How PA Can Be Transformed into True Care Management?

Cohere recently held a webinar with Humana to dive in and understand how prior authorization can truly be transformed into true care management, featuring Dr. Bryan Loy, Market Medical Director at Humana; Dr. Brian Covino, Cohere’s Chief Medical Officer; and Gina Kim, Cohere’s Chief Product Officer. Here were some of the biggest takeaways from the discussion:

1. Prior authorization continues to be a significant burden within the healthcare industry.

Multiple challenges surround prior authorization which impacts a variety of stakeholders within the ecosystem. For health plans, prior authorization has resulted in significant administrative burden, creating provider friction. Physicians are frustrated with peer-to-peer requests which take time away from patient care and increase administrative costs to their practices. For patients, prior auth can negatively impact care quality, delay care, and add unnecessary costs.

Further challenges include complexity around the authorization submission process for back-office users because the user experience has been fragmented and unfriendly. Administrative staff in many physician practices are still utilizing fax rather than more advanced digital solutions. That said, some new automated products have succeeded only in making the process faster. Truly improving utilization management requires a more transformative and innovative approach that puts patients at the center to ensure the most appropriate, timely care.

2. Cohere’s digital prior authorization solution offers the advanced technology required to meet these challenges.

Prior to implementing Cohere’s solution, Humana’s musculoskeletal authorization processes, similar to all other utilization management processes, resulted in care delays, suboptimal choices, and unnecessary costs for stakeholders. They were ready to take a different approach that would allow them to address the challenges associated with prior authorization while maintaining their existing standard of care. Specifically, Humana was interested in adopting a solution that would help them transform their authorization processes into true care management. 

Humana partnered with Cohere with the goal to implement a solution that would drive collaborative care and reduce provider friction.

3. The Return on Investment for this approach is clear.

Since its implementation, Cohere’s solution has driven an industry-leading 93% provider digital adoption rate and has delivered 15-25% of additional medical savings beyond Humana’s current utilization management programs. Learn more about how they did it by listening to the webinar.