New Cohere Health Solutions aim to simplify payers’ clinical reviews
The company announced Monday that clinical intelligence company Cohere Health has launched a new solution called Review Assist, which accelerates health plans for medical necessity reviews.
Boston-based Cohere Health offers AI-powered previous authorization solutions to help improve the relationship between payers and providers. The company said the new tool is designed to help health program clinicians undergo prior authorization reviews, which is often very cumbersome. A typical process requires the reviewer to analyze hundreds of pages of clinical records to determine whether a medical procedure is required for a patient's surgery.
Review assistive tools run in existing utilization management workflows. It uses Cohere's AI and large language models to analyze unstructured and structured clinical data and provides reviewers with actionable insights and links to their source information. Additionally, it has an AI chatbot that can answer questions and find other insights for reviewers.
In addition to prior authorization requests, the product can also be used for appeals, HEDIS measures and other use cases.
“We have built essentially a co-pilot. … It’s on your existing apps and beyond, and it really helps and supports users of these apps, who are real clinical users – nurses, MDS, who are evaluating complex clinical issues.
He added that audit aids can help payers ensure patients get the right care at the right time.
“You don’t want to delay care,” Parker said. “You want to make sure you take care of it properly [and that] It completes on time and does the correct operation. Therefore, it provides an opportunity to improve the speed and accuracy of this information, which we believe is indeed important. ”
Review assist has shown some positive results. According to Cohere Health, it can improve medical necessity review efficiency by up to 50% and accuracy by more than 99%. To further measure the effectiveness of the product, Cohere Health will track accuracy, efficiency and compliance, Parker said.
The launch of the review aid was shortly after Cohere Health announced it raised $90 million in C funding in May. The funding is led by Temasek, including participation from Flare Capital Partners, Deerfield Management, Define Ventures, Longitude Capital and Polaris Partners. This round has brought its total funding to $200 million so far.
Other companies focusing on improving prior authorization include Arrival and Rhyme.
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