Conversations with Perry and Friends: Saar Mahna, J.D., MBA

It seems like everyone in healthcare is talking about artificial intelligence these days. Perry Cohen, Pharm.D., a member of the Managed Healthcare Executive (MHE) editorial advisory board, jumped into the topic du jour in the latest episode of his podcast, “Conversations with Perry and Friend,” hosted by MHE. Cohen’s interlocutor is Saar Mahna, J.D., MBA, CEO of Banjo Health, an artificial intelligence (AI) company that is focusing on using AI to make one of U.S. healthcare’s stickiest sticking points, prior authorization, more efficient. Mahna says the company, which he founded in 2019 before AI was a household word, now provides its services to eight clients covering more than 20 million lives and processes 2 million prior authorizations a year.

Perry Cohen, Pharm.D.

Not surprisingly, Mahna is an AI optimist and casts the brainy technology as ridding healthcare of friction and drudgery.

“AI is not going to fully replace human decision-making,” he told Cohen. “It is going to reshape the conditions in which humans are making decisions, because it's going to surface better insights. It's going to catch those edge cases and really try to reduce that administrative sludge.”

Mahna said he saw the potential for using AI to speed up authorization when he was working for a pharmacy benefit management (PBM) startup that was working on a large Medicaid managed care plan. ”I got front-row seats to what was going on in their specialty drug prior authorization area, at which I said, ‘Boy, there’s an opportunity here to help streamline this process and really drive value for the members and actually help them get that life-altering therapy more quickly.’”

Saar Mahna, J.D., MBA

Mahna noted that prior authorization has both clinical and administrative aspects to it and that AI “does a wonderful job of marrying the two.” He also described his company’s pivot from taking a Bayesian approach to the data in claims that looks for similarities to past claims and approval patterns to a language-based approach that zeroes in on the unstructured portion of the chart notes.

Prompted by Cohen to look into the crystal ball, Mahna painted a picture of AI creating the conditions for less friction and more harmony between payers and providers. “We finally stop fighting over data, and we start collaborating over outcomes. This is the fully aligned world…a physician writes an order, and at that point of order entry, they are getting real-time feedback on appropriateness, coverage, cost.” And, Mahna adds, payers are not just looking at codes, but at rationales for why a provider is pushing so hard for a certain type of treatment.

The human element figures in Mahna’s vision for AI, not just as it is used but also in getting various healthcare interests to work together to adopt AI. “It’s not going to just be like a magic bullet. You’re going to need a lot of different folks involved working to actually build those connections.’