Support rapid growth and improve your Star ratings, by reducing unwarranted care variation, with fewer denials, vs. your current MSK management program.

Delegated MSK with Cohere Health

Is your current delegated MSK management program saving you as much as possible, while limiting provider abrasion? Is that program helping your members receive the best care, with minimal delays, to support higher Star ratings in a time of rapid growth? Cohere has been able to surpass the medical cost savings of similar programs by 15-20% – while actually reducing denials, accelerating access to the most appropriate, evidence-based care, and improving patient outcomes

Download the Case Study:

How Humana Transformed Prior Authorization to Improve Care & Collaboration

Meet your Cohere Team

As COO of the mental healthcare company Mindstrong and as Executive Vice President at Iora Health, Duncan led the rapid expansion for these disruptive businesses. At Iora specifically, Duncan oversaw patient growth, provider satisfaction and operating metrics for thirty-four practices in eight states.

Duncan holds a bachelor’s degree from Colgate University and an M.B.A. from the Tuck School of Business at Dartmouth College.

Co-Founder & COO
Vice President of Strategic Sales

With more than a decade of experience working in Healthcare IT, focused on healthcare payers business, Ryan leads business development efforts for Cohere Health, with primary responsibility for Blues and top 25 Health Plan partnership. Previously, Ryan served as Director of Business Development for Inovalon leading Quality, Risk Adjustment, and Interoperability platform sales.

Ryan has also held sales positions at NANTHEALTH formally NaviNet, SCIO Health Analytics and legacy Cotivity company, Verisk Health. Currently, Ryan resides in New Hampshire with his wife and two children and holds a bachelor’s degree from the University of New Hampshire.

Vice President of Sales
Growth Sales Development Representative
Vice President of Payer Solutions

Most UM programs take a transactional approach to prior authorization. Requests receive a “yes” or “no” response, without presenting alternatives that consider the whole individual patient care episode or journey.  So opportunities to guide providers and their patients – your members – to higher-value medical services are lost. To make matters worse, requests that require clinical review often undergo a lengthy manual review process, which can delay needed care by days or weeks.  Both patient outcomes and Star ratings suffer as a result.

Cohere Health’s delegated UM solution for musculoskeletal management has been proven to drive better outcomes, with lower costs and fewer denials, than other delegated programs. How do we do it?

Immediate determination.  Our solution’s advanced AI-driven technology, combined with nationally respected, evidence-based clinical expertise, enables an industry-best 94% instant determination of MSK authorization requests.  We’re able to automate more clinical reviews than alternative solutions, without losing clinical rigor or nuances associated with individual patient scenarios.

Real-time care alternatives.  Reliance on NCD/LCD limits UM effectiveness for MA plans. Cohere’s unique in-workflow clinical suggestions, or “nudges,” offer real-time guidance to patient-specific, clinically optimal care choices at the point of diagnosis.  This enables  faster recoveries and fewer complications than can be achieved with NCD/LCD alone – and the health plan benefits from less unnecessary medical expense.

Long-term view.  Cohere’s solutions are built to support the entire patient journey, not just a single point along the way.  Our prior authorization process considers the entire episode of care so that downstream services are anticipated and pre-approved all at once.    This drives faster access to the most appropriate care for each specific patient scenario and additional avoidance of unnecessary and potentially harmful medical services.

Have a look at some of our results so far:

Attending AHIP’s National Conference on Health Policy and Government Health Programs? Join us on Tuesday, March 15th at 1:45 pm to hear how our innovative solution improves outcomes while lowering denials and medical expenses