Geisinger Health Plan to reduce denial rates using AI, machine learning

Danville, Pa.-based Geisinger Health Plan partnered with utilization management technology company Cohere Health to support its value-based care delivery and reduce administrative costs. 

Geisinger Health Plan will use Cohere Health machine learning and artificial intelligence technology to create episode-specific care paths based on the member's utilization history and individual care needs to prompt providers to select high-value care options before requests are submitted, according to a July 12 press release. 

The aim is to reduce peer-to-peer clinical reviews and denials, as Cohere Health is designed to reduce denial rates by 63 percent and increase medical savings by 15 percent.  

"Cohere's collaborative platform enables us to further differentiate our value-based care offerings, as our network providers can use the platform's evidence-based, proactive care suggestions to make better health easier and ensure our patients receive optimal care specific to their medical history and condition," said John Bulger, MD, chief medical officer of Geisinger Health Plan.

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