Clinical Intelligence Gains Momentum Across Health Plans as Cohere Health Sees Record 2025 Growth

Expanded adoption reflects growing demand for clinically trained, domain-specific AI to improve payer-provider collaboration, prior authorization, and payment accuracy

BOSTON, Jan. 13, 2026 /PRNewswire/ -- Cohere Health®, the leader in clinical intelligence solutions for health plans, today announced record growth in 2025, reflecting expanded adoption of its platform to support more connected decision-making across the care continuum. Throughout the year, the company expanded its clinically trained, agentic AI capabilities beyond outpatient utilization management (UM) into acute inpatient care, payment integrity (PI), and policy management–strengthening payer-provider collaboration and decision transparency while improving total cost of care management.

Health plans face mounting pressure to control costs, comply with federal and industry requirements, address AI ping-pong with providers, and streamline administrative complexity without compromising the quality of care. As a result, they increasingly turn to Cohere Health's precision AI to automate complex workflows, drive more consistent, evidence-based decisions, and insource UM and PI to improve provider relationships and reduce administrative costs over outsourced solutions that lack transparency. The company has achieved 94% provider satisfaction, up to 85% real-time authorization approvals, 1-3% inpatient medical expense savings in UM, and 8x ROI for payments. Cohere Health's team closed ten new deals in the last year–including the delivery of its platform and clinical expertise to support CMS efforts to reduce waste and abuse in healthcare.

"This year reinforced that health plans are actively working to create a smarter, more efficient healthcare future," said Siva Namasivayam, co-founder and CEO of Cohere Health. "Leading plans are embracing our clinical intelligence and agentic AI to rethink legacy workflows and people-powered processes–enabling faster, more accurate decision-making and empowering skilled clinicians and coders to work at the top of their licenses. With our agentic solutions, the health plans can build an AI layer on top of their legacy systems of record, thereby increasing the speed to ROI. We're entering 2026 with the strongest foundation we've had, focused on what matters most: getting every patient to the right care, at the right time."

Cohere Health's growth was fueled by its $90 million Series C funding announced in May. This investment supported the expansion of the company's clinical intelligence platform across applications, copilots, agents, and services, strengthened health plan regulatory readiness, and extended value beyond UM. To meet the increased demand, the company also scaled its teams across clinical programs, engineering, and client support, enabling improved operational capacity and solution delivery.

"Health plans are recognizing that siloed approaches to medical expense management limit their success and impact," noted Krishna Kottapalli, chief growth officer of Cohere Health. "Reducing waste requires shifting left on payments and leveraging utilization management insights across the organization. This shift is driving more plans to partner with Cohere Health to connect their decision-making across a single clinical intelligence platform, from pre-care to payments and beyond."

Throughout 2025, Cohere Health introduced new solutions to reduce administrative burden and costs and drive medical expense savings for the health plan enterprise. These additions bolstered Cohere Health's ability to drive measurable results for its health plan partners, including:

• Enabled greater payment accuracy for pre-pay reviews through Cohere Validate™ and the Payment Integrity Suite, uniting pre-care clinical insights with claims and coding validation to achieve upwards of 8x ROI. The launch of specialized audit agents extended these capabilities to costly conditions like sepsis, enabling faster, more accurate reviews with a 58% findings rate.
• Improved medical expense management and reviewer efficiency with Cohere Review Assist™, enabling clinical reviewers to complete acute inpatient authorization requests nearly 50% faster, resulting in more accurate decisions and quicker access to medically necessary care.
• Streamlined medical policy management with Cohere Policy Studio™, a centralized hub that accelerates interoperability and automates how plans create, manage, and deploy custom clinical policies with greater speed, precision, and transparency.
• Optimized prior authorization provider performance by launching Cohere Align™, moving the industry beyond traditional gold carding by driving provider satisfaction, more appropriate care choices, efficiency, and savings–reducing authorization submission times by 55%.
• Accelerated regulatory readiness through Cohere Connect™, helping plans meet federal and industry requirements with improved data exchange, provider workflows, administrative costs, and proven APIs that have supported more than 15 million prior authorization submissions.

Additionally, Cohere Health's market-shaping innovation and company growth were acknowledged with national rankings and industry awards. Notable recognitions include:

• TIME's World's Top HealthTech Companies 2025
• Deloitte Technology Fast 500™
• The 2025 Inc. 5000 List
• Gartner Hype Cycle for U.S. Healthcare Payers for the fourth consecutive year, along with many other industry analyst mentions
• HLTH 2025 Digital Health Hub Foundation's Best in Class Award for AI in Health Operations

Cohere Health enters 2026 well-positioned to drive continued innovation and support health plans with an enterprise agentic AI strategy, and to fundamentally reshape the speed, quality, and cost of care across the healthcare ecosystem.

About Cohere Health
Cohere Health's clinical intelligence 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, appeals, and more–the company improves collaboration and reduces burden, resulting in up to 8x 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
Brynn Spicher
anthonyBarnum Public Relations
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SOURCE Cohere Health