Jun 22, 2023

Alina Czekai, Vice President of Strategic Partnerships at Cohere Health, points out the need to transform the often painful prior authorization process. The traditional approach takes a piecemeal view of requests and provides a yes or no response. The Cohere view looks at the process as a multidimensional challenge that requires understanding the entirety of care and leveraging technology and AI to help guide behavior toward what is most clinically appropriate.

Alina explains, "You can think of it as an authorization for a credit card. Ensuring that what is going to be done or what medication or devices are going to be ordered is actually going to be paid for. The process and payments in the healthcare system today have become so complex. It's complex not only for the health plan that's administering payments for care but also for physicians and their staff. Most importantly, it's a confusing and stressful process for patients."

"We believe that prior authorization is a process that can be automated, that should be automated and is really an opportunity in the patient journey to ensure all stakeholders are on the same page. We also think that tools like prior authorization can really be leveraged to understand what's next in a patient's care journey."

"We have a joke at Cohere. None of us were super excited to get in the prior auth business, but we were super excited to get in the business of totally changing a part of the healthcare system that is so antiquated. Prior authorization, for years, has relied on fax. We're not trying to put the fax machine totally out of business, but we think that we can really automate this important process and make access to care even faster for patients."

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