Keith Cline, VentureFizz
Niall, thanks so much for joining us.
Niall O'Connor, Cohere Health
Thank you for having me really excited to talk a little bit about Cohere Health.
Keith Cline, VentureFizz
Yeah, exactly. So Cohere Health, you guys are working on the digital transformation for a major part of the healthcare industry that definitely needs disruption. So talk about Cohere Health and what you guys do.
Niall O'Connor, Cohere Health
Yeah, so cool here, started with the express intention to help patients get more optimal care sooner. And when I say more optimal, there's a lot of things that come into that. So it is the right level of care, quality of care, and cost of care that the patient should be getting at any given time. And so when we started, we started looking at the space, one of the biggest impediments that we ran into was helping physicians better serve their patients, to begin with. So there are a lot of impediments in the way of practicing physicians, with just helping their patients get the right care. So it starts with a conversation that the physician has with their insurance company. And even in this day of modern technology, and machine learning that will, we'll talk about that conversation that a clinicians office is having with insurance company is happening usually on the phone, an analog device, or a fax machine. And they're exchanging really sensitive clinical information over those two mediums about 60% of the time, there's very little automation, or interoperability between your typical physician's office and an insurance company. And so here have come to try and solve that problem first, right. Because if you don't have satisfied physicians, you're not gonna, they're not gonna be able to give the best care they can to the patients. And so what we did was, we aggressively digitize this entire interaction. So, you know, in some interactions, we have connections directly into the electronic medical record. So the physician doesn't have to go to another system, or interact with a fax machine or some other device in their office, they're just using the terminal that they're used to using when they're treating patients. And we're able to get the order and interact with the insurance company and get approval for that order back as quick as possible. And so that's the ideal situation. Not every clinical practice has, you know, electronic medical records that can support these types of interactions. So we also have, you know, a web portal that physicians can come to, and how that's different is it's a web portal was created in the last couple of years with modern web technology, it doesn't look like Windows 95, which is pretty common in healthcare. And so we created this web portal that is, is, you know, using modern user experience and things you'd find in a typical consumer setting. And physicians actually like using us, they're able to populate the clinical information that the insurance company demands in order for them to make medical necessity decisions. And we give them an instantaneous response 90% of the time, so when a physician uses our portal, it's guiding them to the most effective cost-effective and, and clinically appropriate care. And so by the time they click Submit, which is a couple of minutes, typically, that that is going to get instantly adjudicated, because we again, have digitized all the decision making, right, so we've digitized the front end. And then we looked at the back end of you know, we have typically in most insurance plans, there are hundreds, if not 1000s, of clinicians that are taking these requests off a fax machine and reading them, and then turning around a decision that takes typically seven to 14 days and a lot of scenarios, we can do that instantaneously. Because what we did was we took all the clinical guidelines that exist and there is a mountain of these, right. So there are clinical guidelines that CMS at the federal level set, each individual state has their own guidelines as well. And then individual commercial payers have their own guidelines. And it's just an impossible web of rules for a physician to understand in a given context. And so what we've done is we digitize all of those really looks like Boolean logic for the most part. And then we use the digital information stream coming in from the from the front end, and then just turn around those decisions instantaneously. That's that's kind of where we've gotten to today. Right? We're, we're, we're at scale, so we're, we're live in all 50 states, there's about 25,000. physician practices use their software every single day. And we manage the care of about about 5 million lives. So so we have demonstrably changed the experience of not only that we're LIDAR but of these patients in a positive way. So, you know, typically I mentioned that when a when a lot of humans and fax machines are involved, that takes about seven days, seven to 14 days to turn this around. Well, when we look at our patient population, we can see this in the claims data that comes back. Patients that have their authorization requests flow through cohere, they are being scheduled for service on average, four days sooner. And that's, that's a really important element of this because, you know, if your primary caregiver, and you have to go see your physician and come back seven days later for the service after you saw them in the first place, well, that means you're gonna have to take you to know, either time off work or find other care arrangements for your loved ones. And we think it's, you know, these type of administrative delays that have been baked into the process due to manual handling causes health equity problems, people that can't afford to take days off work or find other care arrangements. We think we think we're helping them and then just, you know, patients who are in chronic pain, I feel, I feel it's kind of cruel and unusual to ask someone to go home and wait seven days for an administrative check from your insurance company. And so that's the good we're doing in the world. And we're doing it at scale.
