In this episode, we talk with Syam Palakurthy, Co-Founder and Chief Executive Officer of SamaCare. Syam shares great insight for streamlining the prior authorization process to be sure patients don’t fall through the cracks. And, he encourages us to lean into process improvement to make a positive impact on patients during a vulnerable time in their life.
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Transcript: How to Simplify Pre-Authorizations with Syam Palakurthy
Amanda Brummitt: We Infuse podcast, episode number 58. Welcome to the We Infuse podcast. My name is Amanda Brummett. In every episode, we give you a seat at the table as we talk to Infusion Center owners, operators, and experts, so you can get the insight you need to run a thriving practice. In this episode, we talk with Syam Palakurthy, co-founder and CEO of Samacare. Syam shares great insight for streamlining the pre-authorization process to be sure patients don’t fall through the cracks. And he encourages us to lean into process improvement to make a positive impact on patients during a vulnerable time in their life. Well, thank you so much for being here today, sham. We’re so excited to have you on the show.
Syam Palakurthy: Yeah, I’m very excited to be on the show and obviously to be working with you on with we infuse in general.
Amanda Brummitt: Yeah,
Syam Palakurthy: thank you.
Amanda Brummitt: Well, I suspect that many of our listeners are familiar with you. But for those that aren’t, can you just start at the beginning and give us all of your background?
Syam Palakurthy: Yeah, absolutely. So, my, my background as I started school, I finished school with an engineering and economics degree. I really liked that combination of practical problem solving with the maybe more head in the cloud kind of stuff associated with econ. And I left there to work for a management consulting organization for a Bain Company. And I actually come from a a family of a lot of doctors, both my parents, one of my brothers, uncles, and aunts, some grandparents. It’s just doctors everywhere at family reunions. And when I started at Bain, one of the things that I told the the staffing manager was, I will work on essentially anything except for healthcare. I want to stay as far away from healthcare as possible. No
Amanda Brummitt: healthcare?
Syam Palakurthy: Yeah, I wanted to stay away from healthcare. And when I left Bain because I knew I wanted to be in small companies. I loved the excitement of building something new, of getting it going and really trying to push for scale. And when I left, I had no interest in going into health care for all the reason I wanted to get away from what my family had done, and it just seemed like an old and slow industry, but I kept running into this issue where I talked to companies that were interesting from some intellectual perspective, but I just didn’t. In a sense, care what happened with them. It didn’t feel like I was that motive. Like I never felt like really motivated by what they were working on. Not, no one was working on bad stuff. It just wasn’t stuff that like really got me going and ended up connecting with the founder of a company Through a close friend that was working on healthcare problem, and I actually didn’t really have any interest, but, I had a conversation with him because I respected him as someone that I had known. And what can I say? I fell in love with this industry. And, as frustrating and as slow as it is, and as behind the ball, when it comes to technology, as it is, I think at the end of the day, what was what’s always been really motivating for me and what’s been exciting for me is if you can build something in healthcare that, that makes the system better than at the end of the day, that, that is certainly helping a patient who is probably in a really tough spot in their life and that’s I use whenever things get it hard or I’m frustrated or annoyed. And I also think it’s just a really interesting industry because of, just so many wacky incentives and you start to piece them together and you start to figure out like, how do you align the incentives? The to work together, you can actually make magic happen. So I’ve been in healthcare essentially most of my career ever since leaving consulting and started at a company trying to bring price transparency to healthcare services ended up starting a company in the chronic care management space. And just based on some experiences from that, I it was really a big part of what, what caused us to want to found the company that we did here at SalmaCare.
Amanda Brummitt: And I’m going to get back to SalmaCare in just a minute. I love your concept of making the system better and you help the patient. That’s beautiful. And I also appreciate your humility, but I’m going to brag on you if okay, that’s okay. You failed to mention that engineering and econ degree, was it? Dartmouth.
Syam Palakurthy: Yeah, definitely. I was I was fortunate and happy to have gone there. It’s definitely been an important part of my life.
Amanda Brummitt: Yeah, absolutely. Well, I’m glad that you accidentally got into healthcare.
Syam Palakurthy: Same here.
Amanda Brummitt: And you’ve walked us through how you made that transition into the specialty medication realm. And then after that, then I want to get back to, to soma care and exactly what you do.
