Drive **operational coherence** across your health plan with precision AI
Experience unparalleled operational efficiency, strengthen provider relationships, and optimize care journeys with our enterprise platform designed for forward-thinking health plans.
Challenges
Solutions
Resource constraints across care continuum
Health plans face critical staffing shortages while managing increasingly complex authorization workflows AND payment integrity operations, often relying on expensive vendor stacks with limited transparency.
Cohere Health's clinical intelligence platform scales across utilization management, care management, Quality/HEDIS, appeals, and payment operations with flexible deployment (in-house, delegated, or hybrid) - leveraging the same AI models and clinical expertise to maximize efficiency and control costs.
Provider relationship strain
Traditional authorization processes create friction, and fragmented payment integrity operations compound the problem - providers face multiple record requests, retroactive denials, and a lack of transparency into audit decisions.
Cohere bridges operations to deliver a unified provider experience. Our transparent, evidence-based approach reduces administrative burden in authorization (94% satisfaction rate) AND minimizes payment-related friction. The same connected intelligence layer informs appeals and downstream clinical workflows—so providers face fewer duplicative requests across the care continuum.
Vendor dependency and operational silos
Health plans struggle with expensive PI vendor stacks (30%+ contingency fees) that operate with opaque algorithms, while UM and PI teams work in silos, missing opportunities for integrated cost containment.
Cohere's unified platform eliminates legacy opaque service vendor dependency by connecting UM and PI data for superior case selection, transparent audit rationale, and the ability to leverage authorization and upstream insights for payment accuracy - reducing both operational costs and vendor fees.
Leveraging AI effectively across cost containment
Health plans want AI benefits but struggle with opaque algorithm concerns, while managing costs, risk, and provider trust.
Cohere's platform delivers transparent AI across the entire cost containment spectrum - from automated routine authorizations to clinical coding validation - with full visibility into decision logic and human safeguards throughout.
Oversold on AI, underserved by it
Health plans have invested in AI point solutions that performed in demos and stalled in pilots—built on generic AI that lack the domain depth for complex clinical decisions, and deployed without the data readiness and change management that real health plan operations require.
Cohere offers a third path. Our clinical intelligence is built on 15M+ real health plan decisions, validated by clinical experts, and proven in production, not pilots. Every capability goes through evaluation-driven development benchmarked against human reviewers before deployment.
Case study
Explore the Humana experience
Humana partnered with Cohere Health® to transform prior authorization and improve patient care.
Guide
Your plan doesn't have an AI shortage, it has a coordination problem
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.
Complimentary Gartner® report
Navigate cost pressures, AI innovation, and compliance with clarity
U.S. health plans are managing rising medical loss ratios, the approaching CMS-0057 deadline, and a complex AI landscape. The Gartner® Hype Cycle™ for U.S. Healthcare Health Plans, 2026 gives health plan CIOs a framework to evaluate where to invest and how to balance financial performance with modernization.
*Key advantages of Cohere Health
Looking to automate manual, time-intenstive workflows without adding provider friction?
Cohere offers flexible deployment models and omnichannel intake, meeting you where you are to achieve admin savings.
Struggling with provider abrasion in a legacy delegated model?
Outsource utilization management for precision medex management and build tailored provider experiences.
Need a cohesive enterprise strategy for interoperability?
Cohere offers full CMS-0057-F compliance on a proven platform, which has processed millions of authorizations through our mature APIs.
Tired of legacy opaque PI vendors with 30%+ contingency fees?
Take control with transparent, AI-powered payment integrity that delivers superior results while building internal capabilities and reducing vendor dependency.
Struggling with post-pay recovery and provider abrasion?
Shift left with proactive payment accuracy by bridging UM and PI data to prevent overpayments before they happen, strengthening provider relationships.
Need modern PI services without the legacy vendor drawbacks?
Partner with an AI-native vendor that offers transparent audit findings, lower contingency fees, and actionable insights for upstream interventions.
How Cohere Health Helps Health Plans Modernize and Deliver Smarter Care
Scalable solutions for health plan success
Resource-sensitive approach
From tech-empowered in-house operations to fully-delegated models to somewhere in between, with initial delegation options and a gradual transition to in-house operations as your team develops.
Enterprise performance-focused partnership
Our experience across health plans is broad and deep, and continues to grow with support from a dedicated client success team with health plan expertise, regular capability enhancements, and new modular product innovations that help our clients scale.
Connected intelligence that compounds over time
AI-driven analytics for smarter decision-making and faster cycle times.
Complimentary Gartner® report
Navigate cost pressures, AI innovation, and compliance with clarity
U.S. health plans are managing rising medical loss ratios, the approaching CMS-0057 deadline, and a complex AI landscape. The Gartner® Hype Cycle™ for U.S. Healthcare Health Plans, 2026 gives health plan CIOs a framework to evaluate where to invest and how to balance financial performance with meaningful health outcomes.
