Transform your specialty UM programs to focus on outcomes — not just transactions
Cohere Complete™ outsourced UM solutions add clinical and operational staff to our Cohere PaaS™ Intelligent Prior Authorization solutions in order to provide health plans with complete, end-to-end and fully delegated utilization management operations for select specialties.
Our model combines deep clinical expertise, AI, and real-time analytics to align health plans, providers, and patients on episode-driven care paths, enabling better care quality and outcomes, with fewer denials, and less unnecessary utilization.
We offer fully-delegated management services for key clinical specialties, including:
Transaction-focused outsource solutions fail to improve the care journey.
Traditional utilization management programs are about saying “yes” or “no” to individual services, instead of promoting the best patient care and experience. This orientation can delay care, frustrate providers and patients, and misses an opportunity to proactively drive the best care for that specific patient’s entire care journey.
Cohere’s digital-first approach uses interoperability and intelligence to understand the longitudinal patient journey and recommend patient cohort-specific data, evidence-based care paths, oriented to the entire care journey. This allows us to help health plans transform utilization management from a reactive, transaction-based program to a proactive one that anticipates optimal care needs for the patient, and guides providers and patients to care choices that improve outcomes and reduce cost.
Cohere Complete™
Our differentiated approach
Deep clinical expertise combined with innovative technology help bridge the gap from transaction-focused UM to complete care journey management.
Patient cohort-specific care paths
Identify diagnostic cohorts and enable the authorization of the entire care episode, rather than a series of individual transactions.
Proactive moments of upstream influence
“Nudge” providers toward patient-specific, clinically optimal care choices and high-value specialists at the point of diagnosis.
Intelligent patient and provider-specific decisioning
Incorporate real-time, provider quality, cost, and care appropriateness insights, as well as patient clinical profile information into the automated determination process.
Clinical analytics
Continuously optimize program performance through advanced clinical analytics including provider benchmarking and performance insights.
Realize the value of a cutting-edge, digital-first approach
Our capabilities have driven these unique, actual results
18-43%
Decrease
in complications & unnecessary procedures
Driven by AI/ML-based clinical suggestions
3-4x
Improvement
In provider satisfaction
70%
Faster
access to patient care
Our capabilities have driven these unique, actual results
Learn how our approach helped drive significant quality improvements in musculoskeletal results for a leading national health plan.