Syam Palakurthy: Yeah, absolutely. So, before this, I started a company, as I mentioned, in chronic care management, and I had been in health care at that point for five, six years but I’d never actually worked ironically, given, my parents and my family and whatnot, who are all doctors, I’d never worked in a clinical setting. I’d never seen inside of a clinical setting. And that experience was really eye opening because my, my dad he’s such a mild mannered individual, never complains or gets angry about anything except for a couple of items. And one of those items is actually prior authorization. He just gets so frustrated when he talks about it. And as a kid, I was always, as a annoying teen, I was always like, Oh, dad just wants something to get annoyed by. It’s not that bad. I’m sure. But working inside of clinics, it just got this really interesting eye opening view into how administrative barriers like the prior authorization, they weren’t just an annoyance that caused some frustration here and there. It was this huge deal that had an impact on, how effective providers could be in terms of the overall workflow of the patient. And in their experience of going through going through care and also just this huge impact on patients at, like I said, this incredibly vulnerable point in their lives, where all of a sudden something like an administrative barrier, like prior authorization can just be this overwhelming. It’s like the straw that breaks the camel’s back. And you just get patients who aren’t on, they’re not on the therapies they should be on, not because, they didn’t want to do it, not because their doctor didn’t want to do it, but because this kind of, very intensive process prevented them from actually getting onto the right therapy. And that’s really what got us into what we’re doing now. And, what was interesting was you asked about specialty medications. We when we started to dive into, we said prior authorization seems like this huge problem. Let’s see what we can do here. And maybe because we’re gluttons for punishment, we said, Okay, so prior authorization is a problem. Where is it the worst of the worst problem? Like, we wanted to start in a place where it was so painful. And had such an immediate impact on the provider and on the patient where we could have even if we were partially successful, we could have a really meaningful impact, which is really what brought us to specialty medications where there’s so much pain around getting patients onto these. They’re oftentimes expensive therapies because they’re oftentimes incredibly effective at what they do and very unique. And as a result they end up having just a lot of barriers around the administrative side of things, the prior authorization side of things.
Amanda Brummitt: Yeah, that all makes a ton of sense. So let’s go ahead and dive into soma care. So I understand that you provide software to streamline the prior authorization process for some of these life changing specialty medications. Can you walk us through how that works?
Syam Palakurthy: Yeah, absolutely. So my, my wife always likes to joke that we have the least sexy startup in the entire Silicon Valley area which I think is probably true, but it’s a great tagline. Yeah, that’s right. That should be the new tagline for something. Okay. Yeah. So, so the way that it works is it really comes down to what the providers are experiencing in their and getting into the nitty gritty. And what we saw was that It was just this incredibly fragmented process. So every drug, every payer the provider’s office needed to do something different for each of them. A lot of times, an embarrassing amount of time, not for our providers, but just for the state of the industry is, A lot of it was fax. It’s literally Googling a form, printing off a, that form, filling it out by hand, and then faxing it to the insurance company. Not because doctors are technologically slow. It’s because a lot of times that’s exactly and only what the payer is expecting.
Amanda Brummitt: Yeah, it’s crazy.
Syam Palakurthy: It is totally crazy. It’s totally crazy. And what the impact is for providers is it’s just such a fragmented workflow that it’s very easy for things to get lost for information to get, say miskeyed or mis entered and to get lost somehow in the system where all of a sudden, someone that should be getting onto treatment, tomorrow has to wait another month or a couple of months, or maybe doesn’t ever end up getting on that treatment at all. Okay. And that fragmentation is what we really focused on in our software. So what we do is some of care offers this single place to submit the authorization across all of the various payers across the different drugs that the provider is using to actually submit it to that payer in a single place, and we handle the kind of complexity of, Oh, this particular payer wants you to submit their facts. This payer wants you to submit through. This specific web portal, we manage that process. So we get it to the payer. And then we are tracking the response back from the payer. So we’re intercepting the response when it comes back. So that as soon as we see it, our system is automatically categorizing the response saying, Oh, this has been approved. This has been denied. Here, there’s a request for more information for the payer so that the the provider’s office sees that essentially immediately, or the office sees, Oh, we need to actually take action on Jane Doe, John Smith it’s approved, we can start scheduling the patient. So, so single place to submit, single place to track all those responses. And then just as importantly, a single place to manage this overall process, to be able to say. Okay, across the thousand prior authorizations that are in flight in our practice, 900 of them are actually fine. They’ve been approved. We can start. We can start moving on them. But we know that 100 of those are somehow requesting more information are getting denials require some sort of an appeal. So just being able to see that birds level view, not just for the individual user, but also for the administrator of the practice of the office to be able to say, Oh, here’s where we’re getting problems. Here are the payers that maybe we need to have conversations with because they’re taking a really long time or they’re approving these drugs at a very low rate. So, so having that bird’s eye level view of the management process. So again, single place to submit the authorization to track the authorization to manage all of the authorizations at the office.
