Matt Murphy, Cohere’s EVP of Network & Clinical Content, sits down with Karen Jagoda of the Empowered Patient Podcast to talk about how we are transforming utilization management into true care management through a patient-first approach.
During the podcast, Matt explains,” utilization management really evolved as an adversarial exercise with health plans pitted against physicians. And if you think about the key areas where it’s impacting patients and physicians more broadly, really it’s three things. First is delays in care and access. Really there shouldn’t be anything coming in between a patient and the care they need as long as it’s clinically appropriate. So I’d say that’s probably the first issue.”
“A few weeks ago, we reported out jointly with Humana, one of our first clients, on the impact we had in year one, and it was tremendous in terms of medical expense savings. But I think it goes back to the philosophical differences people have in utilization management.”
“On one side, you have a number of folks who think that the only way to drive down medical expense is to deny services versus our vision, which is if you truly are driving the right clinical care for patients and the highest value care, you’re inherently going to have lower expense. So I think if you can kind of transition across that philosophical boundary into the focus on clinical outcomes, you inherently save money.”
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