What does Pelica Health do?

Pelica Health is the operating system for value-based care. The platform unifies claims, EHR, pharmacy, lab, and ADT data into one canonical record per member, then runs six role-specific AI copilots on top: Risk Adjustment, Quality and Stars, Pharmacy and Part D, Provider Network, Care Management, and an AI Data Analyst. It replaces 8 to 15 fragmented point vendors with a single integrated stack.

Is Pelica Health HIPAA-compliant?

Yes. Pelica Health is HIPAA-compliant and SOC 2 Type II certified. Every system we build is designed for healthcare's highest security standards, with BAAs, audit logging, and enterprise-grade access controls. Full details are available at our Trust Center at https://pelica.ai/trust.

Who founded Pelica Health?

Pelica Health was founded by Catherine Zhao (CEO) and Lalit Kundu (CTO), former Google engineers who left to build AI at Google scale for healthcare. The company is backed by Y Combinator, SurgePoint Capital, Upside Partnership, ISEED Ventures, and Progressive Ventures.

What kinds of healthcare organizations does Pelica Health work with?

Pelica Health works with physician networks, value-based care organizations, ACOs, and digital health companies that have a real operations problem to solve. We keep our client list deliberately small so each engagement gets deep, senior engineering attention.

How is Pelica Health different from point vendors and BI tools?

Most VBC teams stitch together 8 to 15 single-purpose vendors: a risk adjustment tool, a Stars dashboard, a separate pharmacy adherence app, a care management system, plus payer portals and shared spreadsheets. Each vendor sees only its slice of the member, so teams duplicate outreach and miss cross-cutting gaps. Pelica replaces that stack with one canonical record per member that all six copilots read and write to. Insight compounds across teams instead of fragmenting.

What EMRs does Pelica Health integrate with?

Pelica Health integrates with all major electronic medical records including Epic, Cerner (Oracle Health), athenahealth, eClinicalWorks, NextGen, and Elation. We also build against FHIR, HL7v2, and direct database connections when needed.

How do I start working with Pelica Health?

Book an introductory call at https://cal.com/pelica/pelica-demo. The first conversation is a real discussion of your operations problem, with no decks and no canned demos. If there's a fit, we scope a focused engagement that starts delivering value within weeks, not quarters.

What is the operating system for value-based care?

Pelica Health is the operating system for value-based care: a single live data layer that unifies claims, EHR, pharmacy, lab, and ADT data into one canonical record per member, an AI workforce of six role-specific copilots that read and write to that record, and an action layer that closes the loop with members and providers via voice, EMR overlays, provider portal, and coder workspace. It replaces 8 to 15 fragmented point vendors with a single integrated stack.

What are the six AI copilots in Pelica's platform?

Pelica's platform includes six AI copilots, each serving a specific value-based care function: (1) Risk Adjustment Copilot for real-time HCC capture and RADV-defensible documentation; (2) Quality and Stars Copilot for unified HEDIS and Medicare Star Ratings gap closure; (3) Pharmacy and Part D Copilot for PDC lift on triple-weighted adherence measures; (4) Provider Network Copilot for EMR overlay and practice agendas; (5) Care Management Copilot for ADT-driven transitions of care; and (6) AI Data Analyst for plain-English answers from the canonical record. All six share one canonical record, so insight compounds across teams.

How does Pelica support the ECDS transition for HEDIS measures?

NCQA is phasing out hybrid HEDIS measures by 2029 in favor of ECDS (Electronic Clinical Data Systems), increasing supplemental data volumes by 35 to 75 times per measure. Pelica's data layer is built for ECDS-scale operations from day one: continuous full-population evidence gathering rather than seasonal chart abstraction, with native support for FHIR, HL7, payer SFTP drops, and provider-submitted supplemental data feeds. Plans deploying Pelica are positioned for 2029 ECDS compliance without rebuilding their data infrastructure.

What kind of RAF lift can Pelica deliver for risk-bearing organizations?

A physician-led IPA in New York managing 175,000 patients on a risk-bearing contract used Pelica to drive RAF lift in two quarters with no new headcount, alongside a 41% improvement in gap closure rate and a 3x increase in outreach capacity per coordinator. The platform retired 12 separate tools and portals in the process. Real-time HCC capture, V28-aware trumping logic, and submission-window awareness drive the lift; documentation already attached to each captured HCC ensures RADV defensibility.

Who is Pelica Health for?

Pelica serves risk-bearing healthcare organizations: health plans (Medicare Advantage, Dual-SNP, regional Blues), IPAs and MSOs (delegated risk-bearing), ACOs (MSSP, REACH, CINs), and medical groups (primary care, multi-specialty, DSOs in value-based contracts). Typical buyers include COO, SVP Stars, SVP Risk Adjustment, SVP Pharmacy, ACO Executive Director, VP Population Health, VP Provider Network, and Chief Medical Officer.

