Cohere Health Helps Health Plans Unlock Revenue by Closing Hidden HEDIS® Gaps

Cohere Capture™ helps uncover gap closures from existing clinical evidence, improving care quality, financial performance, and member experience at scale with 5x ROI

BOSTON, Sept. 22, 2026 /PRNewswire/ -- Cohere Health^®, the leading clinical intelligence and operations platform for health plans, today announced new performance results demonstrating that its clinical evidence extraction engine, Cohere Capture™, can help health plans close one in four high-value care gaps, raise Medicare Advantage Star Ratings, and improve member health. By uncovering and validating hidden HEDIS^® gap closures buried in a plan's existing clinical data, the AI-powered solution has helped clients achieve an average 15% improvement in Stars performance per measure, 107 gaps closed for every 1,000 members with records, and a minimum 5:1 return on investment with a performance-based approach.

Better Star Ratings translate directly into better member care and stronger financial performance. For Medicare Advantage plans, improved quality ratings can mean millions in CMS bonus payments and rebates that can be reinvested in member benefits and programs, and reduce costs. Health plans are finding Cohere Capture realizes those gains at scale by finding care gap closures buried in their own systems, without adding administrative burden and avoiding per-chart economics.

The quality measurement landscape is evolving rapidly. As CMS removes nearly a dozen administrative measures, greater emphasis will need to be placed on member outcomes and experience to improve care gaps–which are harder to close, rely more on clinical data, and carry more weight in the absence of the retired measures. Overall performance is improving, so plans need to continually optimize to keep up with measures. Meanwhile, NCQA is moving away from seasonal chart review toward year-round, digital quality measurement through Electronic Clinical Data Systems (ECDS), making manual abstraction approaches increasingly unsustainable.

"Moving from 3 to 4 Stars represents $57 million in additional CMS payments per 100,000 members, but plans cannot get there with seasonal chart review alone," said Matt Parker, chief product officer at Cohere Health. "Cohere Capture helps health plans uncover gap closures in the data they already have, giving them a more scalable way to improve quality performance with the clinical rigor required to hold up under audit."

Built on the Cohere Unify™ connected clinical intelligence platform, Cohere Capture can ingest clinical data from both unstructured and structured sources, including prior authorization notes, imaging reports, and EHR data. It uses AI models trained specifically on quality measure logic. The solution identifies gap closures and denominator exclusions and routes findings directly into health plans' HEDIS systems, with every finding linked back to the source documentation, while also supporting human reviewers with a precision clinical AI assistant.

Unlike traditional vendors that charge for each chart reviewed, Cohere Capture uses a pay-for-performance model tied to results, optimizing the system to surface only actionable findings. For existing Cohere Health utilization management clients, it can create additional gap closure opportunities from the clinical data already flowing through Unify, without requiring new data integrations.

Cohere Capture is available now for Medicare Advantage health plans. Interested plans can request a no-cost proof of concept to evaluate the solution against their own gap lists and data sets at coherehealth.com/quality.

Cohere Health is hosting an expert panel on Tuesday, September 29th, "More than a Q4 push: How to evolve your Star Ratings program systematically." To register, please visit https://www.coherehealth.com/event/evolve-star-ratings-program-systematically.

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 list, on the Inc. 5000 list, and by numerous industry analysts.

Cohere Health is a registered trademark, and Cohere Capture is a trademark of Cohere Health, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

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SOURCE Cohere Health