Healthcare systems face growing demands to streamline operations and improve patient outcomes, yet the traditional prior authorization process remains a significant challenge. As the industry shifts towards digital solutions, there is a pressing need for more efficient, automated systems. Cohere Health is at the forefront of this transformation, leveraging advanced AI, clinical expertise, and real-time analytics to digitize prior authorization and optimize care pathways. As one of the fastest-growing healthcare technology companies, Cohere Health delivers faster, better patient outcomes through innovative solutions.
The traditional prior authorization process often slows access to care and compromises quality outcomes. Cohere Health addresses these challenges with the Cohere Unify™ Platform, which uses advanced AI and machine learning to transform prior authorization into a comprehensive care journey management tool. It integrates intelligent digitization and clinical expertise to streamline and enhance the end-to-end patient journey.
The Cohere Unify™ Platform supports this transformation through touchless and predictive technologies, seamlessly integrating with health management systems to convert the cumbersome authorization process into a streamlined, automated experience.
Touchless technologies eliminate manual steps, creating a fully automated prior authorization workflow. Key components, such as EMR integration, fax OCR digitization, and a sophisticated clinical decisioning engine, ensure efficient handling of all authorization requests with minimal manual intervention.
Predictive technologies enhance efficiency by anticipating the next likely steps or best actions. By consolidating data from multiple sources, the platform provides a comprehensive view of the patient’s clinical record, simulating the next steps and applying AI-driven decisioning. This capability enables pre-approval of multiple services upfront, reducing delays and streamlining the authorization process.
A robust analytics layer offers real-time insights and predictions, facilitating improved decision-making and workflow optimization. Evidence-based clinical content guides touchless and predictive technologies, ensuring that decisions are grounded in current and relevant clinical data.
Advanced technical specifications include SaaS-based deployment, HITRUST certification for security, and compliance with interoperability standards such as FHIR and 278. The platform’s scalability handles multi-million transaction volumes effortlessly, and its single sign-on (SSO) capabilities integrate smoothly with common portal technologies like Availity and NaviNet.
Cohere Unify™ minimizes manual effort by consolidating requests into a single digital workflow, automating clinical and business rules, and utilizing AI and machine learning for case pre-processing. This approach ensures timely regulatory compliance, enhances patient outcomes by influencing care decisions before submission, and optimizes the care journey through episodic and individual service authorizations.
The benefits of the Cohere Unify™ Platform are reflected in its actuarially verified results: a 70% increase in the speed of patient care access, a 63% reduction in denial rates, and an 18-43% decrease in adverse outcomes. These outcomes are driven by real-time clinical intelligence and evidence-based decision-making, underscoring the platform’s efficacy in transforming the prior authorization process and delivering exceptional value to health plans and their stakeholders.
Cohere Health Solutions’ benefits extend across multiple facets of healthcare management. For health plans, it delivers substantial administrative cost reductions—ranging from 25% to 40%—while accelerating turnaround times and minimizing provider abrasion. This efficiency translates into a 92% satisfaction rate among providers and a Net Promoter Score (NPS) of 65, reflecting the high regard in which Cohere’s solutions are held within the industry.
Cohere Health’s offerings include Automation Solutions and Clinical Innovation Solutions, which play crucial roles in enhancing prior authorization processes. The Automation Solutions encompass comprehensive workflows for intake, decisions, and review, all designed to eliminate manual steps and expedite the authorization process. On the other hand, Clinical Innovation Solutions focuses on optimizing and transforming patient outcomes through advanced analytics and specialized programs.
Prior authorization should be an ally, not an obstacle. Every patient deserves clarity, every physician deserves support, and every health plan deserves to achieve better outcomes for its members. — Siva Namasivayam, CEO & Co-Founder
Cohere Complete™ represents a major advancement in utilization management, shifting from a transactional focus to one centered on patient outcomes. By combining clinical and operational expertise with the Cohere PaaS™ Intelligent Prior Authorization platform, Cohere Complete™ offers a fully outsourced, specialized management service for musculoskeletal, cardiology, pain management, physical therapy, diagnostic imaging, and sleep.
The Cohere PaaS™ system further exemplifies this innovative approach by enabling health plans to digitize and automate internal prior authorization processes. This solution enhances administrative efficiency and improves patient outcomes through more accurate and streamlined authorization.
Traditional utilization management models often center on binary decisions—approving or denying individual services—without addressing the broader context of patient care. This narrow focus can result in delayed treatment, provider and patient frustration, and missed opportunities to enhance the overall care journey. In contrast, Cohere Complete™ adopts a digital-first approach, utilizing advanced AI and real-time analytics to map the longitudinal patient journey and provide evidence-based care paths. This shift allows health plans to move beyond reactive transaction management and proactively guide care decisions, improving outcomes and reducing unnecessary utilization.
Cohere Complete™ distinguishes itself with a holistic approach integrating deep clinical expertise and innovative technology. It focuses on patient cohort-specific care paths, enabling the authorization of entire care episodes rather than isolated transactions. By “nudging” providers toward optimal care choices and high-value specialists at critical decision points, and incorporating real-time insights into provider quality, cost, and care appropriateness, Cohere Complete™ ensures that care decisions are clinically sound and cost-effective.
The impact of Cohere Complete™ is evident in its results. The program achieved an 18-43% reduction in complications and unnecessary procedures, driven by AI and machine learning-based clinical suggestions. Provider satisfaction has improved 3-4 times, and patients experience access to care that is 70% faster. This advanced, digital-first approach optimizes program performance while bridging the gap from transaction-focused management to a comprehensive care journey strategy, demonstrating Cohere’s commitment to enhancing care quality and operational efficiency.
Cohere Health aims to reduce administrative burdens while enhancing the quality of care. With a mission to simplify healthcare and a vision of a unified system driving the best possible outcomes at minimal cost and effort, Cohere Health is a leader in shaping a more integrated and effective healthcare future.
Looking ahead, Cohere Health will continue to enhance efficiency and outcomes, shaping a future of integrated, cost-effective care with minimal administrative burden.