How Digital Prior Authorization Is Improving Patient Care

Overview

Cohere Health Chief Executive Officer Siva Namasivayam examines how manual prior authorization processes hinder care collaboration and delay patient treatment. He outlines the administrative toll on clinicians and cautions against regulatory approaches that eliminate authorization requirements entirely, noting they can drive up unnecessary medical expenses and compromise quality.

Instead of removing oversight, Namasivayam advocates for digital platforms powered by artificial intelligence and natural language processing. He highlights how these technologies help health plans expedite clinical reviews, interpret unstructured clinical data, and fast-track high-performing providers. By connecting evidence-based guidelines with workflow automation, he explains how organizations can support more efficient, consistent, and collaborative care delivery without sacrificing accountability.

Key themes covered:

1. The clinical toll of manual processes

• Namasivayam cites American Medical Association survey data showing that authorization delays frequently lead to abandoned treatments or adverse clinical events.
• He connects this administrative friction directly to widespread clinician burnout, noting that practices often dedicate two full workdays each week to navigating manual submissions.

2. Evaluating regulatory tradeoffs

• While acknowledging the need for regulatory modernization, Namasivayam warns that policies allowing providers to bypass authorizations altogether remove critical safeguards.
• He emphasizes that eliminating the ability to monitor care quality doesn't solve the core issue, but instead shifts the burden toward higher premiums and member costs.

3. Connecting workflows with digital intelligence

• Artificial intelligence supports faster approvals by categorizing unstructured electronic medical record data and expediting necessary clinical reviews.
• By integrating professional medical guidelines into the workflow, digital platforms help health plans ensure better clinical outcomes, reduce friction, and optimize care paths.

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