Partnering with providers to improve prior authorization and administrative burden

Earlier this month, Cohere Health 's Provider Success team spent two days in the Gulf South region of the United States speaking directly with hundreds of providers who utilize Cohere’s intelligent prior authorization platform in their practices.

For those who aren’t familiar with Cohere, our intelligent prior authorization platform uses a unique blend of AI and deep clinical intelligence to help providers and members get to an appropriate “yes” more quickly, which then drives faster access to care and better clinical outcomes.

As Senior Director of Customer Success at Cohere, I work in lockstep with our industry leading Provider & Client Success teams to support health plan partners and provider organizations across the country. A key differentiator we pride ourselves on is building and nurturing relationships with provider groups after the implementation of new health plan partners. Our team, in collaboration with the Training team, will continually offer all modes of comprehensive training (e.g., webinars, tip sheets) to ensure ongoing success and a superior provider experience.

The Cohere Provider Success team supports the providers who interact with and submit authorizations through our portal, helping to streamline their utilization management processes and provide education to quickly resolve any roadblocks. In turn, these efforts save practices time while allowing their patients to get faster access to care where clinically appropriate.

Throughout our two days of meetings with Gulf South regional providers, we focused on several key areas to ensure we’re providing top-notch support and resources. We also introduced our new programs for Facility-Based Sleep Study and Diagnostic Imaging prior authorizations. Our team led demos and trainings to ensure users understand and have confidence in navigating these new programs in the Cohere portal.

We also spent time with multiple partnering provider offices–in their element!–to learn more about their end-to-end prior authorization processes and how Cohere can work with them to improve user experience.

These insights are invaluable as we strive to refine our support, training, and educational processes to offer smoother, more efficient systems for our providers in the Gulf South region–and ultimately for providers across the country who use Cohere.

Between our meetings, providers pulled me aside to express their gratitude for Cohere Health and how it has positively impacted the day-to-day of their jobs. Below are just a few example of the feedback we heard:

• “I like that if you are ordering a CT and it should be an MRI, it tells you the better CPT code to use. It’ll ask you questions to see if the MRI is contraindicated–like if the patient has a pacemaker. We like when they take out the guesswork cause we don’t have time to figure it all out.” - Radiology Pre-Cert Specialist, Digestive Health Center of Southwestern LA

• “Having the option to print a PDF saying that authorization is not required will be a game-changer.” - Radiology Manager, Digestive Health Center of Southwestern LA

• "For an orthopedic center like ours that practices at and partners with hospitals, it would be nice to have an option to have the approval letter in both of our portals or at least an integration of some sort for both of us on the case. For pre-surgical radiology testing, it makes it so much easier to just pull it up instead of having to send it over or do the website search for status." - Office Manager, Cascio Sports and Orthopedics

• “I didn’t expect this at all; this data is very in depth and could be really beneficial to my team. We haven’t had any denials in the four or so years we’ve been using Cohere. It has been a very easy and simple portal to use. It's always been one of my favorites, and now it definitely is my favorite after meeting with the team!” - Practice Manager, Fyzical Therapy & Balance

Cohere’s intelligent prior authorization platform processes over 5.6 million requests annually, positively impacting more than 15 million health plan members and 457,000 healthcare providers nationwide. Currently, Cohere’s solutions are utilized by several major health plan clients nationwide, including Humana, Geisinger, and Medical Mutual. To date, Cohere’s intelligent prior authorization platform has:

• Enabled 70% faster access to appropriate care (roughly equivalent to five days) for patients
• Saved 32,400 clinical review hours annually for a single health plan client
• Automatically and instantly approved up to 80% of prior authorization requests
• Achieved an industry-leading 90% platform adoption by providers of our digital solution versus fax and other manual methods to submit a prior authorization, along with a 91% satisfaction rate among providers utilizing the platform

💡 Interested in learning more? If you’re a healthcare provider with questions about our intelligent prior authorization platform, please reach out to us here.