How does Pelica unify data across claims, EHR, pharmacy, and labs?

Pelica ingests data at its native cadence: real-time event-driven where supported (HL7, FHIR, ADT, audio forking via DMCC for telephony), hourly polling for SFTP drops, and batch nightly for everything else. It normalizes everything to a canonical schema for member, provider, encounter, claim, diagnosis (with full ICD-to-HCC mapping for V24, V28, and HHS-HCC), gap, contract, and event. Identity resolution matches members across plans, providers across NPI/TIN/contract entities, and encounters to claims.

YC Backed by Y Combinator · Built by Google AI leads

The operating system for value-based care.

Pelica unifies your claims, EHR, pharmacy, lab, and ADT data into one live record, and puts an AI copilot next to every team that depends on it. Risk adjustment, Stars, pharmacy, network, care management. Real-time.

Book a Demo → See how it works ↓

Aaron M.

73 · M · Humana MA · M-2904

Active

CHF CKD stage 3 Type 2 diabetes PCP: Dr. Patel

Epic · ADT feed just now

Discharged from Mercy General. CHF exacerbation, 4-day stay.

↓

Care Management copilot 5-day TOC rule

Drafted follow-up: Tue 9:00 AM, 12-min call. Med rec reviewed, 1 interaction flagged.

↓

Coordinator queue Maria R.

Assigned · awaiting confirmation. Outreach script ready.

How it works

One canonical record.
Every workflow. Real-time.

Three layers. Each addressable on its own. Deployed together, the equivalent of 8 to 15 point vendors in a single platform.

Live data

Claims (MMR, MAO-004, MOR, 277CA), EHR (FHIR/HL7), pharmacy (PDE), labs, ADT, telephony recordings, payer SFTP drops. Built for ECDS volumes: 35-75x the supplemental data of hybrid sampling. Tenant-isolated, BAA-covered, encrypted in transit and at rest.

The AI workforce

A copilot per role plus a cross-cutting AI Data Analyst. Every recommendation cites its evidence. Trumping logic, RADV-defensibility, and submission-window awareness built in.

Action

Outbound voice (TCPA-compliant, multilingual). EMR overlays (Epic SMART-on-FHIR, Athena marketplace). Provider and staff portal. Coder workspace with encounter-and-claim review.

Data Layer

147 streams · live

Epic EHR Cerner EHR Humana CLAIMS CVS PHARMACY Quest LAB Athena EHR UHC CLAIMS LabCorp LAB Surescripts RX PointClickCare ADT Aetna CLAIMS eCW EHR Epic EHR Cerner EHR Humana CLAIMS CVS PHARMACY Quest LAB Athena EHR UHC CLAIMS LabCorp LAB Surescripts RX PointClickCare ADT Aetna CLAIMS eCW EHR

Intelligence Layer

6 copilots · reasoning

Risk Adj

HCC sweep

Stars

Gap closure

Pharmacy

Adherence

Network

Leakage

Care Mgmt

Panel triage

Action Layer

2,184 actions / hr

Voice live

SMS queued

EMR sync

Portal push

One platform. Six copilots.

A copilot for every team.
One canonical record they all read from.

Each copilot is independently useful. Because they read and write to the same record, an HCC captured by Risk informs the Network agenda; a Part D gap closed by Pharmacy updates the Stars projection.

Risk Adjustment

Real-time HCC capture, RADV-defensible.

Quality & Stars

Unified gap closure across every payer.

Pharmacy & Part D

PDC lift on the three triple-weighted measures.

Provider Network

EMR overlay. Providers get credit for care already delivered.

Care Management

ADT-driven TOC worklists. No duplicate calls across teams.

AI Data Analyst

Featured below

Plain-English answers from the canonical record.

app.pelica.ai / analyst

New analysis

Stars glide-path · Q2

PDC cohort review

Live · canonical record

Ask Pelica · en · plain English to SQL

Ran in 1.8s V28-aware Trumping logic View SQL →

Members

1,284

Aetna · MA panel

Open HCCs

2,471

+18 today

Projected lift

$3.1M

PMPY · current contract

Window closes

42d

MAO-004 · Q2 cycle

Top opportunities 7 of 1,284 · scroll for more

Export Route to coder queue

Member	HCC	Action	Lift
MR M. Ruiz MBI-•••4821	HCC 37 · DM w/ comp	PCP recapture	$1,847
DA D. Adler MBI-•••0193	HCC 36 · DM uncontrolled	Care mgmt TOC	$1,212
TT T. Truong MBI-•••7340	HCC 18 · CHF	Specialist note	$1,054
RV R. Vasquez MBI-•••2718	HCC 111 · COPD	PCP recapture	$908
SO S. Okeke MBI-•••5562	HCC 85 · CHF chronic	Encounter review	$842
JN J. Nguyen MBI-•••9104	HCC 38 · DM w/o comp	Outreach · A1C	$711
AP A. Patel MBI-•••3027	HCC 22 · Morbid obesity	Documentation fix	$612

Why VBC operators choose Pelica

Three pains. One root cause.
The same OS.

