BOSTON, Oct. 13, 2021 /PRNewswire/ -- Today Cohere
Health, an emerging high-growth digital health company, announced
that Humana Inc. (NYSE: HUM)
is embarking on a nationwide expansion of Cohere's digital
authorization platform for musculoskeletal (MSK) services, based on
the success of its initial implementation. After rolling out the
platform across 12 states in January
2021, Humana has made significant progress toward achieving
its vision to reimagine and modernize processes for prior
authorization by reducing approval times, increasing provider
satisfaction, and improving delivery of care, all while preserving
important benefits such as safety, predictability, and reducing
waste.
In the currently implemented 12 states, 95% of authorization
requests for MSK services now flow through Cohere's digital
platform. By greatly reducing the need for manual clinical review,
Cohere's digital authorization platform drives a median approval
time of 0 minutes, enabling Humana providers to schedule patients
for the requested service immediately in 89% of cases.1
The upcoming expansion will extend the platform's value to all
Humana Medicare Advantage and Commercial members nationally, and to
more than 65,000 individual practitioners representing more than
10,000 physician practices.
Cohere's digital health plan solutions transform prior
authorization processes to drive collaborative care journeys,
thereby enabling truly touchless authorization. The Cohere platform
automates both provider and payer steps in the process, while also
coupling AI and machine learning with evidence-based clinical
policy to support better care decisions. For MSK care delivery,
Cohere's clinical criteria are informed by policies established by
the American Academy of Orthopedic Surgeons (AAOS). Cohere uses the
point of authorization approval as a trigger to engage plans,
providers, and patients in transparent, episode-based care paths
more than 65% of the time.2 These care paths merge
traditional utilization management, care management, and patient
engagement functions, and make evidence-based policy and
recommendations completely transparent to the requesting
provider.
"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."
As the industry moves toward more value-based arrangements and
risk-bearing payment models, the platform's national deployment
will help Humana better manage utilization by enabling
technology-driven collaboration between Humana, its providers, and
members.
Providers have reported high satisfaction with Cohere's
platform, with 72% indicating they are "very satisfied" and 68%
indicating that the Cohere platform is "much easier" to use than
alternative solutions. Overall provider net promoter scores (NPS)
have increased more than 100% since the platform was implemented in
January.3
Beyond processing the authorization request itself, the platform
uses evidence-based, technology-driven recommendations for
alternative services and care sites, which further improves care
quality and timing. For example, Cohere's solution
successfully influences providers to switch from an inpatient to an
outpatient setting, when warranted by the evidence, in 65% of
cases.4 This same technology enables high-performing
providers to follow a faster prior authorization request process,
while also helping case managers to rapidly prioritize and process
cases that require manual review.
"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."
About Cohere Health
Cohere Health moves quality care
forward. Cohere's digital healthcare collaboration platform and
supporting services align patients, physicians, and health plans at
the point of diagnosis to expedite physician-approved,
evidence-based treatment plans. With the goal of creating optimal
care journeys for every patient, Cohere is transforming legacy
processes to more quickly achieve the goal of higher quality care
and lower cost for all. Cohere works with physicians and health
plans committed to the transparent delivery of quality patient
care. Cohere's investors include Flare Capital Partners and Define
Ventures. For more information,
visit www.coherehealth.com.
About Humana
Humana Inc. is committed to helping
millions of medical and specialty members achieve their best
health. Our successful history in care delivery and health plan
administration is helping us create a new kind of integrated care
with the power to improve health and well-being and lower costs.
Our efforts are leading to a better quality of life for people with
Medicare, families, individuals, military service personnel, and
communities at large. To accomplish that, we support physicians and
other health care professionals as they work to deliver the right
care in the right place for their patients, our members. Our range
of clinical capabilities, resources, and tools— such as in-home
care, behavioral health, pharmacy services, data analytics and
wellness solutions—combine to produce a simplified experience that
makes health care easier to navigate and more effective. For more
information, visit www.humana.com.
1 Cohere Health, Prior Authorization Summary,
September 2021
2 Cohere Health, Care Path Utilization Dashboard,
June 2021
3 Cohere Health, Net Promoter analysis, September 2021; Cohere Quarterly Provider
Satisfaction Survey, August 2021
4 Cohere Health, Care Path Utilization Dashboard,
June 2021
Media Contact:
Jessica
Smith
Amendola Communications for Cohere Health
910.508.9980
jsmith@acmarketingpr.com
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SOURCE Cohere Health