Geisinger and Cohere Health Join in Driving High-Value Care and Reducing Provider Burden


Technology platform will support GHP’s value-based care delivery

Geisinger Health Plan (GHP) and Cohere Health, a leader in utilization management (UM) technology, are joining forces to drive high-value care and reduce provider burden. Cohere’s collaborative UM platform will help GHP support value-based care delivery, reduce administrative costs, and lead the nation in aligning quality improvement initiatives across all its lines of business, including Commercial, Exchange, Medicare Advantage, and the newly expanded Medicaid.

“Working with Cohere Health is a transformational step in Geisinger’s long history of clinical innovation, both in Pennsylvania and nationwide,” said John Bulger, MD, chief medical officer for Geisinger Health Plan. “We’re excited not only to significantly improve the prior authorization process, but also to drive better care experiences and outcomes for our providers and members. Cohere’s collaborative platform enables us to further differentiate our value-based care offerings, as our network providers can use the platform’s evidence-based, proactive care suggestions to make better health easier and ensure our patients receive optimal care specific to their medical history and condition.”

GHP provides coverage to more than half a million members throughout Pennsylvania, and boasts a network of more than 30,000 primary and specialty care physicians. GHP was recently named the commercial health plan with highest member satisfaction in Pennsylvania for the third consecutive year by J.D. Power.

GHP will utilize Cohere’s AI-driven and machine learning technology to accelerate patient access to high-quality care while streamlining prior authorization. Cohere’s digital platform creates episode-specific care paths based on the member’s utilization history and individual care needs, in addition to historic results for a specific patient population. Fully transparent, evidence-based suggestions prompt providers to select high-value care options before requests are submitted, reducing peer-to-peer clinical reviews and denials. Initial clinical improvement programs will focus on increasing patient access to conservative and home-based treatments.

“We’re thrilled to work with Geisinger Health Plan on a digital-first approach to transforming utilization management that furthers their mission: providing members with high-quality, affordable care,” said Siva Namasivayam, CEO of Cohere Health. “The industry is long overdue for a collaborative approach that puts the patient journey at the center of care decisions, and leverages technology and clinical intelligence in a way that supports providers.”

The Cohere platform increases health plan savings beyond traditional UM, as it ensures that prior authorization requests are evidence-based before submission. By offering clinical guidance at the point of authorization, the platform drives 15% incremental medical savings, on average, while simultaneously reducing denial rates by 63%. The platform is designed to reduce provider friction throughout the prior authorization process, an imperative for GHP.

Cohere’s platform delivers digital submission rates of up to 95%. The majority of cases are determined in real time, returning immediate approvals that expedite patients’ access to care by 70%. Cohere has also seen surgical complication rates decrease by 18%. By supporting ordering providers with data, as well as transparent, clinically driven “nudges,” the Cohere platform will build trust with network providers and enable GHP to reduce care variation and incentivize high-value care.