Have a look at some of our results so far:
Is your current delegated MSK management program saving Healthfirst as much as possible, while limiting provider abrasion? Is that program helping your members receive the best care, with minimal delays? Cohere has been able to surpass the medical cost savings of similar programs by 15-20% – while actually reducing denials, and accelerating access to the most appropriate, evidence-based care.
Most UM programs take a transactional approach to prior authorization. Requests receive a “yes” or “no” response, without presenting alternatives that consider the whole individual patient care episode or journey. So opportunities to guide providers and their patients – your members – to higher-value medical services are lost. To make matters worse, requests that require clinical review often undergo a lengthy manual review process, which can delay needed care by days or weeks.
Cohere Health’s delegated UM solution for musculoskeletal management has been proven to drive better outcomes, with both lower costs and fewer denials, than other delegated programs. How do we do it?
- Immediate determination. Our solution’s advanced AI-driven technology, combined with nationally respected, evidence-based clinical expertise, enables an industry-best 94% instant determination of MSK authorization requests. We’re able to automate more clinical reviews than alternative solutions, without losing clinical rigor or nuances associated with individual patient scenarios.
- Real-time care alternatives. Cohere’s unique in-workflow clinical suggestions, or “nudges,” offer real-time guidance to patient-specific, clinically optimal care choices at the point of diagnosis. As a result, patients benefit from faster recoveries, fewer complications and other results associated with better overall outcomes – while the health plan benefits from less unnecessary medical expense.
- Long-term view. Cohere’s solutions are built to support the entire patient journey, not just a single point along the way. Our prior authorization process considers the entire episode of care, so that downstream services are anticipated and pre-approved all at once, instead of piecemeal. This drives faster access to the most appropriate care for each specific patient scenario, and additional avoidance of unnecessary and potentially harmful medical services.
