Cohere Health Earns NCQA Certification for Digital Prior Authorization Platform

Cohere’s solution is the first digital prior authorization platform to achieve NCQA Utilization Management accreditation

Cohere Health, an emerging high growth digital health company, today announced it has earned Utilization Management Accreditation from the National Committee for Quality Assurance (NCQA), validating that the company’s digital prior authorization platform conforms to the industry’s highest standards. It is the first such known digital prior authorization solution to receive NCQA accreditation.

Health plans have traditionally used utilization management to ensure that patients are receiving proper care, reduce unnecessary overuse of resources, and minimize variation from evidence-based care. However, as health plans look to meet interoperability, analytics and timeliness requirements legislated at the state and federal levels, electronic prior authorization vendors have not kept up with quality standards. The most prominent health plans in the country are NCQA certified, and an NCQA Utilization Management Accreditation helps guarantee that organizations making these decisions are doing so based on objective, evidence-based best practices.

“We are honored to have earned this NCQA accreditation,” said Siva Namasivayam, CEO of Cohere Health. “It is a testament to our deep understanding of the relationship between health plans and providers and the ability to drive quality care by reducing the burden and friction that prior authorizations have traditionally caused.”

Prior authorization continues to frustrate care providers, patients, and health plans. An AMA survey from December 2020 shows that 94% of physicians report having experienced care delays while waiting for health insurers to authorize necessary courses of treatment, with 90% of respondents saying prior authorization requirements have a negative effect on patient clinical outcomes. Health plans incur substantial administrative costs related to prior authorization and are equally frustrated with the current processes.

Cohere Health’s digital prior authorization platform, however, is delivering immediate time-to-value, as reported by health plan customers.

  • 92% of all authorization requests are initiated through the platform, significantly decreasing administrative burden and costs of manual functions and systems.
  • 90% of prior authorization requests made through the platform receive an immediate determination, improving patient access to care.
  • Return on investment is greater than 4:1 because the platform has the ability to guide providers, through nudges , to higher-quality treatment options.
  • Providers are giving Cohere’s digital prior authorization platform a net-promoter score as high as 59 in some markets.

“Unlike some electronic prior authorization vendors who are using artificial intelligence to automate some aspects of the provider process, we are using machine learning and deep analytics to influence and improve care decisions within the workflow at an individual patient level,” said Namasivayam. “While there are other ‘touchless’ prior authorization solutions being touted, payers, providers, professional medical associations and regulatory agencies can take confidence that we have a digital prior authorization solution that is accredited by NCQA and has been validated to drastically reduce the time and effort of prior authorizations while improving their effectiveness and patient outcomes for all stakeholders.”

For more information about Cohere’s digital prior authorization platform, click here.