July 12, 2022 – Geisinger Health Plan (GHP) and Cohere Health, a recognized leader in utilization management (UM) technology, announced they 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.
Geisinger is committed to making better health easier for the more than 1 million people it serves. Founded more than 100 years ago by Abigail Geisinger, the system now includes 10 hospital campuses, a health plan with more than half a million members, a research institute, and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually.
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.
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.