Intelligent prior authorization platform plus leading clinical criteria enhances provider experience, improves health plan efficiencies, and accelerates patients’ time to high-quality care
BOSTON, Mass. and SEATTLE, WA (October 8, 2024) – Cohere Health®, a recognized leader in clinical intelligence and prior authorization automation, and MCG Health, part of the Hearst Health network and a leader in technology-enabled, evidence-based guidance, announced they will integrate their content and technology offerings to improve the prior authorization process for providers, patients, and health plans. The partnership’s first joint health plan client is a large regional insurer that plans to launch the combined solution in early 2025.
The partnership will seamlessly integrate MCG care guidelines into Cohere’s Unify Decisioning automation tool to create an industry-leading solution for prior authorization decision-making, driving higher rates of clinically appropriate auto-approvals, while reducing provider submission time and friction.
The collaboration between the two companies will significantly benefit joint health plan clients, their provider networks, and patients. For health plans, clinical review staff will be able to view indications pre-fulfilled by Cohere Models within MCG Cite CareWebQI, enabling much faster reviews. Patients stand to benefit the most from this partnership, as Cohere’s AI-driven technology will reduce time to care, while MCG’s widely accepted clinical guidelines will drive consistent, clinically appropriate care decisions.
“The partnership between Cohere and MCG Health will provide a powerful, unified solution to reduce administrative burdens in prior authorization,” said Jon Shreve, CEO, MCG Health. “Both organizations are respected as innovators in healthcare technology and together, we can accelerate our progress to support payers, providers, and most importantly, patients.”
“MCG Health is the perfect partner to complement Cohere’s groundbreaking, AI-driven offering with industry-leading and nationally recognized clinical criteria,” said Siva Namasivayam, CEO, Cohere Health. “Our leading, proven technology innovations applied to MCG’s substantial clinical guidelines footprint will accelerate a new era of less prior authorization friction. Healthcare constituents are increasingly demanding innovative solutions that provide lower costs and faster access to care.”
For more information about the combined Cohere-MCG solution please visit: https://coherehealth.com/connect/.
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About Cohere Health
Cohere Health is a clinical intelligence company that provides intelligent prior authorization as a springboard to better quality outcomes by aligning physicians and health plans on evidence-based care paths for the patient’s entire care journey. Currently processing nine million intelligent prior authorization requests annually, Cohere positively impacts more than 15 million health plan members and 492,000 healthcare providers nationwide. The company is a Top 5 LinkedIn™ Startup, winner of the TripleTree iAward, three-time recipient of KLAS Research’s Points of Light, and has been named to Fierce Healthcare’s Fierce 15 and CB Insights’ Digital Health 150 lists. Cohere’s investors include Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners.
About MCG Health
MCG, part of the Hearst Health network, provides unbiased clinical guidance that gives healthcare organizations confidence in delivering patient-centered care. MCG’s artificial intelligence and technology, infused with clinical expertise, enable its clients to prioritize and simplify their work. MCG’s world-class customer service ensures its clients maximize the benefits of licensing MCG solutions – demonstrating improved clinical and financial outcomes. For more information visit www.mcg.com.
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