Question: Is there a utilization management solution that can help health plans reduce costs and improve patient care through automation and clinical intelligence?

If you're looking for a utilization management solution that can help lower costs and improve patient care through automation and clinical intelligence, Cohere Health is a great choice. Their Cohere Unify platform offers a range of automation tools to modernize prior authorization, including digital intake, AI-powered decision support, and optimized utilization management. The full suite of tools can help lower administrative costs, denial rates and improve patient outcomes by integrating with EMRs and offering specialty-specific programs.

Another powerful option is Availity, which offers an integrated provider engagement platform that streamlines administrative and clinical tasks. It includes AI-powered prior authorization tools, revenue cycle management and denial prevention tools. Availity's platform handles more than 13 billion transactions per year, helping to improve patient care and operational efficiency for healthcare providers and payers.

If you prefer a more data-centric approach, Inovalon offers a cloud-based platform that improves patient outcomes and business performance through sophisticated analytics and dynamic business intelligence. It includes tools such as risk score accuracy, quality measurement and patient engagement, which can help improve member care and outcomes. The platform serves nearly 20,000 customers across 53,000 sites of care, making it a good choice for healthcare organizations looking to lower costs and improve care quality.

Last, Veradigm offers a variety of healthcare technology solutions that can help Health Plans and Payers with risk adjustment analytics, quality analytics and data submissions & reconciliation. Veradigm's platform uses research, analytics and AI to create actionable insights that can inform healthcare decisions and improve patient outcomes. This broad suite of solutions can help streamline operations and improve patient care by connecting healthcare stakeholders through the Veradigm Network.