Geisinger Health Plan and software company Cohere Health are teaming up to simplify the prior authorization process and ease the burden on providers.
Through this transaction, the Danville, Pennsylvania-based Geisinger Licensing coherentAn AI-driven usage management technology and service platform designed to support value-based care delivery. In a value-based care delivery model, providers are paid based on patient health outcomes and quality of service.
Cohere said in a statement Its technology is designed to simplify the prior authorization process and support value-based care while reducing administrative costs. Cohere also aims to comprehensively transform Geisinger’s utilization management to deliver quality improvement programs in all areas of the integrated health systems business.
Health insurance companies use a prior authorization process to determine whether they will cover a program or service. This is one of the most burdensome aspects of getting approval for patients in advance, and often results in patients waiting for care.
Boston-based Cohere’s platform is designed to make this process more efficient and easier.One way to do this is to provide A physician who provides a path of care based on a Geisinger Health Plan member’s history and their care needs.
The platform draws data from a variety of sources—including claims data, clinical data from electronic health records, and CMS datasets—to find populations with similar clinical characteristics. It then allows providers to compare different treatment plans based on these populations. These recommendations encourage providers to select high-value options before submitting prior authorization requests to payers.
Instead of multiple, disjointed requests, physicians can submit one bundled authorization for a patient’s entire care process—including imaging and diagnosis, surgery, medication, physical therapy, and rehabilitation.
Hopefully, in most cases, patients won’t have to wait for prior authorization approval. According to the company, the average approval time on the Cohere platform is less than a minute. The process is designed to reduce peer-to-peer clinical scrutiny and rejection, and reduce administrative effort by physicians and health plans.
The Geisinger Health Plan, which covers more than half a million members in Pennsylvania, isn’t Cohere’s only paying customer. Humana also uses Cohere’s technology since 2021, and its technology is in use in all 50 states. According to one study, Humana providers were able to schedule patients immediately in 89 percent of cases. Press Releases. When asked about the service charges, Cohere declined to specify its pricing structure.
Cohere claims its platform saves an average of 15% on medical bills and reduces denial rates by 63%. More than 95% of the provider’s customers use its platform to electronically submit and approve prior authorization requests, which has accelerated patient care by 70%. According to Cohere, the platform has seen an 18 percent reduction in surgical complication rates.
John Bulger, Chief Medical Officer of Geisinger Health Plan Press Releases“Cohere’s collaborative platform allows us to further differentiate our value-based care offerings, as our network providers can use the platform’s evidence-based, proactive care recommendations to improve health outcomes and ensure our patients receive access to their medical history. and the best care for your condition.”
Photo: Piotrekswat, Getty Images