Keith Cline, VentureFizz
And it's when I hear the word fax machine, that's still part of the process. It just blows my mind. It's like, okay, digital transformation needs to happen in healthcare, and cohere, is making that happen. So talk about your background, like what you'll How did you get involved with the company?
Niall O'Connor, Cohere Health
Yeah, so my background, so I've been involved in health technology for about 10 years. My prior role, I was Chief Technology Officer at a company. That was it was it was much more digitally focused. So we're actually looking at the genetic sequence of cancer tumors. And we were using that to help patients find more recently targeted therapies that are being approved, the target that specific mutations in their genome or the genome of cancer. And, you know, that was an interesting world to live in, because it's a high technology, right? These is the most advanced drugs that you can imagine. And the sequencing technology didn't exist 20 years ago, right. So we're really at the at the bleeding edge of, of kind of healthcare technology. But when it came to actually putting that into action at scale, you ran into a lot of roadblocks, the same roadblocks that all of healthcare is experiencing. Is that, sure, here in Boston, you have MGH that can afford to have these laboratories, you can have the, you know, physicians that are engaging in research at the real bleeding edge. But that's not the common experience of most healthcare participants. Right. And so what we found was that Sure, there were pockets of real advancement in cancer care, right? Patients were having curative effects from finding the right therapy at the right time. But it wasn't geographically dispersed. It was MD Anderson and Texas. It was MGH and Boston and Dana Farber in Boston. And so I felt that that was like if we're going to actually make a real impact in clinical care. It has to be vigorous. And so when I started looking at kind of my next opportunity, cohere came along, and there is was a mission to really align plan of care along evidence-based guidelines, right? So we have all these guidelines, were able to codify them, right? And then we're able to use the pointy end of the stick of the insurance company's payment incentive to make sure that they're follows. And I thought that is a fantastic avenue to democratize broadly, newer technology, newer approaches in healthcare, and it's not even it's not only like complex, you know, cancer therapies. But there's, there's a million on one small little innovations that happen every single day in healthcare, that aren't widely distributed. And so I felt cohere was the technology platform that could actually disseminate new ideas and healthcare broadly, because it's every single physician's office that has to deal with the patient population that we're hoping so that was the kind of the impetus for me to kind of move and consider this opportunity.
Keith Cline, VentureFizz
So talk about the team. Obviously, this is an incredibly complex problem to solve. So you need a really, really smart team to address these challenges. So talk about how the team is organized.
Niall O'Connor, Cohere Health
Yeah, absolutely. So you know, it's a very complex field. And so we need a lot of different skill sets to solve challenges here. So we're about 500 people and data split across those that, you know, deal with the physician practices every single day. And so that's a lot of people answering phones if there are any issues with cases, or dealing with the still few faxes that we, that we received today, we have a pretty large clinical team about 50 nurses, and about out of our 20, MDS on staff, and they are dealing with all the cases that don't necessarily meet the perfect articulation of the guidelines, but still require a clinical judgment to create an approval. And then more on the technology side, we've about 40 software engineers of varying different skill sets, from application developers, that are building tools that physicians use every day to people working on clinical intelligence. And then we have data science and machine learning team as well. We have a large product function that, that are responsible for making the tools that we develop the most user-friendly and effective tools in the marketplace. And then we have we've a pretty strong team involved in development of clinical programs. So these are people that are reading literature that are finding the best of breed ways to treat patients and all the kind of new advancements that aren't necessarily being taught in med school today. So so the clinical programs team are really important in helping patients get newer and more effective treatments.
