Three Key Takeaways from Webcast on Transforming Prior Authorization

Earlier this month, Cohere Health hosted a webcast with Humana to discuss key results from the first year of our partnership; how Cohere’s technology is driving value for its members and providers; and areas we’re targeting for future innovation.

We were thrilled to welcome Ross Lagerblade, Associate VP, Value Based Strategies: Care Decision Insights at Humana, onto a panel with Cohere’s Gina Kim, Chief Product Officer, Dr. Brian Covino, Chief Medical Officer, and Matt Murphy, EVP, Network & Clinical Content. Below are 3 key takeaways from the webcast:

The time to address prior authorization inefficiencies is now

The problems Humana faced within prior authorization were not wholly unique to them – they’ve become ingrained in and accepted as part of the healthcare system. Issues like siloed care coordination, administrative burdens, and provider abrasion – coupled with the growing shift from fee-for-service to value-based care models – have created unnecessarily complex patient journeys.

Humana knew that to get to the heart of the issue, they had to find a way upstream; to better understand what physicians want for their patients, without the health plan getting in the way of delivering care. Humana also realized that, instead of being an obstacle to care, prior authorization could serve to break down silos and drive provider coordination across episodes of care. Ross shared that “Humana didn’t have time to wait for the future state…we’re solving these problems right now” by leveraging Cohere’s intelligent, automated digital authorization platform.

A transformative approach to UM drives better patient experiences and outcomes, and more savings, with fewer denials

Since implementation, Humana has realized significant value in a number of key areas: member experience, provider experience, quality of care, and medical expense savings, among others. The webcast highlighted a few markers of success to date, including:

• Provider adoption and satisfaction: Cohere decreases the burden caused by prior authorization by automating many of the administrative tasks that unnecessarily take up providers’ time and resources, in turn resulting in 92% provider satisfaction.
• Patient access and outcomes: By combining intelligent automation and deep clinical expertise, Cohere is helping patients get access to the care they need an average of 4 days faster. Care quality is also improving as evidenced by a 15-20% reduction in complication rates. 
• Lower medical expenses: Humana has realized a 15% incremental impact in medical cost savings since implementing Cohere despite a 63% reduction in denials. Proving that a transformative approach to UM is capable of delivering medical expense savings without negatively impacting the patient or provider experience.

The future looks bright

Cohere and Humana continue to work collaboratively to test and implement new ideas that can improve care quality and support value-based care. In the webcast, we touch on a few spaces in which we’re seeking to drive future innovations, and we welcome you to watch the full recording here.