Fully-delegated cardiovascular services, **optimized by AI**

Using clinical intelligence and precision AI to enhance cardiovascular care management.

Delegate Services in a Heartbeat
Illustration of human heart symbolizing fully delegated cardiovascular care services optimized by AI with minimal manual effort and full compliance
Delegate Services in a Heartbeat

Why leading health plans choose Cohere Health® to support their cardiovascular strategy

Cohere's delegated solution for cardiovascular care takes the administrative burden off health plans while ensuring high-quality, evidence-based care for members. Our delegated model includes:

  • Full clinical and administrative ownership of the prior authorization process

  • Specialized cardiovascular clinical expertise from board-certified cardiologists

  • Advanced technology infrastructure that scales to meet any volume demands

  • Continuous quality improvement through data-driven insights and reporting

  • Collaborative provider engagement focused on optimal clinical outcomes

The result?

  • 15-20%

    medical cost savings

  • 89%

    provider satisfaction

  • $4.56 PMPM

    non-denial medical expense savings

Colorful anatomical heart illustration beside text detailing comprehensive cardiovascular care services, including ablation, implants, and cardiac imaging.

Complete cardiovascular care covered

Cohere's cardiovascular clinical intelligence solution incorporates nationally accepted clinical criteria from the American College of Cardiology (ACC). Our board-certified cardiologists work to implement consistent, evidence-based guidelines across:

  • Ablation procedures
  • Cardiac devices and implants
  • Complex cardiac interventions
  • Advanced diagnostic and cardiac imaging
  • Peripheral revascularization
  • Percutaneous Ventricular Assist Devices (VADs)

Clinical expertise powered by advanced technology

At the core of our fully-delegated cardiovascular services is our clinical intelligence platform. This advanced system integrates:

  • AI-powered authorization intake and processing
  • Sophisticated clinical decision support
  • Real-time analytics and reporting
  • Evidence-based clinical intelligence

This comprehensive ecosystem enables true digital transformation of utilization management, delivering greater operational efficiency and-most importantly-faster, higher-quality patient outcomes.

3D illustration of a doctor on a digital screen with medical icons, symbolizing AI-powered clinical intelligence and technology-driven cardiovascular care.
Illustration of diverse healthcare providers communicating through digital interfaces, symbolizing streamlined provider workflows and collaborative clinical tools.

Provider experience reimagined and proven

Our innovative provider intake application creates a seamless experience that reduces administrative burden and fosters greater clinical collaboration:

  • Intuitive digital interface designed with provider workflow in mind
  • Real-time determinations for many common procedures
  • Transparent decision rationale that builds trust and understanding
  • Secure messaging for efficient clinical dialogue

Benefits

How a clinical intelligence approach can change the game for you

Advanced workflows that identify opportunities for improved efficiency and medical expense savings

Unlike legacy outsourced services that focus on denials, 63% of Cohere's impact comes from non-denial interventions like pre-submission prompts and site of service opportunities that reduce care delays and provider frustration.

Evidence-based clinical decisions informed by the latest cardiovascular research and guidelines

Cohere has a deep clinical team bench and ensures clinical expertise across all delegated workflows from intake to same-specialty peer-to-peer reviews. Our MD & RN clinical experts provide broad clinical expertise, which is leveraged across the offering.

Technology streamlines provider submissions and recommends optimal care choices

Cohere’s provider-facing application has a 96% digital adoption rate. It offers in-workflow, real-time messaging prompts to providers for missing information required for real-time approval. The application also suggests clinically appropriate care recommendations for optimal care to drive maximum cost and quality impact.

Reduce care variation and improve collaboration with transparency

Cohere’s precision AI/ML-based intelligent real-time decisioning: Cohere’s approach to real-time authorizations goes far beyond traditional rules based on manual user input of clinical assessment questions. Cohere achieves a 85% real-time approval rate with higher decision quality and reduced opportunities for gaming by using ML to interpret clinical notes from the EMR.

Cardiovascular Leadership

Intelligence led by world-class cardiologists

Cohere's board-certified cardiologists deliver exceptional clinical expertise, ensuring excellence across our delegated model.

Brian Covino, M.D., FAAOS

Brian Covino, M.D., FAAOS

Chief Medical Officer

With over 25 years of orthopedic surgery experience, Dr. Covino joined Cohere in 2020 after serving as a consultant since 2018. As a former partner at Knoxville Orthopaedic Clinic/OrthoTennessee, specializing in joint replacement surgery, he brings invaluable clinical expertise to our leadership team. Dr. Covino holds a bachelor's degree from Harvard University and an M.D. from Georgetown University School of Medicine, with surgical training from the University of Virginia and a fellowship at The Cleveland Clinic Foundation.

Illustration of clinical cardiovascular care cycle with 3D arrows, heart icon, and symbols for transparent workflows, medical leadership, and non-denial approach.
Illustration of clinical cardiovascular care cycle with 3D arrows, heart icon, and symbols for transparent workflows, medical leadership, and non-denial approach.

Delegate-and elevate-your **cardiovascular care** management

Schedule time with our team to learn more about how our clinical intelligence platform and experienced team can modernize your approach to UM.

Schedule an Overview
Schedule an Overview

Want to learn more about our solutions?

Browse the most common questions we are asked to help you make the most of your decision to modernize your UM operations…and beyond!

What is Cohere Health's delegated cardiovascular solution?

Cohere Health's cardiovascular solution is a fully delegated service that combines clinical intelligence, precision AI, and specialized expertise to modernize prior authorization for cardiovascular care. Our solution leverages advanced technology and clinical expertise to drive better care outcomes, reduce provider burden, and generate significant administrative and medical cost savings.

How does Cohere's approach differ from traditional prior authorization delegation services?

Unlike traditional prior authorization, which often creates barriers to care, our approach uses clinical intelligence to guide providers toward optimal care choices from the start. We focus on transparent decision-making, evidence-based guidelines, and real-time collaboration. Our provider application is designed with clinical workflows in mind, making the process more efficient and less burdensome for cardiovascular utilization management.

What types of cardiovascular services are covered under Cohere's solution?

Our delegated UM solution covers a comprehensive range of cardiovascular services, including ablation procedures, cardiac devices and implants, complex cardiac interventions, advanced diagnostic and cardiac imaging, peripheral revascularization, and Percutaneous Ventricular Assist Devices (VADs).

What does "fully-delegated" mean in the context of prior authorization?

Fully-delegated means Cohere assumes complete responsibility for managing the entire prior authorization process on behalf of the health plan. This includes intake of requests, clinical review, determinations, provider communication, and reporting with optional add-on services for a tailored solution. Our delegated model allows health plans to benefit from our specialized clinical expertise and advanced technology without needing to maintain these capabilities in-house. And in some cases, we support delegated services while health plans build their in-house operations.

What clinical guidelines do you use for cardiovascular care?

Our cardiovascular solution incorporates nationally accepted clinical criteria from the American College of Cardiology (ACC) and other leading cardiovascular organizations. These evidence-based guidelines are continuously updated based on the latest research and clinical advancements.

Is the provider intake application difficult to learn and use?

No. Our provider experience is designed with simplicity and clinical workflows in mind. Most providers report being able to use the system effectively with minimal training. We offer comprehensive support resources, including tutorial videos, quick-start guides, and live support to ensure a smooth onboarding experience.