-Davis and funded by a $16M PCORI grant, will assess AI in breast cancer screening on hundreds of thousands of mammograms.
  • 4The trial will use ScreenPoint Medical’s Transpara model and Aidoc’s aiOS workflow integration, focused on both detection/recall outcomes and trust in AI by radiologists/patients.
  • 5Experts highlight that only 3% of healthcare data is currently used, and shadow (unauthorized) AI use poses security risks in clinical environments.
  • 6Recent research features AI-driven multimodal brain tumor diagnosis, AI for respiratory tracking, and regulatory focus on AI conflict of interest in radiology.

Why It Matters

The PRISM trial will provide the first large-scale randomized evidence on AI’s real-world impact in breast cancer screening in the U.S., potentially influencing future clinical practice and reimbursement policy. CMS’s WISeR initiative signals growing institutional trust in AI for administrative processes, while ongoing debates around data access, security, and bias highlight the complexities of integrating AI into healthcare.
AI in Healthcare

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