Based on the success of its initial implementation, Cohere Health, an emergent high-growth digital health company, announced that Humana Inc. is expanding Cohere’s digital authorization platform for musculoskeletal (MSK) services statewide.
- Progress: Humana has made significant progress toward its vision of reimagining and modernizing prior authorization processes by reducing approval times, increasing provider satisfaction, and improving care delivery, all while preserving important benefits such as safety, predictability, and waste reduction, after launching the platform in 12 states in January 2021.
- Revolutions: Cohere’s digital health plan solutions revolutionize previous authorization processes to enable fully touchless authorization by driving collaborative care journeys. The Cohere technology automates both provider and payer steps in the process, combining AI and machine learning with evidence-based clinical policy to help patients make better decisions.
- Authorizations: “In just nine months, the results of Cohere’s digital authorization platform have exceeded our expectations,” said William Shrank, MD, MSHS, Chief Medical Officer at Humana. “When we got started, we were looking for industry-leading electronic adoption, best-in-class physician experience, demonstrably better patient experiences, compelling medical and administrative return on investment, and rapid innovation. What is exciting is that these results reflect just the beginning. We look forward to reaching even farther and offering these results to more of our members and network partners.”
- Deployment: The platform’s countrywide deployment will help Humana better manage use by enabling technology-driven collaboration between Humana, its providers, and members as the industry transitions toward more value-based arrangements and risk-bearing payment structures. Providers have expressed high levels of satisfaction with Cohere’s platform, with 72 percent saying it is “extremely satisfied” and 68 percent saying it is “much easier” to use than competing options.
- Engagement: “Our platform is designed to treat the ordering physician as a partner, engaging them with evidence-based suggestions that are transparent and helpful. This allows health plans to focus their resources on just the high-impact cases that require manual expert review. As a result, the health industry can handle a much greater volume of authorizations with fewer resources,” said Brian Covino, M.D., Chief Medical Officer at Cohere Health. “Front-line physicians benefit from significant decreases in prior authorization administrative cost and effort, along with far less need for time-consuming peer-to-peer conversations and appeals. Along with the platform’s ease of use, these benefits are why our provider adoption is industry-best.”