This collaboration promotes the use of evidence-based care and drives quality outcomes with medical policies for hip and knee surgeries
BOSTON (March 10, 2025) – Cohere Health®, the leader in clinical intelligence solutions for health plans, announces its expanded collaboration with the American Academy of Orthopaedic Surgeons (AAOS). AAOS’ Clinical Quality and Value team has reviewed Cohere’s medical policies for hip and knee replacements for alignment with the latest medical evidence that supports quality outcomes. This development strengthens the organizations’ pioneering 2020 collaboration.
Hip and knee replacements are the most common musculoskeletal (MSK) surgeries in the U.S, projected to reach 1.26 million and 635,000 procedures annually by 2030. A 2023 HSS Journal study found that hospital readmission for a total hip replacement costs approximately $63,452, emphasizing the importance of evidence-based care that minimizes preventable complications. The collaboration between Cohere and AAOS highlights how prior authorization (PA) can promote evidence-based care, ensuring treatment is research-backed to reduce complications and costs.
American Joint Replacement Registry (AJRR) Chair James I. Huddleston, III, MD, FAAOS, shared, “As the demand for total hip and knee replacements grows, it’s crucial that patients and providers have access to the latest evidence for treatment options. Cohere Health’s intelligent prior authorization solutions, which combine innovative technology with clinical insights, create a strategic approach for improving both patient outcomes and provider experience.”
Traditional PA has long been criticized for administrative burdens and inconsistent clinical criteria. In the American Medical Association’s annual PA survey, one-third of physicians reported PA criteria are rarely or never evidence-based. Cohere Health and AAOS initiated their collaboration to address this issue by embedding AAOS clinical guidelines into Cohere’s policies, helping determine the medical appropriateness of MSK treatments. Providers using Cohere are guided toward evidence-based care that’s more likely to be auto-approved. With an 85% auto-approval rate for MSK treatments, Cohere speeds up time to care and streamlines PA workflows.
The collaboration also allows top-performing physicians opted into AJRR to avoid PA requirements while maintaining quality and cost control. Physicians with high PA approval rates and high performance against AAOS quality metrics can have PAs waived, easing their administrative burden and hastening the PA process.
“Cohere Health is supporting 12 million treatments and procedures annually, and we’re committed to supporting the best possible care for patients,” notes Traci Granston, MD, MBA, FAAOS, Cohere’s SVP of clinical strategy. “As a board-certified orthopaedic surgeon, I understand how extremely important it is that our policies align with AAOS guidance to specialists. We are proud to partner with AAOS to further support our mission and millions of patients.”
###
About Cohere Health
Cohere Health is a clinical intelligence company delivering AI-powered intelligent prior authorization solutions, which streamline patients’ access to quality care by aligning their physicians and health plans for improved collaboration, transparency, and care coordination. Cohere works with nearly 600,000 providers and processes more than 12 million prior authorization requests annually, using AI to auto-approve up to 90% of requests for millions of health plan members around the country. The company was recognized twice in the Gartner® Hype Cycle™ for U.S. Healthcare Payers, is a Top 5 LinkedIn™ Startup for 2023 & 2024, and is a three-time KLAS Points of Light award recipient. Its investors include Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners.
About AAOS
With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world’s largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level to best treat patients in their daily practices. AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal healthcare issues; and it leads the healthcare discussion on advancing quality.
Share:
About the Author: Cohere Health
