Technology will bundle and accelerate prior
authorization for cardiovascular and surgical services
BOSTON, Oct. 24,
2022 /PRNewswire/ -- Today Cohere Health, a leader in
intelligent utilization management (UM) technology, announced that
Humana Inc. (NYSE: HUM) will expand its use of Cohere's
digital UM collaboration platform to enable seamless prior
authorization for cardiovascular and surgical services.
In addition to digitizing prior authorization requests for these
services, the technology automates clinical intelligence into the
provider's workflow, enabling episode-based, longitudinal
management of the patient's care journey to reduce care variation,
drive higher quality care, and minimize administrative burden.
Both solutions will be deployed nationwide on January 1, 2023 for Humana Medicare Advantage
members and Humana employees with the company's health plan.
Cardiovascular care is clinically complex, with multiple
exchanges between primary care physicians, cardiologists, and
subspecialty clinicians that can contribute to costly and
unnecessary variations in care. Cohere's solution for
cardiovascular services improves care quality by promoting
consistent adherence to clinical guidelines, and by generating
patient-specific care paths that optimize outcomes for everyone.
The solution incorporates patient-specific, evidence-based guidance
from the American College of Cardiology within the automated
authorization workflow, helping guide physicians to the
highest-value care choices for patients.
For surgical services, Humana staff will use the Cohere Unify™
platform to accelerate patient access to care by facilitating the
review and approval of surgical procedure prior authorization
requests. By ensuring requests are reviewed expeditiously, the
platform helps providers and patients avoid the complications that
can arise from delayed care.
"By deploying a digital approach across multiple specialties, we
can ease the burden of prior authorization for providers," said
Lisa Stephens, Senior Vice President
of Operations at Humana. "In addition, we better support our
members along their clinical care journeys for cardiovascular and
surgical services with the deep clinical intelligence of this
partnership."
Last December, Humana launched a focused pilot program to test
Cohere's new cardiovascular services platform, inviting nearly 200
provider groups across the nation to complete cardiovascular prior
authorizations. Participating providers were able to submit
authorization requests 34% faster compared to other portal
solutions, and after eight months, portal adoption among
participating providers had risen to nearly 99%, with 83% of
providers reporting they were satisfied or highly satisfied
with their experience.
"We're pleased to launch the next phase of our partnership with
Humana. Expanded use of our UM platform will further help Humana
fulfill its mission of improving health outcomes for every member,
as it enables optimal care paths for patients whose cardiovascular
disease will likely require long-term care management," said Siva
Namasivayam, CEO of Cohere Health. "We're also excited to leverage
our digital prior authorization solution to help Humana unify the
provider experience and automate the bulk of surgical services
requests. Humana will be able to use real-time, in-workflow
analytics to drive collaboration between the patient and their
providers during the care journey."
About Humana
Humana Inc. (NYSE: HUM) 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.
To accomplish that, we support physicians and other health care
professionals as they work to deliver the right care in the right
place for their patients, our members. Our range of clinical
capabilities, resources, and tools – such as in-home care,
behavioral health, pharmacy services, data analytics and wellness
solutions – combine to produce a simplified experience that makes
health care easier to navigate and more effective. Learn more:
www.humana.com.
About Cohere Health
Cohere Health is a digital
intelligence company that's transforming utilization management
(UM) by aligning physicians and health plans on evidence-based care
paths for the patient's entire care journey. By integrating these
care paths into the prior authorization submission process,
Cohere's digital UM collaboration platform reduces denial rates and
medical expenses while improving patient outcomes. The company is a
winner of the TripleTree iAward and has been named to both Fierce
Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.
Cohere's investors include Flare Capital Partners, Define Ventures,
Deerfield, Polaris Partners, and
Longitude Capital.
CONTACT:
Yancey Casey
Amendola Communications for Cohere Health
ycasey@acmarketingpr.com
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SOURCE Cohere Health