What You Should Know:
– Cohere Health announced that Humana Inc. is embarking on a nationwide expansion of Cohere’s digital prior authorization platform for musculoskeletal (MSK) services, based on the success of its initial implementation.
– After rolling out the platform across 12 states in January 2021, Humana has made significant progress toward achieving its vision to reimagine and modernize processes for prior authorization by reducing approval times, increasing provider satisfaction, and improving the delivery of care, all while preserving important benefits such as safety, predictability, and reducing waste.
Digital Prior Authorization Results
In the currently implemented 12 states, 95% of authorization requests for MSK services now flow through Cohere’s digital platform. By greatly reducing the need for manual clinical review, Cohere’s digital authorization platform drives a median approval time of 0 minutes, enabling Humana providers to schedule patients for the requested service immediately in 89% of cases. The upcoming expansion will extend the platform’s value to all Humana Medicare Advantage and Commercial members nationally and to more than 65,000 individual practitioners representing more than 10,000 physician practices.
Providers have reported high satisfaction with Cohere’s platform, with 72% indicating they are “very satisfied” and 68% indicating that the Cohere platform is “much easier” to use than alternative solutions. Overall provider net promoter scores (NPS) have increased more than 100% since the platform was implemented in January
“In just nine months, the results of Cohere’s digital authorization platform have exceeded our expectations,” said William Shrank, MD, MSHS, Chief Medical Officer at Humana. “When we got started we were looking for industry-leading electronic adoption, best-in-class physician experience, demonstrably better patient experiences, compelling medical and administrative return on investment, and rapid innovation. What is exciting is that these results reflect just the beginning. We look forward to reaching even farther and offering these results to more of our members and network partners.”
How It Works
Cohere’s digital health plan solutions transform prior authorization processes to drive collaborative care journeys, thereby enabling truly touchless authorization. The Cohere platform automates both provider and payer steps in the process, while also coupling AI and machine learning with evidence-based clinical policy to support better care decisions. For MSK care delivery, Cohere’s clinical criteria are informed by policies established by the American Academy of Orthopedic Surgeons (AAOS). Cohere uses the point of authorization approval as a trigger to engage plans, providers, and patients in transparent, episode-based care paths more than 65% of the time. These care paths merge traditional utilization management, care management, and patient engagement functions, and make evidence-based policy and recommendations completely transparent to the requesting provider.