Quality, risk, and care leaders across MA plans, ACOs, IPAs, and medical groups describe the same three pains. They're structural, not vendor-specific, and each one gets fixed at a different layer of the work.

"Our data lives in twelve places. By the time we know there's a problem, the submission window has closed."

DR Director of Risk Adjustment

The fix lives in the data layer→

"One team contacts a member for a care gap another team already closed. We're solving the same problem five times."

SM Stars Program Manager

The fix is one shared record→

"We can build the most beautiful predictive model. If we can't get it into the provider's hands, it's nothing."

VQ VP of Quality

The fix lives in the action layer→

Customer story

How a physician-led IPA stopped
calling the same patient three times.

A physician-led IPA managing 175,000 commercial, Medicare, and Medicaid members across New York. Here's what changed when their teams started working from one shared record.

Physician-led IPA · New York

One canonical record across risk, quality, pharmacy, and care management.

A physician-led IPA serving 175,000 commercial, Medicare, and Medicaid members across New York. Risk adjustment ran out of one set of files. Quality and Stars ran out of another. Pharmacy adherence lived in the PBM portal. Provider performance was assembled in spreadsheets.

Patients fell through the seams between teams. The same member got three calls in the same week: one from risk, one from quality, one from the practice. Sometimes in a language the member didn't speak. Submission windows closed before suspect HCCs surfaced.

The mandate

One shared record across risk, quality, pharmacy, and care management. Outreach in the right language, only once. RADV-defensible chain-of-custody on every captured HCC. No new headcount.

In their words

"We were calling the same member three times. Risk, then quality, then the practice. Sometimes in a language they didn't even speak. Now one outreach goes out, in the right language, and the patient actually comes in."

Quality Coordinator New York

Calls to member 4117 · same week

Before

3 calls, 0 confirms

3 teams, no shared record

Risk English script, member is Spanish-only.

Quality Voicemail, no clinical context to leave.

Practice Front-desk caller, recall scheduled.

→

Now

✓

1 outreach, coordinated

Spanish-fluent CHW, full chart context

A1c retest scheduled, RAS refill confirmed

All 3 gaps closed, single member-friendly call

Audit-ready note auto-filed to all 3 teams

Who we serve

For the teams that own
risk-bearing contracts.

If your margin moves with clinical and quality outcomes, your team is the buyer. We work across health plans, IPAs and MSOs, ACOs, and risk-bearing medical groups.

Health plans

MA · Dual-SNP · Regional Blues

COO · SVP Stars · SVP Risk Adjustment · SVP Pharmacy

IPAs and MSOs

Delegated risk-bearing

COO · Director of Risk Adjustment · Director of Quality · VP Provider Network

ACOs

MSSP · REACH · CINs

ACO Executive Director · VP Population Health · CMO

Medical groups

Primary care · Multi-specialty · DSOs

CMO · COO · VP Operations

The team

Built by AI leaders from Google.
Focused on patients.

Two ex-Google AI engineers, embedded directly with VBC operators.

Catherine Zhao

Co-Founder & CEO

Led Google AI work on Gemini and enterprise AI agents. Clinical AI researcher at Stanford School of Medicine. Front-line patient care at clinics in California and New Hampshire.

Google AI · Gemini Stanford Research Dartmouth Y Combinator

Lalit Kundu

Co-Founder & CTO

Built software for regulated industries at Google and YouTube. Engineering and ML lead on YouTube Payments, running a 45+ person team in Commerce Billing. Wharton MBA. ACM-ICPC World Finalist.

Google · YouTube ML Wharton MBA ACM-ICPC Finalist Y Combinator

Backed by Y Combinator and operators from healthcare and AI companies.

Y Combinator SurgePoint Capital Upside Partnership ISEED Ventures Progressive Ventures

Security and compliance

Built for healthcare's highest compliance bar.

Tenant isolation, encryption end-to-end, full audit trail, and contractual zero-retention with every LLM provider in use. Available on request: SOC 2 Type II report, BAA template, subprocessor list, pen-test history.

Visit our Trust Center →

SOC 2 Type II

Compliant

HIPAA

Compliant

SOC 2 Type II Compliant

Independently audited on an annual cadence. Customer data is protected under continuous operational and security controls.

HIPAA Compliant. BAA available.

Business Associate Agreement signed at deployment. PHI handled under full HIPAA Security and Privacy Rule compliance.

Tenant isolation. End-to-end encryption.

Per-customer data plane. Encryption at rest and in transit. Customer-managed keys, role-based access, automated backups, and zero-retention agreements with every LLM provider in use.

Full audit trail. SAML / SSO.

Every recommendation, query, and outbound action logged with attribution. SAML / SSO via Identity Platform. HITRUST certification in progress.