The relationship between payers and providers has been historically contentious, with prior authorization being one of the biggest pain points. The process remains a heavily manual and costly burden for both physicians and health plans — and often results in patient care delays, which can be dangerous or even fatal..

付款人和提供者之间的关系历来存在争议，事先授权是最大的痛点之一。这个过程对于医生和健康计划来说仍然是一个沉重的手工负担和昂贵的负担，并且经常导致病人护理延误，这可能是危险的，甚至是致命的。。

On Thursday, a startup focused on simplifying the notoriously difficult prior authorization process announced that it has raised $50 million.

周四，一家专注于简化臭名昭著的事先授权流程的初创公司宣布，它已经筹集了5000万美元。

The financing brings Boston-based Cohere Health’s total funding to $106 million. The round was led by Deerfield Management, with participation from Define Ventures, Flare Capital Partners, Longitude Capital and Polaris Partners.

这笔资金使总部位于波士顿的Cohere Health的总资金达到1.06亿美元。本轮谈判由迪尔菲尔德管理层牵头，来自Define Ventures、Flare Capital Partners、Longitude Capital和Polaris Partners的参与。

The startup, which was founded in 2019, seeks to digitize and expedite the prior authorization process to ensure patients receive faster access to the care they need.

该初创公司成立于2019年，旨在数字化并加快事先授权流程，以确保患者更快地获得所需的护理。

“Whether initiated by fax, web portal or directly from electronic health records, Cohere’s solution digitizes authorization requests, automatically applies rules to adjudicate the request and returns a response to the provider in real-time. AI-driven ‘nudges’ help ensure providers make requests in line with administrative and clinical policies, so that instant approval is much more likely,” explained CEO Siva Namasivayam..

“无论是通过传真、门户网站还是直接从电子健康记录发起，Cohere的解决方案都可以将授权请求数字化，自动应用规则来裁决请求，并实时向提供商返回响应。人工智能驱动的“轻推”有助于确保提供商根据行政和临床政策提出请求，因此即时批准的可能性更大首席执行官Siva Namasivayam解释道。。

Cohere’s prior authorization platform doesn’t just say “yes” or “no” to the authorization request, he noted. The startup’s technology combines the request with population data and analytics to generate customized care paths — an approach that aligns with emerging value-based care models, Namasivayam pointed out..

他指出，科尔的事先授权平台并不仅仅对授权请求说“是”或“否”。Namasivayam指出，这家初创公司的技术将请求与人口数据和分析相结合，以生成定制的护理路径，这种方法与新兴的基于价值的护理模式相一致。。

The need for software to streamline the prior authorization process is incredibly evident given CMS’ new rule on the matter, which was finalized two weeks ago. The rule applies to Medicare Advantage organizations, Medicaid managed care plans, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service programs, CHIP managed care entities, and issuers of Qualified Health Plans offered on the Federally-Facilitated Exchanges..

鉴于CMS在这一问题上的新规定（两周前定稿），简化事先授权流程的软件需求非常明显。该规则适用于Medicare Advantage组织、Medicaid管理的医疗计划、Medicaid和儿童健康保险计划（CHIP）服务收费计划、CHIP管理的医疗实体以及在联邦便利交易所提供的合格医疗计划的发行人。。

Beginning in 2026, these payers will have to issue prior authorization decisions within 72 hours for urgent requests and seven calendar days for non-urgent requests — and they must specifically state why they denied a request. CMS claims this rule will slash non-urgent prior authorization decision timelines in half for some payers, as well as save about $15 billion over 10 years..

从2026年开始，这些付款人必须在72小时内就紧急请求和7个日历日内就非紧急请求发出事先授权决定，并且必须明确说明拒绝请求的原因。CMS声称，这项规定将使一些付款人的非紧急事先授权决策时间表减半，并在10年内节省约150亿美元。。

Namasivayam said that Cohere is well-positioned to help payers comply with this rule.

