Digital health company Cohere Health has raised $90 million in a series C funding round to bolster research and development opportunities.
The round was led by Temasek, an investment firm owned by the Singapore minister for finance. Other investors joining the round are Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital and Polaris Partners.
For most of Cohere’s history, the company has focused solely on simplifying prior authorization for payers and risk-bearing providers. Cohere is now looking to use artificial intelligence to improve care management and other instances of administrative burden, said CEO Siva Namasivayam in an interview with Fierce Healthcare.
“Now we are finding that, since we have a lead in the marketplace, we want to be able to take the clinical grade AI we developed and get into additional areas that can help both the payers and the providers,” he said.
The funds will primarily go toward AI models—which are costly and need adequate cloud bandwidth and processing power as well as expertise. Secondarily, the funds will add to the company’s sales and marketing budget.
Cohere is also looking at the possibility of small acquisitions to “bolster our subject matter expertise,” said Namasivayam.
The company already processes 12 million prior authorization requests annually. In 85% of instances, the AI is able to make a real-time decision, and 15% of decisions get final sign-offs from nurse reviewers and medical doctors. These medical professionals are assisted by AI assistants, or co-pilots, to make decisions faster. No claim is denied exclusively by AI, he added.
Namasivayam sees similar opportunity to ease the care management process just how the company has attempted to clarify the back-end process for prior authorization.
“We believe we can simplify the whole thing, so instead of it taking 40 to 50 minutes for the physician to be able to review, with our copilot we can get that down to 10 minutes,” he explained. “That allows them to work on top of their license because today, people actually spend a lot of time … not able to truly focus on their clinical expertise.
“We are going to digest the information so that they can focus on what they’re really good at, which is reviewing these notes and then making a judgment on what is the right outcome for the patient,” Namasivayam added.
This same concept can be applied to other administrative tasks, such as when multiple provider departments are involved with a patient’s medical records. If these records and information can be compiled and distilled, the next physician to treat the patient will be able to do so more quickly.
In turn, physicians will be less likely to suffer from burnout, Namasivayam said.
Last year, Cohere closed a series B round valued at $50 million to help streamline its prior authorization technology. The company has now raised more than $200 million.
