Plenful Raises $50M To Transform Healthcare Providers’ Back Office With AI, Saving Millions

Healthcare may be slow to modernize, but AI-powered startups like Plenful are betting big that change is coming to its most painful corners — the back office — through automation. The San Francisco-based startup has announced a $50 million Series B raise co-led by Arena Holdings and billionaire Mitchell Rales, co-founder of Danaher Corporation, with participation from Notable Capital, Bessemer, TQ Ventures and Susa/Kivu Ventures, to automate the repetitive, bloated administrative workflows that cost healthcare providers millions every year and fuel rampant provider burnout. “This is a trillion-dollar market with significant white space, and Plenful has built a compelling wedge,” explains Chelcie Taylor of Notable Capital. “That’s why we were excited to invest.”

With AI at its core, Plenful is positioning itself as the “behind-the-scenes fix” for a healthcare system struggling under the weight of outdated processes. And the startup has rapidly gained traction, onboarding 60 healthcare institutions to date — including Cencora, UCLA, MUSC, and Tampa General — and is sustaining strong momentum with 4x year-over-year revenue growth.

To get a deeper understanding of the actual day-to-day problems Plenful is addressing, I spoke with Founder & CEO, Joy Liu in an exclusive interview for Forbes. Prior to founding Plenful in 2022, Liu worked as Director of Strategic Operations at Shields Health Solutions, a specialty pharmacy, where she was able to see first-hand the “sheer volume of work” that staff have to manage. “It was eye popping…and that workflow burden definitely shows up for the patient,” she explained. By leveraging automation, “we are freeing up staff who can now focus more on patients,” and support a greater patient load.

The reality is that physicians spend nearly twice as much time on paperwork as they do on direct patient care. Furthermore, nurses spend up to 25% of their shift on documentation tasks (non-clinical work), while pharmacists spend 30% of their time verifying prescriptions versus other duties like patient education and counseling.

To help ease this workload, Plenful focuses on various workflows that consume valuable staff time, such as prior authorization workflows and compliance with the 340B Drug Pricing Program. Here’s a closer look at each.

Prior Authorizations Workflows

If you are not a medical professional, chances are you may not be familiar with the mechanics of how this antiquated system works, but prior authorization (PA) is a complex set of requirements that US healthcare providers must satisfy to get medical care and medications approved by health insurers – payers.

The PA submission and review process often involves providers scrambling to gather patient-specific medical information including a summary of the patient’s condition and treatment history. The submissions are typically manual, with phone calls, or faxed paperwork going back and forth between providers and insurers. And during the PA review period, a patient’s medical care is often delayed – for days or even weeks, if the treatment, test, or medication requires PA before insurance will pay for it.

Dr. Elizabeth Ofili, a practicing cardiologist and founder of Health 360x, a platform supporting healthcare institutions with clinical research, shared that: “in one case, after many hours of my time and staff time, we were unable to convince the health plan that a 55 year old man, with significant risks for heart disease should receive a recommended heart catheterization. After many visits to see me with complaints of chest pains and an inconclusive nuclear scan, he was eventually approved for the test, which showed severe heart blockage in his main artery – and this type of blockage is actually called the ‘widow maker’ because it can lead to sudden death.” Indeed, 29% of physicians report that PA has led to a serious adverse event for a patient in their care, according to the 2024 American Medical Association (AMA) Prior Authorization Survey.

Beyond the potentially catastrophic consequences for patient care and wellbeing, the PA process places an immense amount of financial strain on healthcare institutions and, by extension, patients. According to a 2023 CAQH Report, the cost of manual prior authorization administration for providers was $1.05 billion annually. In addition, when medical care is provided before a PA is approved, which is sometimes necessary in urgent or ambiguous cases, providers are often forced to absorb the full cost if the claim is later denied, which can lead to thousands of dollars per patient — which are subsequently passed on to patients in the form of unexpected medical bills.

Plenful’s belief is that in many instances, the health information necessary to satisfy PA is available though perhaps not easily accessible. And so the platform is designed to find and extract required information from various sources of medical records.

