Cohere Align delivers a personalized approach to prior authorization by streamlining utilization management, improving the provider experience, and accelerating care access
Cohere Health®, the leader in clinical intelligence solutions for health plans, announces Cohere Align™, a new solution designed to improve provider satisfaction and accelerate access to high-quality care with personalized prior authorization (PA). By leveraging advanced analytics, curated AI-powered PA workflows, and direct provider engagement, Cohere Align moves beyond the limitations of legacy gold carding, blanket PA waivers, and long 6-12 month evaluation periods, to deliver a smarter, faster, more targeted approach.
Clients are already seeing strong results for Cohere’s approach:
- 80% of PA submissions streamlined for trusted providers through provider green lighting
- 55% reduction in time needed to submit PAs
- 98% provider satisfaction rate
- 4x faster trend analysis to identify utilization pattern changes and outliers
“Health plans want to support providers in delivering appropriate patient care and reducing abrasion,” notes Cohere Health’s Chief Product Officer Matt Parker. “Gold carding programs often create new roadblocks, lack transparency for providers, lead to spikes in utilization, and can end up increasing complexity and friction. Cohere is focused on creating better provider experiences, working closely with our AI, Clinical, and Provider Engagement teams. With Cohere Align, we’re giving health plans new tools to manage these processes, with the flexibility to give providers a more personalized, supportive PA experience.”
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A tailored approach to prior authorization and utilization management
Cohere Align personalizes the PA process by identifying trusted providers, tailoring workflows, and continuously optimizing engagement. This approach enables health plans to reduce provider abrasion while ensuring appropriate utilization, care quality, and patient safety. Three key capabilities include:
- Provider identification: Identifies trusted providers, such as those who qualify for green lighting or other curated, goal-based experiences, using deep analytics to assess provider trend data;
- Curated engagement: Delivers personalized in-platform journeys and external communications to ensure providers have clear, efficient experiences; and
- Continuous optimization: Allows access to real-time provider performance dashboards, which actively monitor for ongoing performance, patient procedure safety, and unnecessary utilization for engagement refinement, and uncover new opportunities for better experiences and collaboration.
Health plans face continued pressure to reduce providers’ PA burden. In fact, the American Medical Association reports physicians and staff spend 13 hours per week on PAs, pulling them away from patients. In response, some health plans and state regulators have turned to programs like gold carding. These programs are often imprecise, resource-intensive, and can drive up utilization and unwarranted medical expenses, leading to downstream provider abrasion issues. Cohere Align delivers a smarter, personalized, and data-driven approach, without the provider abrasion inherent to rigid legacy efforts.
Source: PRNewswire