Amanda Brummitt: That seems very efficient. And like something that we definitely need. Tell me about you. You talked about in the fragmentation people get lost. You hit a barrier, so they just fall off and what does your system do to ping the payer or ping the provider’s office and keep it keep it. Keep it something that we’re paying attention to. So the patient doesn’t fall through the cracks.
Syam Palakurthy: Yeah, absolutely. So the biggest thing, right, is just having this organization this place to have everything in 111 site, one view. So we have different filters for being able to see, like, where their authorizations that are say, For a patient that’s coming up in seven days, 14 days a month. So basically making it really easy for the provider. See that where they’re expired authorizations that like, Hey, it looks like this patient maybe is coming in next month, but their authorization has expired as of today, how do we make it really easy? The one see that and then to take action on it. So we have this ability to duplicate the authorization. That’s something that we get a lot of utilization out of. And we see a lot of our users and providers really like that is to be able to get that back to the payer and to get the response as quickly as possible. So, so really what it comes down to is having that view and that ability to see what’s going on rather than having to track it in unstructured. Notes in an EMR or to have to look at a spreadsheet somewhere and making it easy for like, if, if my colleague has gone tomorrow on vacation for me to pick up their authorization and to figure out what’s going on, or someone has to leave the practice for whatever reason, to be able to pick it up quickly and That to make sure that doesn’t result in some sort of a positive care.
Amanda Brummitt: Yeah, that’s perfect that the process is not determined around a certain person, but it lives independently. Love that.
Syam Palakurthy: Absolutely.
Amanda Brummitt: So then as I understand, there is now a, we infuse and saw my care partnership. So for folks that are on the we infuse software platform, how does that look for them? Do they need to turn it on? What does it cost? Is it already there? Give us all those details.
Syam Palakurthy: Yeah, absolutely. So, one of the easy, easiest ones there is on the cost. There is no cost. Yeah there’s no cost either to from we infuse or from Sama care to turn that on. There’s just some of the details of turning it on where we’re working some of those out. But Basically, they don’t need to really do anything besides letting we infuse now. Like, hey, we’re partnered with some care. We want to make sure that data that’s coming from we infuse is getting transferred into some care and vice versa. And the way we think about it is in the short term, it’s really just about making sure that. Like the simplest information, the demographics of the patient of the provider’s office, that kind of stuff is getting transferred nicely from we infuse that they’re already using into Sama care. So they don’t need to re enter manually enter any of that information. That’s the initial phase of it. What I’m really excited about long term is Really deepening the way those integrations work. So everything that’s going into the we infuse that’s relevant for the authorization just gets automatically pushed into Simon care. And when there’s a response that’s coming back and there’s information about the authorization of the patient that’s. That’s coming in through some of care that’s getting pushed back into. We infuse. So that’s the longer term plan. But just to make sure that this is an immediate win for practices, really just making sure that information on the demographic side is getting pulled from, we infuse into some of care. So it’s just reducing manual entry to start off in longterm. We want to work with, we infuse, and I know. Those like the, we infuse folks are super excited about this too, is how do we make that process as automated and integrated as possible long term
Amanda Brummitt: or sure, because every time we don’t have a human being rekeying something, we reduce the opportunity for errors.
Syam Palakurthy: Yeah, absolutely. Absolutely.
Amanda Brummitt: Well, that sounds like an amazing partnership and I’m really excited about it. Let’s dive a little bit more into your experience in infusions. What would you say has been your biggest challenge in infusion practice and maybe a specific story that gives us a behind the scenes view?
Syam Palakurthy: Yeah, it’s a great question. So, I was thinking about this question and I don’t think there’s been like one, capital C big challenge that we’ve run into. It’s been more just a small set of challenges and it really comes down to, uh, it’s comes down to workflow. Workflow is just a little bit different. And, when we started with infusion centers yeah. All of our experience had been with providers that were actually both prescribing the drug and administering the drug. And so we just have to we have to come to learn the way the workflow works. And I think there’s some small challenges that I can bring up like, we didn’t used to think so much about the difference between the referring prescribing prescriber. And doctor and the administering doctor. Those were always the same. And so that ended up having some ways that it flowed into our system that we needed to change and to make it really easy for infusion centers, for example, who, they might have a single doctor on staff, but they’re servicing 1000 doctors. And so we’ve made some changes to our system to make it so. You can do that where you can upload all of those doctors that you’re servicing. So you don’t need to reenter those every single time that you’re going through the system and so that it maps really nicely into the different ways that the payer is asking for that information. That’s one thing that, that we’ve had to learn a little bit about the others, just, for an infusion center, we understand speed is of the essence. It’s so important because. They might get, it might be a few different providers or a provider might send to a few different infusion center and ultimately comes down to the infusion center and needs to deliver an awesome experience for both the patient and for the prescriber. And one of the ways that they do that is. by being able to act really quickly. And so we’ve made some changes to our workflow to be more infusion center specific in that use case, so that they are able to to get through our system more quickly and to be able to to get the response more quickly. And there, there’s some other things that we’re working on in that regard, where it’s like, how do we make sure that It’s really easy for them to deliver information back to patients or back to the prescriber. So, so, like, one of the things that we’ve done, for example, is surfacing more of the expected time to approval so that the infusion center can tell their prescribing doctors or can tell the patient, like, here’s how long the data showing it should take so you can just plan around that and can plan accordingly.