Liu explained: “There’s so much disparate data that exists in all these organizations. Whether it’s a fax, a messy Excel spreadsheet or pulling from one of their existing electronic medical records or other systems, we’ve built a very robust machine learning stack to wrangle those data sources.” After submission, the platform assists with tracking the status of each PA request and flagging any follow-up actions needed from providers in a dashboard interface.

340B Drug Pricing Program Compliance

Now another key use case for Plenful is 340B compliance because the 340B Drug Pricing Program is big business in healthcare — to the tune of $54 billion, and is actually quite complex. Launched in 1992, as a safety net program to help support cash-strapped healthcare institutions serving medicaid patients (termed, “covered entities”), the 340B program allows for price arbitrage – where healthcare institutions buy prescription drugs from pharmaceutical manufacturers at a discounted price and get reimbursed by insurance companies, or payers at the market price – and the savings goes to support lower-cost medication and medical care for low-income and uninsured patients, in theory. It’s the “Robin hood principle” in action.

The eligibility criteria has evolved since the program’s inception due to both policy changes and industry consolidation, and so too the number of participating institutions. For example, in 2010 the Affordable Care Act added Critical Access Hospitals, Rural Referral Centers, Sole Community Hospitals, and Free-Standing Cancer Hospitals to the program. Around the same time the agency that administers the 340B program – the Health Resources and Services Administration (HRSA) expanded coverage to the outpatient clinics and pharmacies attached to existing hospitals; in addition, covered entities were permitted to contract with multiple retail pharmacies to dispense 340B drugs, further extending the universe of 340B participants. While there were fewer than 1,000 covered entities in 1994 — mostly public hospitals, community health centers, and clinics receiving federal funding, today there are over 50,000 covered entities eligible for the 340B Program.

With billions of dollars of discounted drugs flowing to healthcare institutions, alarm bells have been ringing, especially from drug manufacturers, about a lack of transparency and accountability in the administration of the program, and a misallocation of the cost savings away from the intended recipients – lower income patients. On the other hand, healthcare institutions insist that the intent of the program is being honored, with 340B savings being reinvested in community health services, free clinics, charity care, uncompensated care, and patient access initiatives. Some healthcare executives admit the program has veered from its original intent, but assert that healthcare organizations operate at “razor thin margins”, struggling to make ends meet due to being underpaid for services by payers, and “340B savings fills the gap”. In either case, the pressure placed upon healthcare institutions to tighten up their 340B programs has increased, in line with the enhanced scrutiny of the program.

Enter Plenful, which performs compliance audits to ensure adherence to the HRSA rules and manufacturer terms, checking for things such as site eligibility and unlawful duplicate discounts (receiving a 340B discount and then submitting a Medicaid claim for the same drug). At the same time, the platform is able to review prescriptions or treatments that were originally assumed ineligible for 340B discounts — and uncover hidden savings by identifying eligible claims that manual processes might have missed. As a point of clarification, although institutions purchase drugs at a 340B discount, they often determine after the fact which prescriptions meet the full eligibility criteria based on data pulled across different systems – EHRs, pharmacy dispensing systems and medical billing platforms. Liu shared that in one instance, “after two months of working with a system, we identified $1.2 million of additional 340B savings. It was really exciting to see that kind of output.”

Addressing the controversy around 340B, Liu noted that given the macro environment and increased scrutiny from both manufacturers and payer groups, the operational complexity and burdens have just increased on healthcare providers, so having a platform like Plenful which offers more transparency has really resonated. “We’re all about transparency and data harmony.”

Final Thoughts

The fact that healthcare in America is a broken system is an often cited but less understood reality. Beneath the surface of every delayed treatment and rising hospital bill lies a maze of outdated, manual back office processes and workflows that drain both financial and human resources. Plenful is not trying to reinvent clinical care — it’s aiming to modernize the infrastructure beneath it. By automating some of the most time-consuming and error-prone workflows, from prior authorizations to 340B compliance, the company is unlocking real savings for institutions and giving frontline staff something increasingly scarce: time to focus on patients.