Cohere Health uses AI to analyze a patient's clinical data and care history during the prior authorization process and send real-time suggestions — called 'nudges' — to providers if the requested treatment may not align with evidence-based guidelines or cost-effective care pathways.

When a provider submits an authorization request, Cohere's platform identifies where the patient is in their care journey and any potential risks based on diagnosis and medical history. If the requested service is the appropriate next step in an evidence-based care pathway, the request proceeds to approval; if not, the AI triggers a 'nudge' prompting the provider to consider an alternative. Clinical nudges leverage machine learning to analyze patient clinical data and compare it against evidence-based care alternatives — for example, suggesting that a procedure be shifted from inpatient to outpatient care. The nudge capability covers specialties including musculoskeletal, cardiology, pain management, physical therapy, and imaging.