Tech Firms Strike Revenue Management Deals With Insurers

Oct 29
Oct 29, 2021

Humana Inc. and Blue Shield of California recently became the latest payers to ink deals with prior authorization (PA) and billing tech vendors, following a national trend. Experts tell AIS Health that such deals by insurers are key to managing utilization and spending; improving patients’ and providers’ experiences; and complying with federal mandates for interoperability, price transparency and cost estimation — and could be a strategic differentiator for proactive carriers.

Humana struck a deal on Oct. 13 with Cohere Health, Inc., a Boston-based utilization management software firm, to expand a pilot for musculoskeletal (MSK) prior authorization to all 50 states. The deal expands on a 12-state pilot program; in those states, 95% of Humana’s MSK claims are managed on Cohere’s platform, according to a press release. Meanwhile, Blue Shield of California reached an agreement with Google on Oct. 18 to “automat[e] and simplif[y] the billing and payment process for both providers and patients,” a deal that will eventually “scale the initiative over time to all providers, plan types, and categories of claims processed, as well as to health information exchanges,” per a press release.
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Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.