It starts with a prescription. First, the patient consults their health plan’s complex and sometimes confusing policy. They then search for their doctor’s phone number, call the office to request a prior authorization, wait on hold for 20 minutes, get transferred to another doctor’s office and are put on hold for 11 more minutes — only to be told the form is available as a PDF online on their health plan’s website.
Next, the patient works with a physician assistant to submit the request according to their health plan’s specific guidelines. Days or even weeks later, the patient receives a letter approving or denying the authorization request. An approval letter may include terms and restrictions about how their care must be provided.
Patients, who are often under high levels of stress and pain, must interpret these rules correctly. If they misstep, they risk incurring higher out-of-pocket costs or even having their coverage for necessary medical procedures denied. It’s a frustrating, flawed, and fragmented process.
Enter Cohere Health, a Boston-based company built to streamline the cumbersome prior authorization process for patients, physicians, and health insurance plans alike. Cohere, afterall, means “to hold together firmly.” The company’s intelligent prior authorization platform uses responsible AI and machine learning, deep, evidence-based clinical expertise, and real-time analytics to guide the best and fastest care for patients.
WHAT COHERE DOES
Cohere’s prior authorization solutions drive better healthcare outcomes.
These solutions cater to each plan’s needs and leverage AI, machine learning, clinical expertise and real-time analytics. The platform enables end-to-end prior authorization automation and not only digitizes the process but guides holistic quality care across the patient journey.
The digital health disrupter started with 10 employees in 2019 now has a staff of morethan 500 people and closed a $36 million series B raise in 2021. Its total funding now stands around $55 million.
As the company grows, Cohere plans to bring employer benefits data to the point of care so that doctors can suggest services—like physical therapy, or weight loss and smoking cessation programs—that can further benefit a specific patient.
VP of Clinical Programs Brianna Demaray and VP of Clinical Programs and Quality Analytics Tracy Zheng are two Cohere team members who design and implement innovative programs that uplift patients. Read on to learn more about Cohere’s impressive growth and how its leaders are tracking trends and expanding teams to prepare for what lies ahead.
Brianna Demaray had a strong foundation in program management and process improvement when she came to Cohere in 2021. While she had seen organizational change, her previous understanding of company growth centered around bottom-line profitability and market share presence.
However, one reason she joined Cohere was for their unique approach to growth.
“Cohere has and is aligned with current industry trends around business development and company growth,” she said.
Demaray and her colleagues are passionate about making prior authorization less burdensome on providers and patients — they know their work will remove delays in care and optimize patient outcomes. To find success, they have to watch industry trends and build effective teams.
Here’s what Demaray had to say about…
Meeting increased demand: “There are several factors that make this the right time for growth, and Cohere is well positioned to answer this demand since our solutions largely address emerging concerns in very real and actual ways.”
Hiring goals: “I want to build a team that compliments one another and builds on the fabric of experiences each person brings to the table. There are several teams at Cohere expanding quickly, and each person is integral in continuing to scale the company and grow our business.”
Tracy Zheng is a health policy expert and analytics leader who remains passionate about improving both collaboration and outcomes. She’s been with Cohere since 2020, and although the company’s mission hasn’t changed, the steps its employees take to execute it have evolved.
“We offer solutions to meet our clients where they are,” Zheng said.
Zheng is doing just that by helping expand their analytic capabilities and extending their productized analytical and technical ability to automate more customer trend reports, savings reports, quality reports and provider intelligence reports. The company plans to bring on senior clinical analytics and provider analytics leaders to further enhance Cohere’s client-facing analytics strategy.
Cohere is moving past the transformation of utilization management, quality improvement and care management. The company has evolved solutions with modules focused on prior authorization process and intake automation. As changes to legislation and increased requirements hit the industry, Cohere’s powerful analytics and intelligence engine can help clients manage their utilization and quality trends.
Here’s what Zheng had to say about…
Building a culture of collaboration: “Cohere has multiple functional analytics teams sitting within each department. Our analysts across departments share overlapping and complementary skills, which means across the company we have actuarial and underwriting skills, data management skills, AI/ML, predictive modeling, health economics and provider analytics. We encourage cross-functional collaboration and love to see people across all teams share knowledge.”
Aligning with company needs: “We have to align our strategy with our company’s fast growth in our customer base as we strengthen our market fit.”