Namasivayam表示，Cohere在帮助付款人遵守这一规定方面处于有利地位。

“With Cohere’s intelligent prior authorization technology, 83% of requests are immediately approved. In the small number of cases where clinician review is required, Cohere averages a 4.5-day turnaround time and only nine hours for expedited cases,” he declared.

他宣布：“凭借科尔的智能事先授权技术，83%的申请立即获得批准。在少数需要临床医生审查的病例中，科尔平均周转时间为4.5天，加急病例仅需9小时。”。

The startup currently serves five health plans — including Humana and Geisinger — that are charged on a per-member per-month basis. Cohere processes 5.5 million prior authorizations per year for 15 million plan members and 420,000 providers across the country, Namasivayam noted.

这家初创公司目前为五项健康计划提供服务，包括Humana和Geisinger，这些计划每月按每位成员收取费用。Namasivayam指出，Cohere每年为全国1500万计划成员和42万供应商处理550万份事先授权。

He thinks his startup has set itself apart from other companies selling prior authorization software, such as Change Healthcare and Evolent Health. Namasivayam argued that Cohere is the only company to offer both a licensed platform-as-a-service solution, as well as a fully delegated solution — which gives health plans the option to use the technology in-house or outsource their entire utilization management operations for certain specialties to Cohere..

他认为，他的初创公司与其他销售事先授权软件的公司（如Change Healthcare和Evolent Health）不同。Namasivayam认为，Cohere是唯一一家既提供许可平台即服务解决方案，又提供完全授权解决方案的公司，该解决方案使卫生计划可以选择在内部使用该技术，或者将某些专业的整个利用管理运营外包给Cohere。。

Additionally, he pointed out that Cohere’s platform has advanced predictive analytics, which anticipate changes in utilization, find outlier provider patterns and predict patient outcomes.

此外，他指出，科尔的平台具有先进的预测分析，可以预测利用率的变化，发现异常的提供者模式并预测患者的结果。

Photo: Piotrekswat, Getty Images

照片：盖蒂图片社Piotrekswat

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BioLabs Pegasus Park Cultivates Life Science Ecosystem

生物实验室飞马座公园培育生命科学生态系统

Gabby Everett, the site director for BioLabs Pegasus Park, offered a tour of the space and shared some examples of why early-stage life science companies should choose North Texas.

BioLabs Pegasus公园的场地主任加比·埃弗雷特（GabbyEverett）提供了一次太空之旅，并分享了一些早期生命科学公司为什么应该选择北德克萨斯州的例子。

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在HLTH上听到：量子健康

Quantum Health’s Chief Product Officer, Dan Shur talks about the company’s recent Index Report on the changing landscape of healthcare consultants.

Quantum Health首席产品官丹·舒尔（DanShur）谈到了该公司最近关于医疗保健顾问不断变化的情况的指数报告。

Quantum Health and MedCity News

量子健康与医学城新闻

BioLabs Pegasus Park Cultivates Life Science Ecosystem

生物实验室飞马座公园培育生命科学生态系统

Gabby Everett, the site director for BioLabs Pegasus Park, offered a tour of the space and shared some examples of why early-stage life science companies should choose North Texas.

BioLabs Pegasus公园的场地主任加比·埃弗雷特（GabbyEverett）提供了一次太空之旅，并分享了一些早期生命科学公司为什么应该选择北德克萨斯州的例子。

Stephanie Baum

斯蒂芬妮·鲍姆

Heard at HLTH: Quantum Health

在HLTH上听到：量子健康

Quantum Health’s Chief Product Officer, Dan Shur talks about the company’s recent Index Report on the changing landscape of healthcare consultants.

Quantum Health首席产品官丹·舒尔（DanShur）谈到了该公司最近关于医疗保健顾问不断变化的情况的指数报告。

Quantum Health and MedCity News

量子健康与医学城新闻