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Banjo Health Quarterly Update – Q1 2021


Have questions for Banjo Health? Contact us.


A Message from CEO, Saar Mahna:

The first quarter of 2021 went by in a blink. Our team has accomplished some tremendous things over the past three months. We have added to our marquis client base, expanded our product offerings, and begun to lay the foundation for us to expand into complementary markets. All the while, we have had a lot of fun in the process. I am tremendously excited for what 2021 is shaping up to be for Banjo.


What is happening at Banjo Health?

Continuing off the momentum created at the tail end of 2020, this quarter was filled with significant new milestones both internally and externally that continue to stretch and push Banjo Health to grow and improve. With an internal philosophy of being “always yellow,” the team is never satisfied in its efforts to improve the overall prior authorization experience leading to the following achievements in Q1 2021:


With each passing quarter, one unique way that Banjo Health stays motivated is by allowing employees to share quotes that have had an impact on them at each week’s all hands. One of the quotes from this quarter’s series of midweek motivation is:


Perfection is boring. Getting better is where all the fun is.” - Dragos Roua, author


This quote ties into the philosophy of “always yellow” by expressing the sentiment that the team never rests on its laurels when challenges inevitably pop up leading to fun and engaging opportunities to band together to craft novel pathways forward. Learning and sharing new skills at Lunch & Learns, diving into cutting-edge research to adapt into the solutions, ideating sessions tackling previously unaddressed needs in the market. All of these and more are what make up the family culture at Banjo Health keeping the team dedicated to the never-ending and enjoyable pursuit of “getting better.”


If you would like to learn more about Banjo, contact us at contact@BanjoHealth.com or visit Banjohealth.com to Get In Touch.


Employee Spotlight

Yuan Yu - Data Scientist

I joined Banjo Health in 2019 after I graduated from Worcester Polytechnic Institute, where I met a group of people who have a passion to change the prior authorization industry and gradually grow together as a team.


Q: What made you decide to pursue your Ph.D. in Bayesian statistics and why did you decide to join Banjo Health to apply that knowledge?

The first time I experienced Bayesian statistics was back at a seminar about Bayesian statistics during my undergraduate study. What really triggered me to go deeper into this area was the guidance of my advisor who showed me the power of Bayesian statistics and inspired me to explore more.


I am always ready to seek more opportunities to pursue further applications of Bayesian statistics. The whole idea is that the AI machine is able to perform like humans, do what people can do but by relying on data only. Inherently, what aids human beings to make decisions exactly follows the Bayesian idea that the current decision you are making is reliant on the decisions you have made in the past and the corresponding feedback.


The same principle applies to the prior authorization industry where the prior knowledge from the expert is essential for building a machine learning model that meets clinical criteria.


Q: How do you think Banjo Health’s application of AI/Machine Learning improves over existing AI technologies? What makes Banjo Health’s AI unique?

Among all the AI applications in the healthcare industry, there are not many focusing on solving the problems in prior authorization. Under close collaboration with a clinical pharmacist with domain knowledge, we are able to understand the issues that each of our clients specifically encounters in order to act with corresponding solutions quickly and efficiently.


Originally, we designed a unique process to provide solutions that support fast and intelligent decision-making.


Q: What are your hobbies outside of Banjo Health?

I am fond of various sports activities, like table tennis, badminton, and skating. I also enjoy planting and cooking in my spare time especially when related to traditional Chinese cuisines. Hiking and traveling are the top two items on my wish list this year.


Open Positions

Sales Positions:

  • Sales Ops / Enablement

Technology / Development Positions:

  • Software Engineer

  • Architect

Clinical Positions:

  • Staff Pharmacist

  • Pharmacy Tech

Data Positions:

  • Data Engineer

If you would like to learn more about current and future positions at Banjo, please visit the careers section at BanjoHealth.com.

Market Prospective

Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information

On December 10, the U.S. Centers for Medicare & Medicaid Services (CMS) released new rules relating to patient health exchange, or interoperability, and what that means for providers, patients, and payers within this context. While providers and patients will see reduced burden, payers will now have additional requirements to fulfill.


CMS aims to build on the original ruling, ‘Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information,’ as part of their initiative to improve health information exchange and reduce patient burden. Taking the original rule, CMS has now expanded it to ensure that payer and provider burden is reduced while still creating more accessible avenues for accessing health information.


The rule would require increased patient electronic access to their health care information and would improve the electronic exchange of health information among payers, providers, and patients.


With these new measures in the mix, payers will likely need to take a long look at current processes, especially relating to prior authorization and its role in patient health information exchange.


Officially titled ‘Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information,’ we will look at the requirements laid out broadly and then examine some of the implications for payers and medical prior authorization in more detail.


Here is what you need to know about CMS and its requirements around promoting interoperability.


What are the CMS interoperability requirements?

The broad scope of the rule is to improve interoperability and patient access to health information, and this applies to:


Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information

• State Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs

• Medicaid managed care plans

• CHIP managed care entities

• Qualified Health Plan issuers on the federally facilitated exchanges


More specifically, these specific CMS-regulated payers will need to improve interoperability and electronic healthcare data exchange via Application Program Interfaces (APIs) to streamline prior authorization processes and ensure that patients can access health data easily.


This is particularly important as patients will likely switch in and out of various programs based on eligibility and different requirements. Therefore, they will face medical prior authorization challenges that can cause delays in care. As patients switch between payer types and plans, this rule can help avoid any disruption in care. It protects patient health data and enables it to move with them as patients switch providers and payers.


How do CMS interoperability requirements affect prior authorization?

To read more about how Banjo Health believes the CMS interoperability requirements will affect prior authorization moving forward, please explore the Banjo Health blog here. If you would like to learn more about Banjo’s thoughts on the PA landscape, please contact us at contact@BanjoHealth.com or visit Banjohealth.com to Get In Touch.

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