Cohere Health partners with Humana to modernize prior authorization process
October 23, 2020
BOSTON, Oct. 22, 2020 /PRNewswire/ -- Cohere Health, a healthcare collaboration technology company, announced today an agreement with Humana Inc. (NYSE: HUM) to improve the prior authorization process for musculoskeletal treatment across 12 states, starting Jan. 1, 2021. Cohere aligns physicians, patients and health plans on a patient's optimal healthcare experience—enabling access to higher quality care while at the same time minimizing administrative burden and siloed decision-making.
The partnership leverages CohereNext Platform's prior authorization capability which grants authorizations across an entire episode of care, in effect pre-authorizing a complete treatment regimen from initial diagnosis to treatment plan selection, and, ultimately, to the patient's return to good health. Cohere's approach aims to expedite evidence-based treatment plans to improve the healthcare experience for doctors and patients alike.
Humana will employ the CohereNext Platform to streamline prior authorizations in musculoskeletal treatment in Alabama, Georgia, Indiana, Kentucky, Michigan, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and West Virginia. The platform will initially serve approximately 2 million members and more than 3,500 physician practices.
"Through this strategic initiative and collaboration with Cohere Health, Humana is building on its commitment to reduce the complexity and friction of prior authorization for our physicians and members," said William Shrank, MD, MSHS, Chief Medical Officer, Humana and Board Member, Cohere Health. "Cohere's solution was co-designed with physicians and represents a major leap forward in improved physician experience and the adoption of evidence-based medicine."
This partnership supports Humana's vision to reimagine and modernize processes for prior authorization by reducing approval times and improving delivery of care, all while preserving important benefits such as safety, predictability and cost containment.
Cohere's solution will initially focus on prior authorization; the company is developing additional use cases such as value-based contract performance, improving physician and patient engagement, and optimizing health plan clinical programs. By facilitating physician and health plan collaboration, Cohere's technology will help accelerate the evolution to value-based care models.
"We are pleased to partner with an industry leader and innovator like Humana to reduce the administrative burden on physicians and improve clinical outcomes for its members. Physician and patient transparency is the cornerstone of our approach," said Siva Namasivayam, CEO, Cohere Health. "Cohere Health is focused on simplifying healthcare's status quo by addressing barriers to experience, quality and cost. Our platform and solutions are developed with the latest design thinking and technologies with physician and patient-centric perspectives that acknowledges the realities of the variations in individualized care journeys."
The CohereNext Platform improves the physician experience and quality by:
Authorizations that begin with diagnoses and not billing codes
Facilitating and auto-approving evidence-based treatment plans
Delivering a peer review process with a true peer specialist or sub-specialist
Sharing quality performance relative to peers for specific care paths and patient cohorts
Providing tools, data and technology that optimizes value-based payment
About Cohere Health
Cohere Health moves quality care forward. Cohere's digital healthcare collaboration platform and supporting services align patients, physicians and health plans at the point of diagnosis to expedite physician-approved, evidence-based treatment plans. With the goal of creating optimal care journeys for every patient, Cohere is transforming legacy processes to more quickly achieve the goal of higher quality care and lower cost for all. Cohere works with physicians and health plans committed to the transparent delivery of quality patient care. Cohere's investors include Flare Capital Partners and Define Ventures. For more information, visit https://coherehealth.com.
Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.