Cohere Health

The team at Cohere Health
Cohere plans to more than double its revenue by significantly expanding its health plan client base in 2022, executives said. (Cohere Health)

Cohere Health is a winner of FierceHealthcare's Fierce 15 awards. See our other honorees here.

Cohere Health launched based on a very simple premise: every patient deserves to know where they’re going, every physician should feel supported in their decisions and every health plan should be able to deliver better outcomes for their members.

Cohere Health

The big idea: Cohere Health leverages the latest advancements in technology, interoperability and analytics to help health plans intelligently automate manual processes and bridge the gap from volume to value. Cohere enables greater collaboration between health plans, providers and patients, driving better care quality, better outcomes and less unnecessary medical cost.

Headquarters: Boston 

CEO: Siva Namasivayam 

Launched: 2019

Latest milestone: In 2021, Cohere Health implemented the first care path-driven, digital, prior authorization platform across 2.5 million lives, and the company achieved an unprecedented 94% provider adoption of the digital platform.

Goal for 2022: Cohere plans to more than double its revenue by significantly expanding its health plan client base and to increase its employee size by more than 15%. In addition, the company wants to close out the year with four-to-six times its current number of clients.

Funding to date: $56 million

FY2021 revenue: Declined to state

Number of employees: 400

As of the start of 2022, Cohere’s platform works with 65,000 providers and gives coverage to 5.5 million people. Uniquely, providers using the Cohere platform can immediately schedule patients for the clinically approved service in 89% of cases, with the remainder receiving expedited review – overall allowing patients to receive requested services four days faster.  

The speed and agility of the platform have proved to have a substantial impact on patient care outcomes, including an 11% shift from inpatient to outpatient settings and a 43% decrease in medically unnecessary surgeries. 

Cohere’s CEO Siva Namasivayam has found that differentiation and value are key to his company’s success in the healthcare space but equally important is adaptability and usability with an organization’s systems and processes.

Fierce Insights from Siva Namasivayam, CEO of Cohere Health

What is your best piece of advice for launching a healthcare company that challenges the status quo?

The key to success is to focus on a niche problem. The healthcare space is vast and complex, with a wide variety of stakeholders and competing interests. Attempting to boil the ocean will kill a company. Successful companies are laser-focused and take a differentiated approach that challenges the status quo, and then backs that approach with quantifiable ROI and outcomes. With this type of foundation in place, companies can expand and take on bigger challenges.

Siva Navasivayam, Cohere Health CEO
Siva Namasivayam (Cohere Health)

What is the failure you’ve learned the best lesson from?

In my previous work, our team focused on building a product around value-based benefit design. The work was truly innovative, the ROI was there and we had genuine excitement, but at the end of the day, it was challenging to integrate the solution into the day-to-day workflow and legacy ecosystems in place. This became a particularly important learning point for me. You may have the best product in the world, but if you can’t figure out how to fit that product into established workflows and ecosystems of the key players in the healthcare market, you are not going to be able to make a difference.

What is the book you recommend to other healthcare leaders?

"Noise: A Flaw in Human Judgement," by Daniel Kahneman, Olivier Sibony and Cass R. Sunstein, which discusses chance variability in judgments. They demonstrate the detrimental effects of noise in several fields including medicine. Healthcare is full of experts making clinical judgments – physicians, specialists making decisions based on an individual’s diagnostics, nurses reviewing cases – and there is so much opportunity for variability. Understanding and addressing the issue of noise in the context of clinical judgment could have a considerable impact on variability in care, health outcomes and medical spend.

What is your prediction for how the healthcare industry will change in 2022?

2022 is going to be the year of post-COVID analysis and planning. There is already a realization and acceptance that many of the changes driven by the pandemic are here to stay; virtual care is one example. Healthcare leaders will be examining how they build these changes more permanently into existing frameworks, while also evaluating what additional investments need to be made. Interoperability, data and AI will continue to grow in importance as a result. 

What advice would you offer healthcare leaders seeking to make a real impact on health equity?

While health equity has rightly begun to generate a certain amount of “buzz” in the industry, it is rarely resulting in concrete actions. To make a real impact on health equity, organizations need to approach it not as a marketing or public relations exercise, but as a business priority. Healthcare leaders need to examine their domains of focus and identify discrete areas where they can drive meaningful change and then transfer the role of health equity into a measurable KPI. Health equity then becomes an organizing principle and shared objective of the organization, positioning them to drive real change.  

Cohere Health