A&M Inside the Plan Podcast: Episode 3: Kaleb Guion and Gigi Yuen-Reed, Cohere Health

In this podcast episode, Kaleb Guion and Gigi Yuen-Reed discuss how health plans can manage rising costs by modernizing utilization management. The conversation explores how connected clinical intelligence helps health plans move beyond fragmented point solutions to create a shared intelligence layer. They emphasize that successful modernization requires workflow transformation, human oversight, and clinically trained AI to improve payer-provider collaboration and support more informed clinical and operational workflows.In this episode of the Alvarez & Marsal Healthcare Industry Group’s Inside the Plan podcast, Cohere Health’s Gigi Yuen-Reed and Kaleb Guion explore why legacy infrastructure and isolated AI point solutions can’t keep pace with the growing complexity of health plan operations. The solution: a connected operating model that unifies workflows such as prior authorization, payment integrity, care management, and quality through shared clinical intelligence. When done well, connected intelligence can improve care quality and member experience, reduce provider friction, and lower medical and administrative expenses. Gigi and Kaleb discuss the other key considerations for scalable transformation, like intentional change management, strong AI governance, clinician oversight, trustworthy data, and more.

Key points discussed:

• Clinical and industry pressures: Health plans today must contend with increasingly complex decision-making and greater regulatory scrutiny
• Connected intelligence: Connected siloed operations into a shared clinical intelligence layer can eliminate friction, delays, gaps in clinical context, and costs
• AI as workflow redesign: The true value of clinical AI isn’t speed alone, but rather its ability to transform operations with greater precision, accuracy, efficiency, and trust
• Path to transformation: Sustainable change depends on quality data, human-in-the-loop design, risk-adjusted governance models, and AI that aligns with business goals and strengthens teams’ existing workflows

Watch here