Technology will bundle and accelerate prior authorization for
cardiovascular and surgical services
BOSTON, MA (October 24, 2022) – Today Cohere Health, a leader in intelligent utilization management (UM) technology, announced that Humana Inc. (NYSE: HUM) will expand its use of Cohere’s digital UM collaboration platform to enable seamless prior authorization for cardiovascular and surgical services.
In addition to digitizing prior authorization requests for these services, the technology automates clinical intelligence into the provider’s workflow, enabling episode-based, longitudinal management of the patient’s care journey, in order to reduce care variation, drive higher quality care and minimize administrative burden. Both solutions will be deployed nationwide on January 1, 2023 for Humana Medicare Advantage members and Humana employees with the company’s health plan.
Cardiovascular care is clinically complex, with multiple exchanges between primary care physicians, cardiologists, and subspecialty clinicians that can contribute to costly and unnecessary variations in care. Cohere’s solution for cardiovascular services improves care quality by promoting consistent adherence to clinical guidelines, and by generating patient-specific care paths that optimize outcomes for each individual. The solution incorporates patient-specific, evidence-based guidance from the American College of Cardiology within the automated authorization workflow, helping guide physicians to the highest-value care choices for patients.
For surgical services, Humana staff will use the Cohere Unify™ platform to accelerate patient access to care by facilitating the review and approval of surgical procedure prior authorization requests. By ensuring requests are reviewed expeditiously, the platform helps providers and patients avoid the complications that can arise from delayed care.
“By deploying a digital approach across multiple specialties, we can ease the burden of prior authorization for providers,” said Lisa Stephens, Senior Vice President of Operations at Humana. “In addition, we better support our members along their clinical care journeys for cardiovascular and surgical services with the deep clinical intelligence of this partnership.”
Last December, Humana launched a focused pilot program to test Cohere’s new cardiovascular services platform, inviting nearly 200 provider groups across the nation to complete cardiovascular prior authorizations. Participating providers were able to submit authorization requests 34% faster compared to other portal solutions, and after eight months, portal adoption among participating providers had risen to nearly 99%, with 83% of providers reporting they were satisfied or highly satisfied with their experience.
“We’re pleased to launch the next phase of our partnership with Humana. Expanded use of our UM platform will further help Humana fulfill its mission of improving health outcomes for every member, as it enables optimal care paths for patients whose cardiovascular disease will likely require long-term care management,” said Siva Namasivayam, CEO of Cohere Health. “We’re also excited to leverage our digital prior authorization solution to help Humana unify the provider experience and automate the bulk of surgical services requests. Humana will be able to use real-time, in-workflow analytics to drive collaboration between the patient and their providers during the care journey.”
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About Humana
Humana Inc. (NYSE: HUM) is committed to helping our 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. Learn more: www.humana.com
About Cohere
Cohere Health is a clinical intelligence company that provides intelligent prior authorization as a springboard to better quality outcomes by aligning physicians and health plans on evidence-based care paths for the patient’s entire care journey. Cohere’s intelligent prior authorization solutions reduce administrative expenses while improving patient outcomes. The company is a winner of the TripleTree iAward and has been named to both Fierce Healthcare’s Fierce 15 and CB Insights’ Digital Health 150 lists. Cohere’s investors include Flare Capital Partners, Define Ventures, Deerfield, Polaris Partners, and Longitude Capital.
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