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AiThority Interview with Siva Namasivayam, CEO at Cohere Health

Hi Siva, please tell us about your role and the team/technology you handle at Cohere Health.

I’m the CEO of Cohere Health. We are a digital healthcare technology company focused on helping health plans transform utilization management into truly collaborative care management, using next-generation technologies such as artificial intelligence and machine learning.

How did you arrive at Cohere Health?

I was drawn to Cohere because of the company’s focus on ensuring that patients get the most optimal health outcomes. To make that goal a reality, Cohere is committed to playing a big role in transforming the vexing healthcare processes that undermine patient care. That is the company’s mission, and that’s what attracted me to Cohere.

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Tell us about current developments in healthcare management and how it is influenced by data intelligence and behavioral analytics.

COVID has been a major catalyst for healthcare in multiple ways because it has laid bare the inefficiencies and inadequacies of the system. We can send people to the moon and potentially to Mars, but in 2020 we were unable to get ventilators to people who were dying. We also saw how much frontline workers were struggling to get the resources they needed to treat pandemic victims. This has led to a dramatic increase in investments into technologies that change how healthcare is delivered. So COVID has been a powerful catalyst in driving more innovation and efficiency in our healthcare system.

One of the biggest challenges in healthcare is that we have so many interconnected parties—think about hospitals and other various medical facilities, surgical centers, nursing centers, physician offices, insurance companies, pharmacies, manufacturers—but there are no standards by which they all collaborate. That’s the biggest problem we need to solve because that lack of collaboration results in delayed or unnecessary care, which in turn drives unnecessary expense and suboptimal patient outcomes. Getting the health plans, providers and patients working together on a single IT platform or “care path” enables the use of AI, ML and other technologies to guide all the players to the best care choices, without unnecessary delays, which promotes the best and quickest outcomes.  Analytics are already being used to do many things, from supporting administrative processes to identifying the most efficient providers to detecting fraud and abuse in the system. Many interesting things are happening with analytics in healthcare. But high quality, easily accessible data is the inhibitor for analytics. EMRs are closed systems and don’t share much data.

Regarding behavioral analytics, healthcare is all about consumer and physician behavior. Lots of waste happens because of the lack of consumer behavior change. Early detection and preventing or slowing a chronic disease can result in significant savings down the road.  One of the biggest issues is that the longer it takes to get the right care, the more it costs. Using what we call nudges (based on behavioral economics), we can impact patient and provider behavior earlier in the care cycle, which helps drive down costs and improve outcomes. For example, our analytic capabilities automatically flag evidence-based opportunities to shift site of service, service type, service frequency etc. before services are ordered or performed, within the prior authorization workflow, and very often providers accept this automated guidance. Our solutions also analyze what drives high-quality physicians and how to use technology to drive the same behavior in nonconforming physicians.

What is the idea behind partnering with Vori Health? How would it benefit your customers?

The partnership enables Cohere to offer its health plan and risk-bearing customers the ability to connect with Vori as a preferred musculoskeletal ecosystem partner accessed through Cohere’s digital prior authorization platform. Cohere’s health plan customers will be able to activate Vori for patients and providers connected to Cohere via Cohere’s evidence-based clinical pathways. Our health plans and their members will benefit by having a virtual musculoskeletal care option available directly in the prior authorization workflow, saving additional time and cost, and promoting faster return to normal daily activities for orthopedic patients.

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Tell us more about Digital Prior Authorization Solution and how it improves patient health outcomes.

The solution improves patient health outcomes by reducing or eliminating delays in care caused by inefficiencies in other prior authorization processes. First, we set out to automate administrative processes—such as interoperability and use of faxes and inbound calls—and also various back and forth due to missing information. And if all the information is correctly presented, we do an auto-determination and authorize the procedure immediately without any delay. And for things that need to be reviewed, we are automating the clinical review process using AI and natural language processing.

But we don’t stop at the administrative processes. We then look at eliminating certain prior authorization codes where the analytics indicate authorization may not be necessary. We look at which providers are doing a great job and greenlight them to approve their procedures automatically. We ensure that the guidelines are based on what the providers are comfortable with—that is based on evidence espoused by their respective professional organizations. Through our use of technology and artificial intelligence, we can determine in real-time the optimal care path for that specific patient episode. So, when we do a prior authorization, we know if there are risk factors to a specific patient if they undergo a certain procedure, or if alternatives would produce a better outcome at lower cost. This allows us to inform a physician about the most optimal care pathway based on the data. Again, it gets back to our focus on patient outcomes, versus just saying “yes” or “no” as in a typical prior authorization process. On top of it, we are able to activate the patients for programs offered by third parties and insurers, that can enable highly efficient care.

So, our Digital Prior Authorization is not only about automation of administrative processes, but it is also about reduction of waste, and ensuring that patients get high quality care in a timely manner. This is what makes our solution unique.

How do you use data science and AI ML for healthcare solutions?

There are two or three ways we are using AI and machine learning. One is we can figure out what information is missing and then retrieve that information from unstructured data in the EMR. Second, we accelerate the process by which clinicians are presented the data for review. We are able to use natural language processing to summarize information and highlight relevant clinical events buried in unstructured data to enable faster decision-making. And third, we’re developing a recommendation engine that takes all the information on a patient and proposes a clinical care pathway that is best suited for that person.

Hear it from the pro: What are the biggest trends in virtual patient care delivery industry that every medical professional should watch out for in 2021-2022?

There’s been a big shift in terms of COVID and making virtual care possible. We’re going to see legislation that will allow for reimbursements for virtual care. My bet is that Congress will be passing regulations and laws to make virtual care even easier for patients and providers. We also are going to see the development of devices that can interface with patients and get information from them so that more virtual care will be possible, along with devices at home that will enable virtual care. Virtual care is here to stay—and we are going to see virtual care replace most of the physician office visits.

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Tell us more about the hiring challenges for product/marketing teams of leading technology companies like Cohere. What advice do you have for the industry leaders in this regard?

We look for people with fairly advanced skills in terms of cloud and AI, but that talent can be hard to come by because the field is new and there is a limited amount of experienced candidates. So, we look for talent that can be groomed into those roles. It is a major challenge, though, and probably will be an even greater challenge as we come out of the pandemic. One thing we do at Cohere is to meet the needs of employees to do their jobs remotely, have flexible schedules, and work with cutting-edge technologies. We believe that what we offer, one cannot get at a large organization.

The U.S. has a shortage of people with technology and data science skills. There has to be more training, more programs in college to attract people, and we need to talk more about the rewards of a career in data science.

Thank you, Siva! That was fun and we hope to see you back on soon.

Prior to co-founding Cohere Health, Siva was a founding partner of SCIO Health Analytics which served over fifty Fortune 500 clients. Siva’s experience also includes serving as SVP, Chief Revenue Officer at MphasiS, SVP, Payer Services at Dell, and Senior Software Engineer at Intel. Siva received his bachelor’s degree from the National Institute of Technology in Tiruchirappalli. He holds a master’s in computer science from the University of Pittsburgh as well as an M.B.A. from the University of Michigan.

Cohere’s digital health plan solutions fundamentally transform utilization management in order to drive truly collaborative care journeys.  Their solutions not only automate provider and payer preauthorization functions, but also generate clinical policy guidance that drives better care decisions without having to delay or deny care.  Cohere then uses prior authorization as a trigger to engage plans, providers and patients in episode-based care paths that merge traditional utilization management, care management and patient engagement functions. Cohere’s solutions also fully support pending CMS and state regulatory requirements, including immediate auto-determination, review turnaround times and FHIR interoperability standards.

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