Achieve better outcomes, lower costs, and happier providers—without the administrative burden
We manage the entire spectrum of musculoskeletal care with evidence-based guidelines developed in partnership with the American Academy of Orthopaedic Surgeons (AAOS):
At Cohere Health, our clinical expertise is reinforced by technology—not replaced by it. Our delegated offering enables real-time, clinically sound decisions that traditional prior authorization programs can't deliver. Why? Because our platform’s precision AI is trained on the collective expertise of our MSK-specialized physicians and nurses.
Our fully-delegated musculoskeletal management program aligns clinical expertise with intelligent technology to deliver results that traditional utilization management simply can't match:
32%
reduction in medically unnecessary surgeries
16%
shift from inpatient to outpatient settings
15%
medical cost savings over previous programs
63%
reduction in denial rates
93%
provider satisfaction score
Whatepaper
Episodic authorizations represent an innovative application of technology that takes advantage of a digitized PA process to further reduce burden and drive better outcomes. This novel approach leverages a high-profile health episode to consolidate authorizations for multiple related services, which in turn lightens the associated administrative burden and reduces the length of the care episode.
Overview
Benefits
We take our delegated responsibilities seriously. Our end-to-end approach across specialties bridges the gap between fragmented authorization transactions and comprehensive clinical care management, including:
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.
Senior Vice President of Clinical Strategy
For more than twenty years, Dr. Granston has been an orthopedic surgeon specializing in hand surgery. She received her undergraduate degree in science and master’s of business administration from the University of Washington, attended medical school at Vanderbilt University School of Medicine, and completed her orthopedic surgery training at the University Hospitals of Washington, Cleveland, and Case Western Reserve. Dr. Granston is active in the Vanderbilt University’s School of Medicine Campaign Cabinet, the American Academy of Orthopedic Surgeons, and the American Society of Surgery of the Hand.
Associate Medical Director
Dr. Thomas is a Board Certified Orthopaedic Spine Surgeon who has been in practice since 2010. In addition to serving as Associate Medical Director at Cohere, he is a partner at New Hampshire NeuroSpine Institute in Bedford, NH. Dr. Thomas received his undergraduate degree in Molecular Biophysics and Biochemistry from Yale University, attended medical school at Stanford University School of Medicine, completed his orthopaedic surgery residency at Hospital for Special Surgery in New York City, and an adult spine fellowship at New England Baptist Hospital in Boston.
Our precision clinical intelligence is a flexible foundation for all your delegated needs.
Browse the most common questions we are asked to help you make the most of your decision to modernize your UM operations…and beyond!
A fully-delegated MSK program means Cohere assumes complete responsibility for the utilization management of musculoskeletal services on behalf of your health plan. We handle everything from medical policy development, coding, provider intake across multiple channels (phone, fax, call, provider application), provider engagement, clinical reviews, and reporting—all while adhering to your specific requirements and regulatory standards.
Legacy UM focuses primarily on denying individual services through rigid guidelines to save on expenses. Cohere's approach looks at the entire episode of care, using real-time clinical decision support to guide providers toward optimal treatment paths before services are even requested. Rather than focusing on denials, we influence care decisions upstream by providing evidence-based guidance that shifts utilization toward more appropriate treatments, settings, and providers. This approach reduces unnecessary procedures and transitions care to more cost-effective settings while maintaining or improving clinical outcomes.
Cohere's platform integrates responsible AI with clinical expertise to eliminate the traditional "black box" approach to utilization management. Precision AI can swiftly extract and surface unstructured indication data from extensive clinical documentation, automate approvals for appropriate care, all while providing clear reasoning behind decisions, explicit guidance on clinical criteria, and transparent processes for health plans and providers, addressing a fundamental flaw in conventional authorization systems. Additionally, we meet providers where they are with multichannel intake options and can engage providers in tailored performance programs to ensure ongoing engagement.
While Cohere manages day-to-day operations, your plan maintains appropriate oversight through regular reporting, joint operating committee meetings, and access to our analytics dashboard. You can monitor performance metrics, track savings, and ensure compliance with guidelines, your custom business rules, and regulatory requirements while delegating the operational burden.