STARS (Medicare Star Ratings)
CMS’s performance rating system for Medicare Advantage plans based on quality, access, and patient experience. Cohere supports STARS improvement by optimizing care quality and reducing delays.
Service Level Agreement (SLA)
A formal commitment between a service provider and client outlining expected performance metrics. SLAs often include PA turnaround times and approval rates.
Site-of-service nudge
A real-time suggestion that encourages use of a more appropriate or cost-effective care setting (e.g., ambulatory surgery center instead of hospital).
Software as a Service (SaaS)
A cloud model delivering ready-to-use software applications over the internet, accessible by users without installation. Unlike PaaS, SaaS provides complete applications, such as provider portals or dashboards.
Turnaround time (TAT)
The time from when a PA request is submitted to when a decision is returned.
Utilization Per 1,000 (UPK)
A utilization metric indicating how often a service is used per 1,000 members. Useful for tracking trends and outliers.
Utilization management (UM)
A process used by health plans to ensure appropriate and cost-effective care.
Value-based care (VBC)
A reimbursement model that rewards quality outcomes instead of volume.