Humana Taps Cohere Health to Modernize Prior Authorizations for Musculoskeletal Treatment

Cohere Health Launches with $10M to Increase Transparency Across Care Journey
Cohere Health Launches with $10M to Increase Transparency Across Care Journey

What You Should Know:

– Cohere Health partners with health insurer Humana to modernize
the prior authorization process for musculoskeletal treatment across 12 states.

– In addition, the company has closed an additional $10M
in funding led by Flare Capital Partners and Define Venture, bringing the
company’s total funding to $20M.


Health insurer Humana has signed an agreement with healthcare collaboration company Cohere Health 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 the 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 to Leverage CohereNext Platform to Streamline
Prior Authorizations

As part of the partnership, 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.

This partnership supports Humana’s vision to reimagine and modernize processes for prior authorization by reducing approval times and improving the 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.

“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.”


Cohere Health Closes Additional $10 Million in Funding to
Accelerate Delivery of Patient Journey Platform

In addition, the company announced it closed an additional
$10 million in funding led by Flare
Capital Partners
and Define Ventures,
bringing the company’s total funding to $20 million. The funding will be used
to enhance the company’s scalable CohereNext® platform that is built on
next-generation cloud and data technologies and provides interoperability to
existing healthcare infrastructure as well as the emerging digital health
economy.

This
Series A extension comes just two months after Cohere Health’s initial $10 million Series
A funding, which was also led by Flare
Capital Partners with Define Ventures contributing as an investor and partner,
as well as participation from a leading national strategic partner.

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

“The tragedy of COVID-19 has reinforced that the basic infrastructure supporting healthcare innovation is fundamentally broken. The shift from fee-for-service to value-based-care requires enabling interoperable capabilities to facilitate care around the interests of patients, and as a result, Cohere Health continues to rapidly grow and attract additional investments,” said Siva Namasivayam, CEO and founder of Cohere Health. “The additional funding will enable us to expand the CohereNext platform to impact more failure points across patient journeys so that physicians can deliver better outcomes and we can continue building our team, which has grown by more than 95 people this year.”

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