Amanda Brummitt: Beautiful. Yeah. And you said this earlier, you talked about patients being at a really vulnerable state. So I love that you’re one managing their expectations. So you’re not adding anxiety on top of chronic disease. But to doing what you guys can to act quickly and get their treatment faster is huge.
Syam Palakurthy: Yeah, absolutely. Absolutely. Because exactly to that point about, at the end of the day, the patient, they don’t care about the prior authorization. They don’t care about any of these other pieces of this very large puzzle for getting on therapy. Especially for the therapies that we work with, because we tend to work with, specialty medications that are incredibly important for them functioning as a normal person in their life. All they care about is like, how do I get on therapy quickly? And how do I move on from this? What can be a traumatic experience in their life to just getting back to their life? And so. One, of course, is how do you make that as fast as possible, but then two is how do you give them, because sometimes patients are like, well, I understand if you tell me that it’s going to be a week or two days or, whatever it’s going to be before I can get on therapy. But I’d like to know that. So I can plan and set my expectations accordingly.
Amanda Brummitt: Yeah, absolutely. Totally makes sense. Well, tell me what has been your biggest lap bulb moment so far in the industry?
Syam Palakurthy: Biggest light bulb moment. I think, I’ll cheat Amanda and I’ll give you two. One was very early on where we didn’t realize how this is one where I think it sometimes gets underappreciated is just how many drugs and how many patients rely on infusions. That was definitely a light bulb moment. And I think, I honestly think that’s increased so much over the last decade that I think it’s something the industry hasn’t quite caught up on. It’s why frankly, like companies like we infuse are so valuable. And frankly, like why we focus in the area that we do is because it has been historically underserved. And I think you look at, if you look at the number of patients that were getting infusions, Say in 2005 compared to 2015 or compared to like 2023, it’s just gone up so much. And that, that’s been a huge, that was a very early light bulb moment for us. The second light bulb moment that I’ll say for me was, it was midway through or on the earlier side of starting the company but a little bit later than the first was just how. Incredibly important. It is to pay attention to the specific workflow of any individual providers office, and, you can have a one doc practice, you can have a 5, 000 doc health system, they all operate a little bit differently. And it’s important to really get into it because you can talk about those at a very high level and you can start to find commonalities. But until you get into the very detailed workings of how do they get from a prescription is written to the patient actually gets on to therapy, so you start to really map that out at a very nitty gritty level, I think any solution that you create ends up being, it ends up being too broad or doesn’t end up being specific enough. And that’s been something I’ve come to really appreciate over the last five years is how important it is to dive very deeply into the workflow and understand that. when you’re crafting any solution that uses technology.
Amanda Brummitt: That is so right, Sean. And I do think a lot of times we want practices to fit our technology and it sounds like you customize your technology to fit the practice. And what’s good for the patient, which probably makes you a great fit with the, we infuse software too.
Syam Palakurthy: Yeah, absolutely. There has to be, you have to have the humility to realize like there’s not one, one solution to everything. And over time, I think there’s almost a merger, right? Is if you start to think more about like, what are the many different kinds of workflows that exist out there that you need to support as a technology, I think what ends up happening on the provider side is They start to see like, Oh, this is working more than this other thing I was doing. And you start to get a little bit of a convergence between what a tech, cause any technology company has to be, you can’t build something truly bespoke for everyone, or it’s no longer a technology company. Right. But I think what happens is if you’re very respectful of the workflow as it exists, then that workflow does eventually change in ways that are both beneficial for the provider and for. Like the technology actually meeting the provider’s needs
Amanda Brummitt: for sure. Well, you’ve shared a lot and really thinking about, how many patients rely on infusions and how rapidly the industry’s changing. It’s actually really exciting. What are you most excited about right now in the infusion industry?
