Cohere Health digitizes clinical policies using AWS Bedrock agents

Prior authorization represents a critical bottleneck in healthcare operations because the policies governing it exist in static, unstructured formats—PDFs, documents, and manual records—that resist automation. The challenge is not that the medical reasoning behind prior authorization is flawed; rather, policies vary by clinical area, geography, line of business, and health plan, and they evolve constantly as medicine and technology advance. Historically, health plans lacked systematic tools to manage, analyze, and optimize these policies at scale. By digitizing policies into machine-readable, structured data using standard terminologies, Cohere Health removes this operational bottleneck and enables consistent, computable workflows.

The urgency is regulatory and competitive. The Centers for Medicare & Medicaid Services (CMS) has mandated API-based electronic prior authorization by January 2027, and the America's Health Insurance Plans (AHIP) has set a commitment for 80 percent real-time approvals. Meeting these targets requires automation, but automation of clinical workflows demands domain expertise, transparency, and accountability. Cohere Health's approach addresses this by building a modular skills framework where clinical policy experts author and refine domain-specific capabilities directly. Skills are evaluated against ground truth datasets for accuracy, completeness, and consistency before production deployment, then monitored via Arize AI with feedback from clinical analysts. This design preserves human oversight while enabling rapid deployment across multiple health plans—a multi-tenant architecture that isolates each customer's data while sharing a common runtime infrastructure.