The guiding principles of responsible AI

Artificial intelligence (AI) has been taking a lot of heat in the press lately. But when organizations use AI responsibly in prior auth, not only does it help get to a faster “yes,” but it also drives new care quality and cost benefits for plans, providers and patients alike. 

To ensure we use AI responsibly, Cohere Health always has a clinician in the loop and follows these principles:

📈 Our team of 150+ clinical experts ensures accountability—our offerings must be grounded in evidence-based clinical knowledge and expertise.

🔎 For transparency, we share with the requesting provider the clinical basis for our decisions to approve, or to pend for further review.

🪪 To maintain privacy and security, our AI models do not use explicit identifiers for patients, such as names, locations, and providers for additional care option suggestions.

⚖️ Our AI models leverage a variety of policies, and clinical experts review pended requests, to apply standards of care with inclusivity and fairness across a plan’s entire membership.

We never use AI to deny. Intelligent prior authorization uses responsible AI to get to a faster “yes,” and to improve quality of care for patients.

Blog: Responsible AI and the prior authorization trends making waves in 2023

Discover how we're implementing responsible AI to enhance the prior auth process.

1. Tackling healthcare's biggest burdens with generative AI (McKinsey): Disparate sources of unstructured data are now assets to power generative AI. Learn how payers and healthcare systems can use the tech to deliver care.
2. White House gets top AI companies to commit to responsible development (The Hill): The White House secured voluntary commitments to manage AI risks from seven top companies. An official described the commitments as “pushing the envelope” on safety and security in AI.
3. Joint Letter on PA Attachment Standards (AHIP): AHIP, AMA, AHA, and BCBSA came together to urge CMS to reconsider prior authorization standards the agency has proposed.

1. Applying AI to prior authorization reduces the pain for all stakeholders (Empowered Patient Podcast): Leveraging AI technology can help address the burdensome process of PA and guide toward the most clinically appropriate care.
2. AI guardrails that can eliminate PA denial nightmares (HIMSS TV Interview): Preventing overwhelming admin burdens with machine learning strategies that look at a patient’s needs beyond a single transaction.
3. 2023 Hype Cycle for U.S. Healthcare Payers (Gartner): We were featured in Gartner’s report for a second year. Gartner moved intelligent prior auth up within their Hype Cycle curve to the “Transformational” designation - their highest priority level.

Earlier this summer, I gathered members of our Medical Advisory Board in Boston to discuss how we’re utilizing technology and data to improve prior auth.

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