Cohere Health Launches Early Trend Signal Intelligence to Predict Utilization Trends Earlier than Claims-based Methods

Leverages intelligent prior authorization to inform policy and financial strategies up to three months earlier

Boston, MA (May 14, 2024) – Cohere Health®, a recognized leader in clinical intelligence and prior authorization automation, announced the launch of early trend signal intelligence. By applying advanced artificial intelligence and predictive analytics to proprietary prior authorization data, early trend signal intelligence predicts medical utilization trends up to three months before claims data is available. This early insight enables health plans and other risk-bearing entities to understand trends, which in turn supports decision-making to address unnecessary utilization and associated costs.

With medical costs predicted to increase by 7% in 2024, health plans continue to face a growing challenge in managing financial risk while delivering quality care. Traditionally, health plans have relied on historical claims data to predict medical utilization – an approach that significantly delays responses to growing utilization trends. Cohere’s early trend signal intelligence addresses this challenge by analyzing and revealing trends from proprietary prior authorization data, which is available months before associated claims are processed. Additionally, the analysis pinpoints providers responsible for the trend shift. This proactive approach enables health plans to make faster and targeted utilization management and network adjustments.

“Our mission is to go ‘beyond UM’ by leveraging prior authorization for greater impact on appropriate utilization and patient outcomes,” said Dr. Brian Covino, Chief Medical Officer at Cohere Health. “Early trend signal intelligence is our latest entry in fulfilling that mission and will enable substantial improvements in the timeliness, scope, and effectiveness of our health plan clients’ UM activities.”

As an example, in 2023 early trend signal intelligence helped one health plan identify high trends (e.g., 10-15%) for musculoskeletal surgical procedures such as arthroplasty and spinal procedures months earlier than claims data. The solution identified high-trend providers attributable to 1-2 percentage points of joint arthroplasty trend and counted for up to $10 million of utilization beyond normal trends, providing an earlier basis for intervention than typical analytic programs.

Three ways early trend signal intelligence helps health plans facilitate proactive decision-making:

1. Proactive adjustments: Allows health plans to predict changes to their medical loss ratio to anticipate higher-than-expected utilization and associated costs.
2. Strategic predictions: Increases the accuracy and scope of predictions with year-over-year data sets.
3. Collaborative care: Identifies providers with atypical authorization trends for targeted intervention and collaboration opportunities

Health plans can use early trend signal intelligence for more than cost forecasting. By synthesizing intelligent prior authorization data, health plans can identify trends in subspecialties and lines of business to inform clinical and coverage policy adjustments, as well as to establish a data-driven framework for effective collaboration with high-utilization providers. This collaborative effort aims to reduce medical costs and ensure compliance with quality regulations, promoting a more efficient and cost-effective healthcare system.

Access the white paper to learn how early signal trend intelligence can foster stronger relationships between health plans and providers, ultimately leading to improved care quality and financial outcomes.