Using clinical intelligence and precision AI to enhance cardiovascular care management.
Cohere's delegated solution for cardiovascular care takes the administrative burden off health plans while ensuring high-quality, evidence-based care for members. Our delegated model includes:
Full clinical and administrative ownership of the prior authorization process
Specialized cardiovascular clinical expertise from board-certified cardiologists
Advanced technology infrastructure that scales to meet any volume demands
Continuous quality improvement through data-driven insights and reporting
Collaborative provider engagement focused on optimal clinical outcomes
15-20%
medical cost savings
89%
provider satisfaction
$4.56 PMPM
non-denial medical expense savings
Cohere's cardiovascular clinical intelligence solution incorporates nationally accepted clinical criteria from the American College of Cardiology (ACC). Our board-certified cardiologists work to implement consistent, evidence-based guidelines across:
At the core of our fully-delegated cardiovascular services is our clinical intelligence platform. This advanced system integrates:
This comprehensive ecosystem enables true digital transformation of utilization management, delivering greater operational efficiency and-most importantly-faster, higher-quality patient outcomes.
Our innovative provider intake application creates a seamless experience that reduces administrative burden and fosters greater clinical collaboration:
Benefits
Unlike legacy outsourced services that focus on denials, 63% of Cohere's impact comes from non-denial interventions like pre-submission prompts and site of service opportunities that reduce care delays and provider frustration.
Cohere has a deep clinical team bench and ensures clinical expertise across all delegated workflows from intake to same-specialty peer-to-peer reviews. Our MD & RN clinical experts provide broad clinical expertise, which is leveraged across the offering.
Cohere’s provider-facing application has a 96% digital adoption rate. It offers in-workflow, real-time messaging prompts to providers for missing information required for auto-approval. The application also suggests clinically appropriate care recommendations for optimal care to drive maximum cost and quality impact.
Cohere’s precision AI/ML-based intelligent real-time decisioning: Cohere’s approach to auto-approving authorizations goes far beyond traditional rules based on manual user input of clinical assessment questions. Cohere achieves an average 90% auto-approval rate with higher decision quality and reduced opportunities for gaming by using ML to interpret clinical notes from the EMR.
Musculoskeletal Leadership
Our clinical team is led by storied physicians who, together, bring decades of combined surgical expertise to every MSK program we manage.
Chief Medical Officer
With over 25 years of orthopedic surgery experience, Dr. Covino joined Cohere in 2020 after serving as a consultant since 2018. As a former partner at Knoxville Orthopaedic Clinic/OrthoTennessee, specializing in joint replacement surgery, he brings invaluable clinical expertise to our leadership team. Dr. Covino holds a bachelor's degree from Harvard University and an M.D. from Georgetown University School of Medicine, with surgical training from the University of Virginia and a fellowship at The Cleveland Clinic Foundation.
Vice President of Clinical Strategy and Innovation, Cardiovascular
Dr. Rotondo joined Cohere in 2021 after practicing cardiology for more than 25 years in Knoxville, TN. Previously with Humana Inc., he brings extensive clinical and payer expertise to our cardiovascular program. As a former partner at East Tennessee Heart Consultants, Dr. Rotondo practiced general, invasive, and interventional cardiology. He holds both bachelor's and M.D. degrees from Brown University, with Internal Medicine training at the University of Tennessee Medical Center and the Washington University Medical Center, where he also completed his cardiology fellowship.
Medical Director, Operations Cardiovascular
Dr. Agunanne joined Cohere in 2022, bringing extensive experience in both clinical practice and utilization management. He is Board-Certified in Advanced Heart Failure and Transplant Cardiology, Cardiovascular Disease, Internal Medicine, Nuclear Cardiology, and Comprehensive Adult Echocardiography. Dr. Agunanne received his Advanced Heart Failure and Transplant Cardiology Fellowship training at the Baylor University/Texas Heart Institute/St Luke's Hospital and his Cardiology Fellowship at Texas Tech University. He also holds a Master of Public Health degree.
Schedule time with our team to learn more about how our clinical intelligence platform and experienced team can modernize your approach to UM.
Browse the most common questions we are asked to help you make the most of your decision to modernize your UM operations…and beyond!
Cohere Health's cardiovascular solution is a fully delegated service that combines clinical intelligence, precision AI, and specialized expertise to modernize prior authorization for cardiovascular care. Our solution leverages advanced technology and clinical expertise to drive better care outcomes, reduce provider burden, and generate significant administrative and medical cost savings.
Unlike traditional prior authorization, which often creates barriers to care, our approach uses clinical intelligence to guide providers toward optimal care choices from the start. We focus on transparent decision-making, evidence-based guidelines, and real-time collaboration. Our provider application is designed with clinical workflows in mind, making the process more efficient and less burdensome for cardiovascular utilization management.
Our delegated UM solution covers a comprehensive range of cardiovascular services, including ablation procedures, cardiac devices and implants, complex cardiac interventions, advanced diagnostic and cardiac imaging, peripheral revascularization, and Percutaneous Ventricular Assist Devices (VADs).
Fully-delegated means Cohere assumes complete responsibility for managing the entire prior authorization process on behalf of the health plan. This includes intake of requests, clinical review, determinations, provider communication, and reporting with optional add-on services for a tailored solution. Our delegated model allows health plans to benefit from our specialized clinical expertise and advanced technology without needing to maintain these capabilities in-house. And in some cases, we support delegated services while health plans build their in-house operations.
Our cardiovascular solution incorporates nationally accepted clinical criteria from the American College of Cardiology (ACC) and other leading cardiovascular organizations. These evidence-based guidelines are continuously updated based on the latest research and clinical advancements.
No. Our provider experience is designed with simplicity and clinical workflows in mind. Most providers report being able to use the system effectively with minimal training. We offer comprehensive support resources, including tutorial videos, quick-start guides, and live support to ensure a smooth onboarding experience.