Shiva Namasivayam said he is passionate about solving some of the toughest problems in healthcare.
Namasivayam is CEO of Cohere Health, a healthcare technology company based in Boston. The company is working to eliminate some of the complications in the prior authorization process, which requires physicians, health systems, and medical practices to obtain payer approval for certain treatments, drugs, and procedures.
In the latest episode of the Data Book podcast, he says he wants to “solve problems using all the best tools available today in terms of data and technology.”
Doctors and hospitals have long criticized the prior authorization process. They say this could delay patients from receiving the treatment they need and lead to worse outcomes, with some patients forgoing treatment. Hospitals and medical organizations also say the preclearance process greatly contributes to physician burnout. Payers argue that the pre-approval process helps control costs and reduces unnecessary procedures.
Cohere Health works with healthcare providers to help you avoid the hassle of getting approval. The company’s technology uses artificial intelligence to review medical records to determine whether a treatment plan meets payer requirements or if an insurance company requires additional information.
In most cases, Cohere’s technology turns out to get the procedure approved, but Namasivayam says the process allows providers to know sooner which treatments require more documentation. He said this could potentially avoid conflicts with payers.
Cohere processes millions of transactions annually. Namasivayam said his company aims to ease tensions between payers and healthcare providers, leading to better care for patients.
The company says it has reduced the time it takes to make approval decisions.
Improving the prior authorization process is also a health equity issue, Namasivayam said. Health care providers with more modest resources and equipment must devote more human resources to the process, resulting in greater delays for patients to receive approval for treatment.
Namasivayam says he would like to see more conversations between providers and payers about licensing centered around patient safety.
“That’s not what’s being done today, because a lot of health plans are just saying yes or no,” he says. “But I think they need to go beyond that and figure out what is the best treatment for the patient. Where can they get it, how can they get it, and can they communicate that? And the available alternatives are:
“I think healthcare providers should push this into their health plans as well, so everyone is actually trying to benefit the patient,” he added. “That has to be the goal.”