Why has Cohere Health's prior authorization platform seen a 15% drop in approval rates over the past month?

Introduction

Cohere Health's prior authorization platform has experienced a concerning 15% drop in approval rates over the past month. This significant decline in a critical metric requires immediate attention and a thorough root cause analysis. I'll approach this issue systematically, examining both internal and external factors that could be contributing to this performance dip.

Step 1

Clarifying Questions (3 minutes)

• Looking at the timing, I'm thinking there might have been a recent system update. Has there been any significant change to the platform or its algorithms in the last 1-2 months?

Why it matters: System changes often have unintended consequences on performance metrics. Expected answer: Yes, there was a recent update to the authorization criteria. Impact on approach: If confirmed, we'd focus on the changes made and their potential impact on approval rates.

• Considering the scale of the drop, I'm wondering about data integrity. Have there been any changes to how approval rates are calculated or reported?

Why it matters: Ensures we're dealing with an actual performance issue and not a data anomaly. Expected answer: No changes to calculation methods. Impact on approach: If there were changes, we'd need to reassess the validity of the 15% drop.

• Given the nature of prior authorization, I'm curious about any recent policy changes. Have there been any updates to insurance policies or healthcare regulations that might affect approval criteria?

Why it matters: External policy changes can significantly impact approval rates. Expected answer: Some minor policy updates, but nothing major. Impact on approach: If major changes occurred, we'd need to assess their impact and potentially adjust our platform accordingly.

• Thinking about user behavior, has there been any shift in the types of authorization requests being submitted?

Why it matters: Changes in request patterns could explain the drop in approval rates. Expected answer: No significant changes noticed. Impact on approach: If there were changes, we'd need to investigate why and how they're affecting approval rates.