Prior authorization automation platform Cohere Health and MCG Health, part of the Hearst Health network that provides evidence-based care guidelines, announced they will integrate their content and technology offerings to enhance the prior authorization process for providers, patients and health plans.

The aim is to integrate MCG care guidelines into Cohere's Unify Decisioning tool to build a solution for prior authorization decision-making, driving higher rates of clinically relevant auto approvals while decreasing provider submission time and friction.

The companies said a large regional insurer that intends to launch the two companies' combined platform in early 2005 will be their first client.

The partnership is designed to benefit joint health plan clients and their provider networks and patients. 

As a result of the integration, health plan clinical review staff members can view indications, pre-filled by Cohere models within MCG Cite CareWebQI.

Cite CareWebQI aims to ease access to evidence-based best practices and criteria to support clinical decision-making. In addition, health plans, payers and insurers can track members and episodes while monitoring and identifying variances from best practices.

According to the two companies, Cohere's AI-driven technology is expected to lower time to care and MCG's clinical guidelines are intended to drive steady, clinically relevant care decisions. 

"MCG Health is the perfect partner to complement Cohere's groundbreaking, AI-driven offering with industry-leading and nationally recognized clinical criteria," Siva Namasivayam, CEO of Cohere Health, said in a statement. 

"Our leading, proven technology innovations applied to MCG's substantial clinical guidelines footprint will accelerate a new era of less prior authorization friction. Healthcare constituents are increasingly demanding innovative solutions that provide lower costs and faster access to care."

THE LARGER TREND

In April, Cohere Health and health insurer Humana expanded their 2021 partnership, which focused on the prior authorization process for musculoskeletal issues, to include diagnostic imaging and sleep services. 

Through the expanded partnership, diagnostic imaging and sleep solutions would be added to the services Humana offers its members and providers via Cohere Health.

In 2021, Cohere Health secured $36 million in Series B funding. Polaris Partners led the round, with participation from investors Longitude Capital and Deerfield Management. Also contributing to the funding round, Flare Capital Partners and Define Ventures.

In 2016, consumer engagement software company PegaSystems partnered with MCG Health to join forces in the Pega Care Management Application. The app puts patient records in one unified, collaborative platform, permitting each member of the care team to access information and oversee patient care.