What Penguin AI does
Penguin Ai is a platform that automates the administrative and back-office work that weighs on clinicians, coders, and operations teams. Its AI agents handle tasks like prior authorization, medical coding, claims review, and risk adjustment, freeing health plans and providers to spend less time on paperwork and more on patients.
The platform is built on generative AI. These models can read documents and process huge amounts of information meant, which makes them well suited to the administrative problems health plans face
Why this matters
Health plan administration shapes the sustainability of Medi-Cal, how satisfied providers are, and the quality of care patients get. Prior authorization, for example, helps confirm that care is safe and necessary, but it can also delay care. CHCF’s 2024 Health Policy Survey found that four in 10 Californians say they or a family member has had to wait for a prior authorization, and more than half of them waited a week or longer.
The burden is not shared evenly. CHCF’s research found that Californians with low incomes were more likely than those with higher incomes to need a prior authorization and to wait longer than a week for care to be approved.
Founder and CEO: Fawad Butt
Fawad has served as Chief Data Officer at UnitedHealth Group and Optum, and Chief Data Governance and Chief Data Officer at Kaiser Permanente. At UnitedHealth and Optum, he oversaw the enterprise’s data and analytics capabilities. At Kaiser, he helped define the data governance model, led an enterprise-wide data privacy and security effort, and built the data foundation that supported Kaiser’s digital care delivery for years.
Why CHCF cares
This program-related investment fits our Technology in Medicaid work, which supports responsible AI in the Medi-Cal delivery system. It backs emerging AI that could help Medi-Cal managed care plans serve their members and providers better. That includes streamlining workflows to keep providers satisfied, giving members a better experience, speeding up prior authorization to improve access, and reducing delays in enrolling people and confirming eligibility so care isn’t interrupted.
CHCF wants to see AI tools reach the safety net. Right now there is a real risk that safety-net plans and providers fall behind on these tools, which would widen the gaps in care for communities that already face the greatest challenges to access and quality. Penguin AI aims to partner with CHCF to bring AI tools to Medi-Cal plans, and its team is building ways to monitor and address bias in its AI systems.
See the Innovation Fund FAQ to learn more about program-related investments at the California Health Care Foundation and how we reinvest profits in our mission-related work.