The AI operating system for quality, risk, and care operations.
Pelica’s AI workforce helps teams close quality gaps, lift adherence, coordinate providers, manage care workflows, and reduce avoidable utilization with less manual coordination behind every step.
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.
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 belowPlain-English answers from the canonical record.
| 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 |
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.
DR
Director of Risk Adjustment
Regional MA plan · 240k members
SM
Stars Program Manager
Top-10 national MA plan
VQ
VP of Quality
MSSP ACO · 175k attributed lives
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.
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.
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.
"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."
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
IPAs and MSOs
Delegated risk-bearing
ACOs
MSSP · REACH · CINs
Medical groups
Primary care · Multi-specialty · DSOs
Built by AI leaders from Google.
Focused on patients.
Two ex-Google AI engineers, embedded directly with VBC operators.
Catherine Zhao
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.
Lalit Kundu
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.
Backed by Y Combinator and operators from healthcare and AI companies.
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 →
See Pelica on data that looks like yours.
30-minute walkthrough. We'll run the copilots live on a redacted book of business from a real risk-bearing org.
Book a Demo →