AAOS Registry Program Blog

Reimagining Prior Authorization for Musculoskeletal Care

Jun 16, 2022 5:08:03 PM

Whitepaper Title in Pink Circle

AAOS and Cohere Health have formed a partnership to improve the prior authorization process (PA) for musculoskeletal care on a national scale. Recently, we co-authored a whitepaper outlining how combining Cohere's technology and AAOS's clinical expertise is transforming the historically burdensome PA process into a strategic asset for health plans, enabling better relationships with providers and improving patient outcomes without delays.

Reorienting PA Around Evidence-based Care Paths, Integrating the AAOS Guidelines 

While traditional PA largely focuses on individual services, care paths are built around a diagnosis and better align with the ways physicians think about patient care and their interactions with the healthcare system. Integrating care paths into the PA process enables approval of all services for the care episode up front, and adds alternative care suggestions, which shortens the care journey, further reduces unnecessary medical costs, and results in better patient outcomes.


Rewarding (and Defining) with Green Lighting Approach

Cohere's technology leverages data-driven intelligence to "green light" physicians who have high approval rates for specific services. Their unique approach has been proven to reduce the overall amount of administrative burden caused by PA without jeopardizing patient care or safety.


Partnering on a Data-Driven Approach to Ensuring High-Quality Care

AAOS and Cohere are piloting a program with physicians in the AAOS American Joint Replacement Registry (on a voluntary, opt-in basis) who can qualify for green lighting based on their performance against select metrics - namely, 90-day readmissions, home discharges, and patient completion of pre-and post-op health status assessments. This program will shed light on predictors of quality for learning and provider feedback around the operationalization of green lighting.

Interested in learning more? Download the whitepaper: Reimagining prior authorization for musculoskeletal care




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Topics: Hip and Knee

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