Cohere Health Gives Health Plans a Path Beyond Retrofitting AI to Redesigning Operations

The expansion of Cohere Unify™ brings proven, domain-specific clinical intelligence AI capabilities from utilization management and payment accuracy into appeals, care management, claims operations, and quality

BOSTON, June 9, 2026 /PRNewswire/ -- Cohere Health® today announced a significant expansion of Cohere Unify™, its clinical intelligence and operations platform, extending its proven agentic AI capabilities already deployed at scale across utilization management and payment accuracy into appeals, care management, claims operations, and quality. This marks a fundamental shift in how health plans can address complex challenges and deploy AI as a coordinated intelligence layer across the care and cost continuum.

Too often, value is lost between functions that operate without coordinated intelligence and connected data. While fragmented AI point solutions may automate isolated tasks, they cannot bridge these gaps or extend intelligence across the enterprise. As health plans navigate rising medical and administrative costs, evolving member expectations, provider abrasion, and workforce constraints, Cohere Unify is built around those connections–bringing clinical context, continuity, and intelligence across workflows to realize value beyond any single function alone.

Move beyond retrofitting AI to redesigning clinical operations

"Health plans have been told to add AI to existing broken processes. Cohere Health offers a different path: redesigning how clinical operations work and sharing intelligence on a proven, trusted AI foundation," said Siva Namasivayam, CEO of Cohere Health. "We pioneered clinical intelligence and now we're building the new agentic operational model that reduces administrative costs while optimizing medical expenses, and compounds in value over time with expert human interaction."

Most AI solutions automate individual tasks without understanding how complex clinical decisions are actually connected. The result is fragmented intelligence, siloed data, and generic AI that never scales beyond its original use case. Cohere Health was built on a connected foundation shaped by more than five years of delivering real clinical decisions and outcomes at scale. Health plans gain both administrative and medical cost savings through AI-powered intelligence that works with their existing core systems of record.

Unlock operational coherence built on deep clinical intelligence, context, and expertise

That depth and breadth of human expertise is codified into a proprietary coordinated AI intelligence layer and composable agentic skills library spanning more than 15 million clinical decisions annually, 4,500 clinical policies and medical guidelines, 100,000 clinical indications, and 27 million unique patient profiles. Domain-specific agentic AI understands the complex connections among symptoms, diseases, treatments, and evidence-based policies, and reasons across structured and unstructured records with full clinical context at every step.

This foundational coordinated AI intelligence layer powers every agentic use case across the platform, ensuring each clinical and operational decision benefits from the same context, continuity, and expertise, regardless of where it sits in the care and payment lifecycle.

Support governance that evolves with AI and organizational needs

As regulatory scrutiny intensifies, health plans are prioritizing AI trust, transparency, and safety. Cohere Unify is designed for responsible AI governance across the enterprise, and at every stage of AI adoption. The platform adapts to each plan's governance requirements and risk tolerance–from augmenting clinical teams with decision support, to deploying more automated workflows with configurable clinical governance and human oversight. Health plans can scale automation at their own pace as confidence thresholds and quality benchmarks are met. Cohere Health's commitment to responsible AI is reinforced by its HIPAA compliance and HITRUST, NCQA, and URAC certifications.

"With safety and governance under the microscope, complex operations and clinical AI deployment require more than quick-to-implement point solutions, which lack domain expertise and flexibility," said Gus Weber, chief digital and technology officer at Cohere Health. "Unify responsibly connects with health plans' data to enable a unified clinical intelligence layer across operations. With rigorous governance, domain-specific AI, and expert collaboration as its foundation, the platform empowers teams to manage operational complexity and enhance decision-making while benefiting from automation."

Extend the impact of connected AI to new use cases

• Appeals: Identifies the clinical evidence most likely to impact a determination, helping human reviewers close cases in half the time, with greater consistency and full decision auditability.
• Care management: Synthesizes longitudinal clinical and utilization data to identify rising-risk members, surface care gaps, and generate compliant care plans within existing workflows, helping care managers spend more time coordinating care.
• Claims operations: Continuously updated data fabric automatically maintains the accuracy of claims rules across code sets, contracts, benefits, authorizations, and policy sources–surfacing claim anomalies and improving processing throughput. Rule development timelines have been reduced from weeks or months to hours.
• Quality: Shifts from a traditionally reactive approach to year-round clinical documentation evaluation against HEDIS and other quality measures–closing gaps and identifying exclusions buried in unstructured records, and improving Stars HEDIS performance by 10-20% per measure.

Great technology makes humans better, not replaceable. Learn how a connected AI intelligence layer drives operational coherence and empowers health plan teams at scale by visiting www.coherehealth.com/platform.

About Cohere Health
Cohere Health's clinical intelligence and operations platform and agentic AI-powered solutions connect health plans' strategic goals and providers' needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 9x ROI and 94% provider satisfaction. Cohere Health is recognized on TIME's World's Top HealthTech Companies 2025 list, on the 2025 Inc. 5000 list, and by numerous industry analysts.

Media Contact
Rachel Rabinowitz
Cohere Health
[email protected]

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SOURCE Cohere Health

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