Cohere Health

Cohere Health is a clinical intelligence company founded in 2019 that specializes in automating and streamlining the prior authorization process in healthcare. The company's intelligent prior authorization platform utilizes artificial intelligence, machine learning, and deep clinical intelligence to digitize and expedite authorization requests for health plans and providers. This technology aims to reduce denial rates, improve patient outcomes, and decrease administrative burdens.

Cohere's platform processes over 5.6 million intelligent prior authorization requests annually, impacting more than 15 million health plan members and 457,000 healthcare providers nationwide as of June 2024. The solution digitizes portal requests and integrates with electronic medical record (EMR) systems to provide a touchless authorization experience, allowing for real-time automatic approval when clinically appropriate. This approach has led to an 83% immediate approval rate for requests, with an average turnaround time of 4.5 days for cases requiring clinician review and nine hours for expedited cases.

The company's technology goes beyond simple approval or denial of authorization requests. It combines request data with population analytics to generate customized care paths, aligning with emerging value-based care models. Cohere's platform has demonstrated a 63% reduction in denial rates, a 70% acceleration in patients' access to care, and an 18% decrease in surgical complication rates. Additionally, the solution drives 15% incremental medical savings on average for health plans.

Cohere Health offers both a licensed platform-as-a-service solution and a fully delegated solution, allowing health plans to either use the technology in-house or outsource their entire utilization management operations for certain specialties to Cohere. The company's advanced predictive analytics can anticipate changes in utilization, identify outlier provider patterns, and predict patient outcomes.

Key customers and partnerships

Cohere Health serves five health plans, including Humana and Geisinger Health Plan. In June 2024, the company announced a strategic partnership with Medical Mutual, the oldest and one of the largest health insurance companies based in Ohio, and Rhyme, an EHR-integrated prior authorization automation company. This collaboration aims to fully automate the end-to-end prior authorization process for Medical Mutual.

Several major Ohio health systems utilize Cohere's intelligent prior authorization platform and Rhyme's EHR-integrated network, including the Cleveland Clinic, The Ohio State University Wexner Medical Center, and OhioHealth. In July 2022, Geisinger Health Plan partnered with Cohere Health to support its value-based care delivery, reduce administrative costs, and align quality improvement initiatives across all its lines of business, including Commercial, Exchange, Medicare Advantage, and Medicaid.