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Technology platform will support GHP’s value-based care delivery

DANVILLE, Pa. – Geisinger Health Plan (GHP) announced it’s joining forces with Cohere Health, a recognized leader in utilization management (UM) technology, to drive high-value care and reduce provider burden. Cohere’s collaborative UM platform will help GHP support value-based care delivery, reduce administrative costs and lead the nation in aligning quality improvement initiatives across all GHP lines of business, including Commercial, Exchange, Medicare Advantage and the newly expanded Medicaid. 

“Working with Cohere Health is transformational in Geisinger’s long history of clinical innovation, both in Pennsylvania and nationwide,” said John Bulger, MD, chief medical officer for Geisinger Health Plan. “We’re excited to work with Cohere not only to significantly improve the prior authorization process, but also to drive better care experiences and outcomes for our providers and members. The collaborative platform enables us to further differentiate our value-based care offerings, as our network providers can take advantage of the platform’s evidence-based, proactive care suggestions to make better health easier for our patients to ensure they receive optimal care specific to their medical history and condition.” 

GHP provides coverage to more than half a million members throughout Pennsylvania and boasts a network of more than 30,000 primary and specialty care physicians. GHP was recently named the highest Member Satisfaction among Commercial Health Plans in Pennsylvania for the third consecutive year by J.D. Power.  

GHP will utilize Cohere’s AI-driven and machine learning technology to accelerate patient access to high-quality care while streamlining prior authorization. Cohere’s digital platform creates episode-specific care paths based on the member’s utilization history and individual care needs, in addition to historic results for a specific patient population. Fully transparent, evidence-based suggestions prompt providers to select high-value care options before requests are submitted. When patients receive care that aligns with clinically accepted best practices, peer-to-peer reviews and denials are reduced. Initial clinical improvement programs will focus on increasing patient access to conservative and home-based treatments. 

“We’re thrilled to work with Geisinger Health Plan on a digital-first approach to transforming utilization management that furthers their mission: providing members with high-quality, affordable care,” said Siva Namasivayam, CEO of Cohere Health. “The industry is long overdue for a collaborative approach that puts the patient journey at the center of care decisions, and leverages technology and clinical intelligence in a way that supports providers.”
 
The Cohere platform increases health plan savings beyond traditional UM, as it ensures that prior authorization requests are evidence-based before submission. By offering clinical guidance at the point of authorization, the platform drives 15% incremental medical savings, on average, while simultaneously reducing denial rates by 63%. The platform is designed to reduce provider friction throughout the prior authorization process, an imperative for GHP. 

Cohere’s platform delivers digital submission rates of up to 95%. Real-time determinations return immediate approvals that enable patients’ faster access to care by 70%, and in areas of complex surgery, Cohere has seen surgical complication rates decrease by 18%. The transparent way that Cohere supports ordering providers with data, as well as clinically driven and technology-delivered “nudges,” builds trust with network providers and will allow GHP to reduce care variation and incentivize high-value care.

About Cohere
Cohere Health is a digital intelligence company that’s transforming utilization management (UM) by aligning physicians and health plans on evidence-based care paths for the patient's entire care journey. By integrating these care paths into the prior authorization submission process, Cohere's digital UM collaboration platform reduces denial rates and medical expenses while improving patient outcomes. The company is a winner of the TripleTree iAward and has been named to both Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists. Cohere's investors include Flare Capital Partners, Define Ventures, Deerfield, Polaris Partners, and Longitude Capital.
 

About Geisinger
Geisinger is among the nation’s leading providers of value-based care, serving 1.2 million people in urban and rural communities across Pennsylvania. Founded in 1915 by philanthropist Abigail Geisinger, the nonprofit system generates $10 billion in annual revenues across 126 care sites — including 10 hospital campuses — and Geisinger Health Plan, with more than half a million members in commercial and government plans. Geisinger College of Health Sciences educates more than 5,000 medical professionals annually and conducts more than 1,400 clinical research studies. With 26,000 employees, including 1,700 employed physicians, Geisinger is among Pennsylvania’s largest employers with an estimated economic impact of $15 billion to the state’s economy. On March 31, 2024, Geisinger became the first member of Risant Health, a new nonprofit charitable organization created to expand and accelerate value-based care across the country. Learn more at geisinger.org or follow on Facebook, Instagram, LinkedIn and X.

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For media inquiries:

Natalie Buyny
Media Relations Manager

814-421-8039
nbuyny1@geisinger.edu
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