Better patient outcomes, faster.
HealthCare Partners is one of the Northeast’s largest IPAs: roughly 1,000 providers and 200,000 lives across the five boroughs and Long Island. As value-based care expanded across more health plans, its quality, pharmacy, nursing, and risk teams needed one place to bring every member opportunity together. They put all of it on Pelica, and went live in two weeks. Pelica’s agents work routine outreach themselves: they call and text in the member’s language, check plan portals, and file their own notes, and they hand a member to a person the moment one is needed.
- 8 hrs → 15 minweekly admin
- 2,500+ hrssaved in a year
- 2 weekssigning to live
The quality, pharmacy, nursing, and risk leaders at HealthCare Partners, in their own words.
- Lives managed
- 200,000+
- Providers
- ~1,000
- Region
- Five boroughs & Long Island
- Teams on Pelica
- Quality, Pharmacy, Nursing, Risk
The data lived everywhere. Bringing it together was the hard part.
Every health plan shares member opportunity data built around its own programs and reporting rules, each on its own cadence and in its own format. HealthCare Partners had solid processes to bring it all together. But as value-based care expanded across more plans, the consolidation alone could eat much of the week before anyone picked up the phone.
That work often fell to a director. Spreadsheets were combined column by column, copied and pasted between portals and databases, filtered, then reassigned across the team one member at a time. It worked. It just didn’t scale with the growth, and every hour spent wrangling data was an hour not spent with a member or a provider.
“You get Excels coming from left, right, and center on different cadences, some regular, some irregular, different columns, different values. Taking all of that and turning it into something actionable and usable is really difficult.”
One record. AI does the heavy lifting. The team does the care.
Pelica turned the same multi-source files into one live record, then put an AI workforce next to every team: it pulls the data together, builds the prioritized work list, works the routine follow-ups, and writes the notes, so quality, pharmacy, nursing, and risk spend their time on members instead of spreadsheets.
- About 8 hours of weekly admin, consolidated by hand
- Notes written up after every call
- One long, flat spreadsheet of members
- Every follow-up worked by a person
- Each team working from its own copy of the data
- 15 minutes, prioritized automatically
- Notes filed in about 10 seconds
- A ranked work list, member by member
- Routine follow-ups carried by agents; the team handles the exceptions
- Quality, pharmacy, nursing, and risk on one record
Every source, one member.
The weekly payer reports load straight in. Medical, lab, and pharmacy claims, the full outreach history, and call notes come together into one cohesive picture of each member and provider, available to every team at once.
The highest-value work, surfaced first.
Pelica reads each member’s record, scores the highest-value opportunities, and builds the work list member by member: who to prioritize today, who can wait. The team sets the rules. When new reports arrive, they rebalance into the existing plan automatically. No more hand-built call lists.
More than a dashboard.
Routine cases are assigned to a Pelica agent the same way they’re assigned to the team. The agent places the call, falls back to a text at the member’s best hour, wakes when the reply lands, and checks the plan portal before the next attempt. A case outside its rules goes to a person with the full history attached, and the note is written and filed in seconds either way.
Hours given back to patient care.
The same shift shows up wherever the work was administrative: preparing the data, prioritizing the outreach, writing the notes, and the routine follow-ups the agents now carry themselves. That time goes back into care, more outreach and earlier intervention, and it shows up in the numbers HCP is measured on.
“We’ve seen real lift on adherence and quality: half a percent to one and a half percent across our contracts, year over year. And we’re only halfway through the year.”Alex Wiggall · SVP, Quality & Clinical Revenue Integrity
Most AI in healthcare writes summaries. Pelica does the work.
Documentation tools and chat copilots answer questions and draft notes. A Pelica agent takes the task itself: it makes the call, sends the text, works the portal, and retries until the gap is closed or a person needs to step in. Your staff set the rules and handle the exceptions. Open any member’s record at HealthCare Partners and the agent’s calls, texts, and notes sit in the same contact history as the team’s.
- Summarize charts and draft documentation
- Answer questions in a chat window
- Flag gaps for a person to work later
- Stop at the recommendation
- Places the outreach call in the member’s language
- Keeps following up until the loop closes
- Files the note and updates the record itself
- Escalates to your team when a person is needed
Drafts and summarizes.
Notes, documentation, and briefs, written for your team to edit and send. The person stays the author.
Runs defined workflows.
Queues, routing, flags, and prep work run on their own. Your team reviews the key steps.
Owns the outcome.
Outreach worked until it is resolved. Your team sets the policy and handles the exceptions, and every action is logged.
At HealthCare Partners, routine outreach runs at the Own level: agents work it until it resolves. Health plans and risk-bearing provider groups run the same quality work on Pelica. You choose the level for each workflow, and autonomy widens as the results hold up.
The team behind the numbers.
I’m no longer behind a computer running power queries for hours every week. With Pelica, the sky has been the limit. It’s reinvigorated my passion for value-based care and quality.
My favorite feature is the AI call recording. My team used to take notes during every call. Now they can be fully present with the member, and the AI writes the perfect note for them.
Now we can see the whole picture for the patient. We’re catching illness early, so we can be preventative instead of reactive.
The biggest opportunity is to put the data that matters most directly in the provider’s hands, and to capture conditions concurrently, at the point of care, not months later.
A few questions, answered.
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Pelica felt like an extension of our team. You don't just get software, you get partners.
Alex Wiggall
SVP, Quality & Clinical Revenue Integrity · HealthCare Partners
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