Cohere Health

Cohere Health is a utilization management solution that helps health plans transform prior authorization processes in healthcare, making them more efficient, accurate and patient centered. With the use of AI, machine learning and real-time analytics, Cohere Health is working to automate the entire prior authorization process, reducing administrative burdens and improving patient outcomes.

Cohere Health's platform, Cohere Unify, includes a range of automation tools to digitize and standardize the prior authorization process. Some of the key tools include:

• Intake: Digitizes all prior authorization requests into a single automated workflow, integrating with electronic medical records (EMRs) and fax submissions via optical character recognition (OCR).
• Decisioning: Automates prior authorization decisions based on health plan-preferred policies, speeding up manual review and checking for completeness and missing information.
• Review: Helps clinical reviewers with AI-assisted manual review, automated queue management and personalized letter generation.
• Optimization: Uses clinical intelligence to optimize utilization management performance, monitoring trends, identifying policy optimization opportunities and detecting abuse.
• Transformation: Improves patient and population outcomes with innovative, specialty-specific programs, including personalized care paths, episodic authorizations and network intelligence.

Cohere Health's solutions benefit both health plans and providers. For health plans, Cohere reduces costs through lower administrative costs and denial rates. For providers, it means faster access to patient care and less administrative burden. Patients benefit from higher quality care and faster outcomes.

Pricing models are flexible, with both platform-as-a-service (PaaS) and fully outsourced utilization management options. Cohere PaaS lets health plans license the platform for in-house use, while Cohere Complete offers outsourced solutions with clinical and operational staff support.

Cohere Health's technology seeks to reconcile the competing demands of efficiency and patient care, using AI to steer clinically appropriate requests and cut back on wasteful utilization. By improving the prior authorization process, Cohere Health ensures patients get timely and effective care while healthcare providers and plans use resources more wisely.

Published on July 6, 2024