Cohere Health empowers health plans to contain costs, reduce operational expenses, and improve medical expense management. Our AI-powered clinical intelligence and operations platform offers a composable and modular solution set across utilization management, appeals, claims, payment integrity, care management, quality, and risk adjustment, so health plans can control costs, achieve financial sustainability, and invest in what matters.
Enable health plans to drive cost savings across medical and administrative expenses. Our solutions reduce inefficiencies, automate complex workflows, and validate ROI with full transparency.
Automate time-consuming tasks like clinical validation and claims reviews, freeing teams to focus on high-value activities. With Cohere, health plans can scale operations efficiently without adding headcount.
Gain actionable insights by connecting data from historically siloed functions. This ensures accuracy, reduces overpayments, and strengthens financial planning.
Whether insourcing, augmenting in-house teams, or delegating operations, our configurable platform adapts to your unique goals.
Featured Guide
This guide provides a practical framework for evaluating, sequencing, and scaling enterprise AI, so your organization can stop retrofitting around legacy systems and start redesigning from within.
Guide
Every new point solution adds another data model, governance process, and integration point. This guide gives health plan executives a framework to evaluate, sequence, and scale enterprise AI so ROI compounds instead of resetting.
Case study
Humana partnered with Cohere Health® to transform prior authorization and improve patient care.
Every standalone function duplicates effort, misses adjacent signals, and measures ROI in isolation. Cohere connects functions into a shared intelligence layer, so each deployment builds on the last, expansion cost decreases, and savings compound over time.
Health plans often struggle to scale operations without costly investments in headcount or vendor contracts. Cohere’s AI-powered platform automates manual processes, helping teams focus on high-value tasks while improving efficiency.
Cohere provides complete visibility into decisioning logic, savings methodologies, and outcomes—no black boxes, no contingency-fee opacity. Finance teams can independently verify performance, trace savings to specific workflow improvements, and strategically allocate budgets based on validated results rather than vendor projections.
Answers to common questions from leaders evaluating Cohere Health’s platform and capabilities.
Yes. Cohere provides detailed analytical dashboards and transparent workflows. Medical leaders gain clear visibility into workflow performance, review activity, and the evidence-based criteria applied to each decision, ensuring a high degree of operational control.
Cohere uses AI to support clinical and operational workflows by surfacing relevant information, applying policy-specific logic, and supporting reviewer efficiency. AI is never used to deny care or replace clinical judgment; medical professionals remain responsible for reviews where clinical judgment is required.
Cohere helps health plans balance real-time approvals with patient safety and medical expense discipline. High-risk, low-evidence, and outlier cases are intentionally pended for clinician review, supporting a workflow where administrative speed is paired with clinical rigor.
Cohere supports provider-aware workflows designed to reduce unnecessary administrative friction. By integrating seamlessly with existing EHR systems, we enable smooth data flows, transparent decision support, and faster responses where appropriate.
