Cohere Policy Studio™: The central hub for modern health plan medical policies

Health plan medical policies sit at the center of clinical operations—guiding prior authorization decisions, shaping payer-provider interactions, fulfilling transparency requirements, and powering automation. But for most plans, these policies still exist as static PDFs, scattered Word documents, SharePoint folders, and disconnected web pages, each requiring manual, one-off translation into operational workflows.

This fragmentation makes policy management slow, risky, and resource-intensive. Every downstream output must be recreated by different teams in different systems. Most health plans juggle several versions of each policy, shifting effective dates, and frequent updates throughout the year—NCDs and LCDs change even more often. As a result, even a minor policy update can trigger hours of rework across the organization and increase the risk of inconsistencies, misalignment, and compliance gaps.

Meanwhile, health plans are navigating an unprecedented wave of regulatory and industry change. CMS-0057-F requires patient-friendly, publicly accessible policies that match the rules used in decisioning. The 2025 AHIP Pledge calls for unprecedented transparency, faster decisions, and greater provider trust.

The challenge is no longer just about publishing policies or meeting deadlines. Health plans recognize that simply “checking the box” is not enough. This is an opportunity to modernize prior authorization and broader clinical operations, improving accuracy, provider satisfaction, and operational efficiency.

Why static policies create system-wide challenges

Today, even the strongest health plan teams struggle with policy workflows that are anything but modern. Applying rules from static documents into operational workflows is time-consuming, error-prone, and disconnected. Each policy update must be manually recreated across multiple downstream outputs, including:

• Prior authorization questionnaires
• Reviewer work instructions
• Denial letters
• Public transparency website content
• Automation rules and decision logic
• Extensions for appeals, payment integrity, and quality programs

The challenge isn’t the policy content itself—it’s the lack of structure, connectivity, and automation. Each output is typically managed in a different system by different teams, increasing the likelihood of duplicated work, inconsistent interpretations, and frequent errors. Even minor updates require cross-checking across internal systems, public postings, and automation engines, creating a resource-intensive and risky process.

Introducing Cohere Policy Studio: The operational backbone for clinical policies

Cohere Policy Studio is an end-to-end policy management platform that replaces disconnected documents and workflows with a unified system of record. It brings together policy creation, review, governance, deployment, versioning, and operational output generation all in one place.

With Policy Studio, health plans can:

• Automate policy ingestion and digitization with highly accurate ML tools 
• Organize and structure policies into clearly-defined sections, extensions, and operational outputs
• Maintain a single source of truth for all policy content and versions
• Maintain decision transparency and link downstream artifacts directly to the source policy
• Integrate policy updates across UM, PI, appeals, and transparency workflows
• Govern policy changes with full auditability and role-based permissions‍
• Power automation confidently, with human-readable, machine-executable decision logic directly tied to approved policy

The result is a connected ecosystem where updates propagate reliably, teams collaborate efficiently, and compliance risk drops dramatically.

How a central hub fixes static policies

Static, document-based policies create operational drag at every turn. Even a simple update triggers a chain reaction across questionnaires, reviewer instructions, denial letters, transparency content, automation logic, appeals, and payment integrity workflows. Each step requires manual interpretation, may be managed by different teams across different systems, and remains disconnected.

Over time, this manual translation introduces policy drift, with questionnaires, decision logic, denial letters, and public transparency content gradually diverging from the original policy intent. Even minor updates compound this drift, increasing both operational and compliance risk.

Policy Studio replaces this fragmented model with a structured, centralized hub:

• Author once, operationalize everywhere.
• Update once, deploy with confidence.
• Review once, govern across the lifecycle.

Instead of re-creating every downstream artifact manually, Policy Studio automatically generates or updates them based on the structured source policy, ensuring that every system and every stakeholder is aligned.

The advantage: Faster decisions, greater accuracy, stronger compliance

By unifying policy operations, Policy Studio provides health plans with a strong foundation for operational quality and performance. 

Key outcomes include:

• Higher decision accuracy, with key operational workflows tied to a structured source policy
• Reduced provider friction, thanks to consistent, transparent criteria and outputs
• Lower compliance risk, supported by version control, auditability, and traceability
• Faster updates, allowing teams to respond quickly to regulatory changes‍
• Greater automation potential, because all policy content is digitized and structured at the source

Most importantly, Policy Studio equips health plans with the infrastructure to transition from manual operations to next-generation clinical intelligence.

From static documents to connected intelligence

Static policy documents are no longer sufficient for clinical operations. Health plans need structured, traceable, and connected policy workflows to meet regulatory requirements, AHIP commitments, and provider expectations while laying the groundwork for next-generation automation and clinical intelligence.

Cohere Policy Studio provides the central hub to make it happen, helping health plans digitize policies, operationalize outputs, automate updates, and govern workflows with full traceability and compliance.

Learn more and see how Cohere Policy Studio can transform your policy operations here