Prior authorization companies are moving into ambient listening, while ambient listening companies are expanding into prior authorization — a trend underscored by yet another partnership bridging the two spaces.
On Thursday, Cohere Health, a clinical intelligence company working to improve the relationship between payers and providers, announced a collaboration with Microsoft Dragon Copilot to advance prior authorization. It comes shortly after Highmark Health and Abridge launched a similar partnership aiming to streamline prior authorization through ambient AI.
Through the Cohere and Microsoft collaboration, providers using Dragon Copilot’s ambient listening technology during patient visits will be able to immediately send prior authorization requests and receive feedback from health plans.
The ambient listening technology will activate Cohere Health’s AI agents to gather and analyze relevant patient data and health history to support these prior authorization requests. Cohere Health will also notify the physician of what conditions need to be met in order for the prior authorization to be approved.
“There’s an opportunity for the physician to be able to ask the patient about, [for example]the type of pain they’re having,” said Gus Weber, chief digital and technology officer for Cohere Health, in an interview. “That may be a prerequisite for the prior auth to be approved. That really reduces the friction for the provider. It also gets the patient the care they need much faster. And so for us, it’s a great opportunity to really move right into the moment of truth with the patient and the physician.”
The Highmark Health/Abridge collaboration, announced in August, has similar goals of reducing the friction between payers and providers. The organizations are building technology that will identify when prior authorization is needed during patient visits, automatically generate a request and ask the clinician to fill in missing information before the patient leaves the room.
This differs from the Cohere/Microsoft collaboration, however, as Microsoft Dragon Copilot is building an ecosystem of third parties that clients can choose to embed into their ambient listening capabilities, such as Cohere, Atropos Health and Ensemble. Cohere was drawn towards working with Microsoft versus Abridge and other ambient companies because of this ecosystem, according to Weber.
By partnering with Cohere, Microsoft ultimately aims to ease the administrative burden on clinicians, said Peter Durlach, CVP and chief strategy officer for health and life sciences at Microsoft. He pointed out that physicians spend a significant portion of their time on administrative tasks, with prior authorization being one of the biggest contributors.
“By enabling Cohere to integrate their AI solution within our AI clinical assistant, we’re giving clinicians and other staff transparency and guidance at the point of care—helping them secure clinical approvals faster and more confidently,” he said in an email. “Our goal is simple: to give clinicians time back in their day so they can focus on what matters most to them, which is caring for patients while simultaneously supporting the financial integrity of the practice.”
Several insurance companies are also working to improve the prior authorization process. In June, more than 50 health plans made a series of commitments to advance prior authorization, such as UnitedHealthcare, Aetna and Cigna. The commitments include standardizing electronic prior authorization and expanding real-time responses.
Photo: Piotrekswat, Getty Images
