Reading for the people who run value-based care.
Operator-grade guides, customer stories, and notes from the Pelica Health team.
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How a 175,000-life NY IPA stopped calling the same patient three times
RAF lift in two quarters with no new headcount. 41% gap-closure improvement. 12 tools retired. The exact workflow change behind the numbers.
Read the story →V28 Risk Adjustment Readiness: A 90-Day Playbook
CMS V28 phase-in completes in 2026. Roughly 3% RAF compression for the average MA plan. The 30-30-30 day plan to close the gap before the submission window does.
Read the guide →Guides
V28 Risk Adjustment Readiness: A 90-Day Playbook
CMS V28 finishes phase-in in 2026, cutting average RAF roughly 3%. A practical 30-30-30 day plan: audit, operationalize, defend.
Read →PDC Math: Why 5 Points Separates 4-Star from 2-Star
The three triple-weighted Part D adherence measures move Stars more than any other lever. The math, the cliff effect, and the operational changes that actually shift PDC.
Read →Building a RADV-Defensible HCC Capture Program from Scratch
The 2023 RADV rule made findings extrapolated and the FFS adjuster gone. Seven design choices that turn an HCC capture program into one that survives audit.
Read →The ECDS Transition: What Changes When Hybrid HEDIS Retires
NCQA retires hybrid HEDIS by 2029. Supplemental data volumes increase 35x to 75x per measure. What the data infrastructure has to look like.
Read →Templates & tools
Printable Annual Wellness Visit Checklist
Every CMS-required AWV component on one page, with eligibility and coding reminders and a chronic-condition recapture section. Print it or save it as a PDF.
Open →CY2027 MA & Part D Operating Calendar
Every CY2027 deadline from the CMS annual calendar merged with the weekly HPMS memos, with an owner, a consequence, and a source on each row. Maintained as dates land.
Open →2026 Star Ratings Cut Points Cheat Sheet
How CMS sets cut points, Tukey outlier deletion, and the 5-point guardrail, plus a glide-path planning worksheet. Print it or save it as a PDF.
Open →From the blog
Why we started Pelica Health
A short founder letter on why we left Google to build the operating system for value-based care.
Read →AI Agents vs. Analytics Dashboards in Value-Based Care
Why an execution layer beats a dashboard, and what AI agents actually do that analytics cannot.
Read →Value-Based Care Software in 2026: A Buyer's Guide
Innovaccer, Navina, Reveleer, Pearl, Stellar, and Arcadia compared on analytics vs execution.
Read →Best Risk Adjustment Software for IPAs and ACOs in 2026
Prospective plus retrospective in one record, V28-aware trumping, RADV-defensible chain-of-custody.
Read →Best Value-Based Care Software in 2026
From Innovaccer to Navina to Pelica: how to choose between an analytics platform and an AI execution layer.
Read →Best Part D Adherence Software for 2026
The best medication adherence and PDC software for Part D Stars, and whether a tool only reports PDC or closes the gap.
Read →Best Care Management Software for 2026
Transitions-of-care software for IPAs and ACOs: real-time ADT, and who closes the loop instead of just documenting.
Read →Best Provider Network Management Software for 2026
Roster and credentialing, or an EMR-overlay layer that preps field reps with a live visit agenda.
Read →Innovaccer Alternatives for Value-Based Care Teams in 2026
A fair comparison of Innovaccer, Arcadia, Navina, Reveleer, Pearl Health, and Pelica on analytics versus execution.
Read →Navina vs Reveleer: Prospective and Retrospective Risk Adjustment
Prospective point-of-care versus retrospective chart review, and why one record that closes the loop beats both alone.
Read →Best HEDIS and Stars Software for Quality Teams in 2026
How to choose for the ECDS transition: pick on ECDS readiness and whether the tool closes gaps or only reports them.
Read →What an AI Agent Actually Does When It Closes a Care Gap
The step-by-step anatomy of an autonomous medication-adherence gap closure.
Read →Prospective vs. Retrospective Risk Adjustment
What belongs in your stack, where each approach shines, and why splitting them across vendors creates blind spots.
Read →How to Improve Your RAF Score Under V28 Without Adding Coders
The real levers: accurate suspecting, pre-claim flagging, correct constrained-group trumping.
Read →AI for HEDIS Gap Closure: Close Care Gaps Faster
Prioritize across data sources, route to the right coordinator, run multi-channel outreach, document the close.
Read →The 2027 Medicare Star Ratings Changes to Plan For Now
Tukey, guardrail removal, the equity-reward reversal, cut-point volatility, and weighting shifts.
Read →The Triple-Weighted Part D Adherence Measures, Explained
Diabetes, hypertension, and statin PDC; the 80% threshold; the 2026 weighting change.
Read →Member Outreach Automation: Multi-Channel Done Right
Email, voice AI, SMS run from one queue so no member gets three calls. What HIPAA and TCPA require.
Read →Transitions of Care: ADT Feeds to Action in Under Five Days
Turn real-time ADT feeds into a worklist and post-discharge contact inside the CMS TCM window.
Read →Is Healthcare AI HIPAA Compliant? What SOC 2 Type II Actually Means
What HIPAA actually requires of an AI vendor, and what SOC 2 Type II proves about how it runs.
Read →The Real Cost of Running VBC on 8 to 15 Vendor Portals
What it actually costs to operate value-based care across a fragmented vendor stack, and the case for consolidation.
Read →Provider Rep Practice Visit Prep with AI
From a 90-minute scramble to a 15-minute agenda: every open gap, MAO-004 issue, and recent ADT event in one view.
Read →Replace the BI Ticket Queue With AI Questions
Why the BI team is a 3-week bottleneck, and how natural-language analytics with provenance changes the work without replacing BI.
Read →Glossary of Value-Based Care Terms
40 terms every VBC operator should know: RAF, HCC, V28, RADV, HEDIS, ECDS, PDC, MAO-004, ADT, TCM, JOC, MSSP, ACO REACH, and more.
Browse →Common questions
What kinds of resources does Pelica Health publish?
Pelica Health publishes operator-grade guides on V28 risk adjustment, RADV-defensible HCC capture, PDC math for the Part D triple-weighted measures, and the ECDS transition for HEDIS reporting. We also publish a blog with short founder letters and operator notes, plus customer stories from value-based care teams running on Pelica.
Are Pelica Health resources free?
Yes. Every guide and blog post is free to read with no email gate. External citations to CMS, NCQA, PQA, OIG, and HL7 source documents are linked inline.
Who is the audience for Pelica Health resources?
Operators at risk-bearing healthcare organizations: SVPs and Directors of Risk Adjustment, Stars, Pharmacy, and Provider Network at health plans, IPAs, MSOs, ACOs, and medical groups in value-based contracts.