Cohere Health Secures $50 Million Funding for Streamlining Prior Authorization Processes

Cohere Health Secures $50 Million Funding for Streamlining Prior Authorization Processes

Cohere Health, a Boston-based company specializing in clinical intelligence and prior authorization automation, has successfully raised $50 million in equity funding. Led by Deerfield Management and featuring participation from Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, this funding round brings Cohere Health’s total funding to $106 million.

Cohere Health, founded in 2019 and led by CEO Siva Namasivayam, focuses on simplifying the often burdensome prior authorization processes in healthcare. The company’s platform aligns physicians and health plans on evidence-based care paths for patients, aiming to reduce administrative expenses and enhance patient outcomes.

The $50 million in funding comes at a time when there is a growing demand for Cohere Health’s platform, prompting the company to accelerate its expansion efforts. The funds will be utilized to meet this increased demand and further develop their intelligent prior authorization technology.

Siva Namasivayam emphasized Cohere Health’s commitment to addressing the challenges posed by outdated prior authorization processes. “The significant growth Cohere has experienced in the last four years demonstrates the high demand we are seeing from health plans and risk-bearing providers,” he stated.

Cohere Health’s platform processes 5.5 million intelligent prior authorizations annually, benefiting over 15 million health plan members and 420,000 healthcare providers nationally. The company’s approach differs from traditional authorization systems by leveraging AI-driven ‘nudges’ to guide providers in aligning their requests with administrative and clinical policies, aiming for a more efficient and patient-centric process.

The technology also stands out by combining the authorization request with population data and analytics to generate customized care paths. This aligns with emerging value-based care models, providing a holistic solution to the challenges of prior authorization.

In addition to addressing current industry challenges, Cohere Health is prepared to meet the requirements of CMS’ new rule on prior authorization, set to take effect in 2026. The rule mandates strict timelines for payers to issue prior authorization decisions, a challenge that Cohere aims to address with its intelligent prior authorization technology.

Cohere Health’s clientele includes major health plans, with a notable presence in companies like Humana and Geisinger. The company operates on a per-member per-month basis and distinguishes itself by offering both a licensed platform-as-a-service solution and a fully delegated solution.

As Cohere Health continues to evolve, their focus on streamlining prior authorization processes has the potential to significantly impact efficiency, reduce costs, and ultimately enhance patient care in the healthcare industry.

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