Syam Palakurthy: Yeah I’m really excited about is it just seems like there’s this, embrace of technology. And, uh, with technology, there’s also an embrace of what I’ll call like a form of experimentation is like it’s a lot of. It’s a, as they say invention is the, well, what is it? Need is the mother necessity is the mother of invention. And I think what’s happening is because, that huge amount of growth that’s happening in the infusion industry, there is an embrace of trying to really figure out like what works and how do we make. This work better for the patient. And with all sorts of trends that are happening in the industry, like side of care trends, things related to that. I think there’s been a lot more of like, how do we create a great experience for the patient at the end of the day? And the way I believe you do that, like technology certainly helps, but I think even more important that is really trying to experiment with different approaches to addressing some of these problems. Hopefully, paired with technology. Thank you. And then really leaning into that and trying to figure out, like, how do we make this the best possible experience? And I think the growth that’s happened as has really has really facilitated that it’s just a different mindset than I think, not every part of the healthcare system has that mindset, unfortunately, and I love seeing that here.
Amanda Brummitt: Yeah, I think that’s a great point. I couldn’t imagine being diagnosed with one of these chronic conditions. Okay. So I find a doctor, somebody is going to help me. They’ve got some miracle drug. And then I find out, but wait a minute, it’s going to take two weeks, three weeks, a month to get it approved. And, you’ve gone from being scared to now I’m being scared and I’m maybe mad because I’m going to have to wait. And I love the way that you’re using technology to really humanize. Healthcare.
Syam Palakurthy: Yeah. And, there’s this experience I had relatively recently with a family member who it it was a really tough situation. It was someone who was towards the end of his life and it seemed like he was deteriorating pretty quickly. And there was this somewhat experimental medication that. His family wanted to get him on and, at the end of the day, I remember getting a call from his wife trying to get help on how to get him onto this therapy because she was getting blocked and her provider was getting blocked by prior authorization and it ended up getting resolved. Unfortunately, he ended up passing away and it probably wasn’t going to be the difference in, him having a shot or not. But what, what makes me so angry about the whole situation is he was always going to get approved for this. They, it was just this thing. I don’t even know if I blame the insurance company. I used to, but I don’t anymore. It was just this whole process and apparatus that slowed down him getting onto therapy. And what kills me, what makes me angrier than the fact that he was put on therapy late was. That his family had to fight in order to get him on therapy for something that was always going to happen just because of this horrible process. And to the extent that like, we can make that a better experience. For folks like, like, this family member and his family, that is like what we’re that’s essentially what we’re trying to do is how do we make sure that just the amount of pain that ricochets at the patient gets reduced to the point where it’s not a pain at all. It’s just a thing where patients are able to get on the right therapy based on purely the clinical nature of what they need, what the doctor thinks is needed and what they feel is right for themselves.
Amanda Brummitt: Yeah. Yeah. To use your words, it’s making the magic happen and the patient never even knows about it. Yeah. Absolutely.
Syam Palakurthy: Absolutely. Which is exactly how it should be.
Amanda Brummitt: Yes. For sure. Well, Sean, you have shared so much great information. If you had one last piece of advice for our listeners, what would it be?
Syam Palakurthy: Yeah. To go back to what I was saying a moment ago is I think always just look for ways to experiment to make the process better. And sometimes that means you need to tolerate some degree of like experimenting is always more painful than doing what you’ve always done in the short term, but it’s almost always much less painful and much better in the long term. And so I think whether it’s frankly technology companies like us, providers, patients, whoever it is, just trying these little experiments that can help figure out. Where can you make it a little bit better? And in trying to lean into those and figure out where there are the wins to be had.
Amanda Brummitt: That is fantastic advice. Thank you so much for that. We can, we all need to remember that every day that we’ve got to tolerate that little bit of discomfort so that we make it better for the patients that trust us.
Syam Palakurthy: Yeah, absolutely.
Amanda Brummitt: Yes. Well, thank you for your time today. Thank you for sharing Salma care with us. And we look forward to our listeners getting to explore it.
Syam Palakurthy: Absolutely. Thank you so much, Amanda. It’s great to talk to you today.
Amanda Brummitt: Well, that was great information from Sean Polakurthi of SamaCare about the complexity of preauthorizations, customizing workflows, and experimenting to improve processes for patients. If you aren’t familiar with the WeInfuse software platform and RxToolkit’s web based resources, I encourage you to schedule a test drive and be sure to check out SamaCare. Transcripts provided by Transcription Outsourcing, LLC.
Guest Speaker:
Syam Palakurthy is the Co-Founder and Chief Executive Officer of SamaCare. With years of experience in the healthcare world, we were thrilled to host Syam as a special guest on the WeInfuse podcasts for this episode.
