Last month, I had the distinct pleasure of representing Cohere Health at KLAS’s Research Payer/Provider Summit to accept the 2022 Points of Light Award.
(Photo courtesy of KLAS Research)
At the event in Salt Lake City, we were recognized with this award for a case study involving Humana, OrthoVirginia, and other provider organizations that demonstrated reduced prior authorization burden, as well as faster patient access to quality care and better outcomes.
Our case study’s collaboration was recognized in the following categories:
- Improved CARE QUALITY: For lowering surgery complication rates and shifting procedures from inpatient to outpatient settings
- Improved PATIENT EXPERIENCE: For enabling faster access to care for patients
- Improved EFFICIENCY: For reducing medical documentation and significantly reducing the administrative burden for payers
- Improved PROVIDER EXPERIENCE: For reducing peer-to-peer reviews and enabling providers to spend less time on the prior authorization process
- Improved FINANCIAL RESULTS: For creating medical expense savings for payers
During my presentation entitled, Transforming UM from Administrative Burden to Quality Program Asset, I spoke about some of the challenges we set out to solve that included:
- Providers overall friction with the prior authorization process, from time and expense spent on requirements like peer-to-peer review
- Disconnections between providers and payer systems that created redundancies and inefficiencies
- Delays in patient access to care up 7 to 10 days
Additionally, I provided some key solutions on how best to overcome these challenges through incorporating clinical criteria based on evidence-based medicine to find the optimal care for the patient’s entire episode of care, or care journey.
Our case study’s findings were validated through in-depth interviews by KLAS Research’s team and showed the following results:
OrthoVirginia & other providers:
- 63% lower denial rates
- 38% less time spent on prior authorizations (reduced medical documentation & reduced peer-to-peer reviews)
Humana:
- 40%-50% reduced administrative burden
- 10%-15% incremental medical expense savings
Humana’s members:
- 70% faster access to care
- 18% lower complication rates (hips/knees)
The patient impact is what Cohere is most proud of, and really what the company was founded on. For us, this wasn’t just about increasing efficiencies, but how to transform UM and the prior authorization process into a driver of improved care quality and patient experience.
As the Chief Product Officer, I’m proud to be helping to lead an organization focused on improving the access to care for patients around the country. This case study shows how much of a real impact we’ve had in such a short amount of time. We’re looking forward to partnering with other health plans and providers to improve the process for patients.
While my Cohere colleagues weren’t able to join me on stage to accept the KLAS Points of Light award, I want to thank them, along with Humana, OrthoVirginia, and the other providers who participated and made this possible.
Interested in learning more about our case study? Watch my presentation from Salt Lake City and/or download the full report.
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About the Author: Cohere Health
