Cohere Health: Everything You Need To Know

Cohere Health: Everything You Need To Know

You’ve probably heard about Cohere Health, the Boston-based clinical intelligence company making waves in the healthcare industry. They’re changing the game with their smart take on prior authorization processes, using AI and automation to optimize clinical reviews and improve healthcare delivery. But what sets them apart from other health tech companies? With their commitment to innovation and patient-centered care, there’s a lot more to uncover about Cohere Health’s approach to transforming the healthcare landscape. Curious to learn more? Let’s begin our exploration.

Understanding Cohere Health

Cohere Health is a Boston-based clinical intelligence company that was established in 2019. The company has been recognized for its focus on intelligent prior authorization, a process aimed at enhancing the quality of care.

Cohere Health employs approximately 700 professionals and has been listed among the Top 5 LinkedIn Startups. It also received the TripleTree iAward.

The company’s approach to prior authorization has attracted attention, but so has its commitment to fostering an inclusive and diverse workplace. Cohere Health allows employees to work remotely from 48 U.S. states and values open communication and teamwork.

The company applies innovative solutions to address healthcare challenges, positioning itself as a leader in its field.

The Prior Authorization Challenge

Cohere Health offers a solution to the complex issue of prior authorizations in healthcare. Their method involves the use of health plan-preferred policies and artificial intelligence to automate the process. This approach prioritizes relevant cases and allows for automated decisions and provider green lighting.

Efficiency is a key aspect of their strategy as all cases are managed in a timely manner and early trend signals are reported for immediate action. Their turnaround times for pended authorizations meet government standards. For cases that can’t be automatically approved, a clinical review is conducted.

Cohere Health’s system provides features to check the status of authorization, submit requests for approval, and receive personalized care path authorizations. This approach to the prior authorization challenge can potentially simplify the process.

The Decisioning Process

Cohere Health has developed a decisioning process that’s designed to be efficient and focused. This process uses automated queue management to prioritize all cases, allowing the clinical team to concentrate on the cases that need their intervention. This approach is designed to ensure timely and accurate responses.

The decisioning process at Cohere Health combines several key components to improve efficiency and effectiveness:

  • The process involves automatic prior authorization decisions, based on health plan-preferred policies.
  • It also includes a mechanism for provider approval, aimed at speeding up the approval process and enhancing satisfaction.
  • Additionally, the process includes the reporting of early trend indicators to help monitor and fine-tune the decisioning process.

The aim of these combined strategies is to ensure that the decisioning process meets the needs of both the providers and the patients. This could potentially lead to improved health outcomes and increased satisfaction.

Clinical Review Assistance

When an authorization request isn’t automatically approved, it’s then forwarded to Cohere Health’s clinical team for review. This team examines the pended authorizations in accordance with both State and Federal government standards.

For transparency, the status of these authorizations can be viewed on the Cohere portal, including the reasons for their pendency. In case of any queries during the authorization review process, the clinical team will communicate with the relevant parties to ensure the accuracy and completeness of the information.

The clinical team isn’t solely focused on compliance checks. They utilize clinical intelligence in their operations, aiming to meet and, where possible, exceed the mandated determination timelines for different types of authorization requests.

The primary objective of this process is to ensure efficient and high-quality care.

Optimization Through Clinical Intelligence

Cohere Health employs clinical intelligence to enhance the process of prior authorization decisions, utilizing AI/ML and automation. By applying data science, the organization conducts automated clinical reviews and prepares necessary documentation for clinical review. This approach not only simplifies the process but also augments accuracy and efficiency.

Cohere Health’s method comprises:

  • AI-supported manual reviews which decrease human error and maintain process efficiency.
  • The development of individualized care path authorizations, forming treatment plans specific to each patient.
  • The recognition of clinical policy optimization, which improves healthcare delivery.

These advanced features allow Cohere Health to offer robust network intelligence and support provider enhancement. The end goal is to refine healthcare efficiency and accessibility utilizing clinical intelligence.

Transformation of Patient Outcomes

Cohere Health’s primary mission is the transformation of patient outcomes through the use of advanced technologies such as artificial intelligence and machine learning. These technologies are used to monitor and guide the progress of patients. This objective influences every part of their operations, from producing outcomes measurement reports to including intake and clinical staff in the process.

It forms part of a detailed strategy aimed at enhancing patient outcomes. Cohere’s technology and design, coupled with AI/ML capabilities, aim not only to monitor progress, but also to facilitate it. They offer network intelligence and provider improvement strategies, with the goal of improving care and patient outcomes. These strategic initiatives underpin Cohere’s dedication to healthcare transformation and their commitment to providing optimal care.

Overview of Cohere Unify Platform

The Cohere Unify platform is a clinical intelligence tool developed to enhance the prior authorization processes, aiming to improve the quality of care. It accomplishes this through its integration with electronic medical records, digitization of fax submissions, and conducting completeness scans to ensure the inclusion of all necessary information.

The Unify platform presents the following three main features:

  • It facilitates automated clinical reviews, contributing to prior authorization decisions with the aid of AI/ML technology.
  • It creates individualized care path authorizations, which are designed to cater to each patient’s unique requirements.
  • It offers useful tools such as trend monitoring, prior authorization list suggestions, care choice guidance, and abuse detection alerts for efficient management.

Leveraging advanced technologies, Cohere Unify is working to bring about changes in healthcare, with a focus on increased efficiency and personalization.

Delivery Options: Cohere PaaS and Cohere Complete

Transitioning from the Unify platform, Cohere Health presents two delivery options: Cohere PaaS and Cohere Complete. Cohere PaaS is a Platform as a Service that offers a wide range of solutions for prior authorization and care journey management. It utilizes technology such as artificial intelligence, machine learning, rules, and analytics engines to efficiently manage medical records and improve their accuracy.

In contrast, Cohere Complete includes all the solutions provided by Cohere PaaS and further extends its services by offering intake and clinical staff support, network intelligence, and provider improvement. As a result, it enhances Cohere’s capabilities, integrating emerging technology and design to provide a comprehensive healthcare delivery solution.

Career Opportunities at Cohere Health

Cohere Health offers career opportunities in a remote work setting, with positions available across 48 U.S. states. The company comprises a diverse and inclusive team with a focus on innovation, tackling significant healthcare challenges such as enhancing health plans.

Cohere Health’s core values include:

  • Open communication and teamwork: The company fosters a culture that supports clear, constructive dialogue.
  • Continuous learning: Professional growth and ongoing learning are encouraged at Cohere Health.
  • Acknowledging employee contributions: Cohere Health values both cross-functional collaboration and individual achievement.


You now know how Cohere Health is transforming healthcare with smart prior authorization processes. Their use of AI and automation streamlines decision-making, improves clinical reviews, and optimizes patient outcomes.

Whether it’s through their Cohere Unify platform or their comprehensive delivery options, they’re committed to making healthcare accessible.

So, if you’re seeking a career in a company that’s driving positive change, Cohere Health could be your ideal choice.