Cohere Health's AI Tool Helps Health Plans Close Hidden HEDIS Gaps and Boost Star Ratings

Author : Daphne Basset | Published On : 24 Sep 2026

Cohere Health, a leading clinical intelligence and operations platform for health plans, has unveiled new results showing how its AI-driven data engine helps close some of the toughest HEDIS gaps hiding in plan records. According to the company, its solution, called Cohere Capture, can help health plans identify and close roughly one in four high-value care gaps that would otherwise go unnoticed, while also supporting stronger Medicare Advantage Star Ratings and better outcomes for members.

The technology works by scanning both structured and unstructured clinical data already sitting within a plan's systems things like prior authorization notes, imaging reports, and electronic health record entries to surface valid quality measure evidence that traditional review processes often miss. Rather than relying on manual chart abstraction, which the company argues is becoming increasingly impractical as national quality measurement standards shift toward continuous, full-population tracking, Cohere Capture applies AI models trained specifically to understand quality measure logic. This lets it flag both gap closures and legitimate denominator exclusions, then route that evidence directly into a plan's HEDIS reporting systems, with each finding traceable back to its original documentation.

Based on results shared by the company, plans using the tool have seen an average 15% improvement in Star ratings performance per measure, along with 107 gaps closed for every 1,000 members whose records were reviewed. Cohere Health also highlighted a minimum 5:1 return on investment tied to a performance-based pricing structure meaning plans pay based on the value of gaps actually closed rather than simply the volume of charts reviewed, a departure from how many legacy vendors in this space operate.

The stakes for getting this right are significant. Higher Star Ratings translate into real financial impact for Medicare Advantage plans, since stronger quality scores can unlock substantial CMS bonus payments and rebates. Those funds are often reinvested into expanded member benefits and programs, which in turn can support better health outcomes and reduce downstream costs for the plan.

Cohere Capture is built on top of the broader Cohere Unify platform, the company's connected clinical intelligence system that already supports utilization management, appeals, care management, and payment integrity functions across health plan operations. By extending that same underlying intelligence layer into the quality and HEDIS space, Cohere Health is positioning the tool as part of a broader shift away from siloed, task-specific AI point solutions and toward a more coordinated approach to health plan operations.

For health plans still relying on manual, retrospective chart reviews to hit their quality benchmarks, this kind of automated, evidence-linked approach may offer a faster, more cost-effective path to measurable Star Rating improvements without adding to the administrative burden already facing clinical staff.

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