Geisinger Health Plan (GHP) announced it’s joining forces with Cohere Health 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 GHP lines of business, including Commercial, Exchange, Medicare Advantage and the newly expanded Medicaid.
“Working with Cohere Health is transformational 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 to work with Cohere not only to significantly improve the prior authorization process, but also to drive better care experiences and outcomes for our providers and members. The collaborative platform enables us to further differentiate our value-based care offerings, as our network providers can take advantage of the platform’s evidence-based, proactive care suggestions to make better health easier for our patients to ensure they 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 highest Member Satisfaction among Commercial Health Plans 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. When patients receive care that aligns with clinically accepted best practices, peer-to-peer reviews and denials are reduced. 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%. Real-time determinations return immediate approvals that enable patients’ faster access to care by 70%, and in areas of complex surgery, Cohere has seen surgical complication rates decrease by 18%. The transparent way that Cohere supports ordering providers with data, as well as clinically driven and technology-delivered “nudges,” builds trust with network providers and will allow GHP to reduce care variation and incentivize high-value care.