Keith Cline, VentureFizz
I assume you're hiring for all those different functional areas that you just outlined?
Niall O'Connor, Cohere Health
Absolutely, yeah, I don't think there's a single department in the company that hasn't open, open positions. And really, that's the story of go here. Right, we've, we've been an incredible growth journey. So a little over two years ago, I joined the company, I think it was the 10th employee. As I said, we're about 500 people now. And we have very quickly doubled almost every six months to get to where we are today. And we are we are not, we're not slowing down. So you know, we've been really successful. With our first customer going into all 50 states, we're now broadening the disease areas are focusing on. So we're building a cardiology program and an oncology program. And we're also interacting with new customers as well. So all of that requires a pretty significant team with some pretty impressive skill sets.
Keith Cline, VentureFizz
So once someone does join the team, what's it like working there? What's the day-to-day culture? Like?
Niall O'Connor, Cohere Health
Yeah, so I'll talk a little bit about kind of the things that I think make working here really, really interesting. The problems that we're working on are, are truly, they're different, difficult and hard problems to solve, whether it's digitization of a pretty entrenched, industry like healthcare, or it's trying to understand the signal from the noise in, in the different clinical activity that's coming towards it coming to us, right. So physicians are free to make decisions about how to treat their patients. And, you know, a lot of the time they are doing the right thing, right, some of the times that they're just not aware of more modern ways to treat their patient populations. And then other times there's actually true innovation in how physicians practice medicine. And we want to be able to distinguish what is kind of willful blindness and what is innovative practice. And that takes data scientists work on work on the data stream that's coming in on that. It takes people with read rich and deep clinical expertise to actually understand what is novel and, you know, an effective way to treat something and what is kind of not a novel way to do it, and probably is ill-advised, right? So the problems that we work on are already really interesting. And it's a collaborative atmosphere where it's not just you know, engineers working in a corner, or data scientists looking at data in isolation to people who are working with technical programs, it really you need a group effort, and we go to great pains to create cross functional teams. And that means everyone from someone answering the phone, in our in our service operation center can be impacted by software that an engineer creates that changes how volume is is routed in the call center to someone who's running a clinical program and changes a rule and so having that cross collaboration between all members is essential to actually driving these programming forward. So it's it's deep and interesting problems. And it's its rich collaboration to try and to try and solve them.
Keith Cline, VentureFizz
So the job market is very active out there, there are lots of opportunities for people to explore. So that's a good thing. So why is now the ideal time to join Cohere Health?
Niall O'Connor, Cohere Health
Well, oh, you know, I think, I think if you asked me in a couple of years time, I'll probably say something similar, right? Every year, that goes by, we're kind of we solved a low hanging fruit that was available at that time, right. So every, you know, for us to advance in terms of helping patients get more effective care, we have to go much, much, much deeper into the understanding of the data, using machine learning to interpret notes, using, you know, PhDs to go out and researching programs. And so every year, the problems that we work on just we get deeper on them, right. And so, the reason why now is the right time is is that a lot of the problems we've already solved are kind of easy for us to solve now. And we need more people now to kind of go deeper and actually solve the kind of really unique problems that only occur in like a fraction of 1% of the of the population. But you know, what, we can learn things from that tiny, tiny population that might be more applicable to a different, wider cohort. And that's the type of interaction that we're constantly battling with Is there small signals that are driving better clinical outcomes that we can take and, and, and expand into guidelines and then codify them into whole programs. And so that now the time is right because because we have a lot of opportunities, we solve a lot of basic problems. And now we're gonna go deeper and solve some of the more challenging ones.
Keith Cline, VentureFizz
Well, if you are interested in exploring opportunities, that cohere help, you need to go to their company page on VentureFizz, which has all their listings, go to venturefizz.com/cohere-health, and you'll see all their listings there. Niall, thanks so much for taking the time to walk us through all the great things happening at the company.
Niall O'Connor, Cohere Health
Thank you, Keith. I appreciate it.
Transcribed by https://otter.ai
