Care Management

Catch the discharge. Close the loop. Before the window slips.

Pelica turns the ADT feed into a transitions-of-care worklist the moment a member is discharged, drafts the follow-up, and tracks the 5-day window to close. One outreach queue across quality, pharmacy, and care management means the same member is never called three times. Proactive, not reactive.

70%+ of TRC gaps in 30 days

75% 7-day follow-up after ED

5-day window, tracked to close

Transitions-of-care worklist

ADT-driven · live

• Aaron M. · discharged, CHF
• Epic ADT · Mercy General · 4-day stay

Day 0
TOC follow-up drafted
Tue 9:00 AM · med rec reviewed · 1 interaction flagged
Scheduled
ED visit · 7-day follow-up
FMC · multiple chronic conditions
In window
Assigned to Maria R.
One queue · no duplicate outreach
Confirmed
One call resolves what took several
Whole-member context · note filed automatically

Why care slips through

You find out about the discharge after the window has closed.

Care teams don't miss follow-ups because they don't care. They miss them because the discharge data arrives late, the member's picture is scattered, and three teams are calling the same person about different things.

The data is already lagged.

By the time the discharge shows up in a report, the 5-day window is half gone. The team is forever catching up, and the readmission risk window is the part you can least afford to miss.

Three calls to one member.

Quality, pharmacy, and care management each run their own list, so the member gets called three times in a week about different gaps, sometimes in a language they don't speak.

Reactive, never preventative.

Without a live picture, the team is responding to problems after they happen instead of catching illness early. The capacity to be proactive never materializes.

The Pelica idea

Two kinds of work. Only one needs a coordinator.

Your coordinators are there for the member: the assessment, the relationship, the care plan. Pelica takes the watching, the drafting, and the tracking so they can be present on the call.

The work only a coordinator can do

• Being fully present with the member on the call
• The clinical assessment and the care plan
• The complex case that needs a human to navigate

Everything that shouldn't need one

• Watches the ADT feed and opens the TOC task in real time
• Drafts the follow-up and tracks the 5-day window to close
• Runs one outreach queue, so no member is called three times
• Surfaces the whole member, and writes the note in seconds

How it works

One canonical record. Every transition. Real-time.

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

01

Live data

ADT feeds, claims, EHR (FHIR/HL7), pharmacy, and labs, unified into one canonical record per member in real time, so a discharge is known the moment it happens. Tenant-isolated, BAA-covered, encrypted end to end.

02

The AI workforce

The Care Management copilot opens a transitions-of-care task on every qualifying event, drafts the outreach with med rec reviewed, prioritizes by risk, and assigns to one shared queue, so nothing is missed and no one is double-called.

03

Action

Coordinators work a prepared, prioritized list with the whole member in view; one call resolves what used to take several; and the call note is written automatically in seconds.

Built for your team

Be proactive on a large panel, without adding coordinators.

A small team managing a large panel can't manually watch every discharge. Pelica watches for them, and hands the team a prepared, deduplicated worklist.

For Care Management & Population Health leaders

Close the loop inside the window.

Pelica catches the discharge in real time, drafts the follow-up, and tracks the 5-day window, so transitions-of-care gaps close before they slip, not at quarterly reconciliation.

• 70%+ of transitions-of-care gaps closed within 30 days
• 75% 7-day follow-up after an ED visit (FMC)
• 1 queue across teams, so no member is called three times

For your coordinators

Be present, not buried in data.

Coordinators stop chasing discharges and stitching context together. They get a prepared list with the whole member in view, so they can be fully present on the call and move to the next member quicker.

• Whole-member context surfaced before every call
• ~10 scall notes written automatically, hands-free
• 2–3× members covered by the same team

Proof, not promises

Live with the largest IPA in the country.

Delivered at HealthCare Partners, a physician-led IPA managing 200,000 lives across 1,000 providers, and live within two weeks of signing.

70%+

Transitions-of-care gaps closed within 30 days, before the window slips.

75%

7-day follow-up after an ED visit for members with multiple chronic conditions.

100%

Adoption across the care management team at one of the largest IPAs.

In their words

The teams that moved from reactive to ahead of it.

Operators at our flagship IPA on what changes when the discharge comes to you, and the member's whole picture comes with it.

We're catching whatever illness early, so we can be more preventative and not reactive. Now we're able to see pretty much the whole picture for the patient, instead of just looking at a spreadsheet.

Mauvalin Jacques Mauvalin Jacques on LinkedIn Quality Interventions Nurse · HealthCare Partners

All these questions can be answered in one call, where previously they were fragmented across multiple calls in multiple departments.

Charlotte Buckley Charlotte Buckley on LinkedIn Director of Quality Performance · HealthCare Partners

Now my team can fully be present and focus on the call. The AI just makes the perfect note for them, so they can move to the next member quicker.

Bonnie Kaprat Bonnie Kaprat on LinkedIn Pharmacist & Supervisor, Quality Intervention · HealthCare Partners

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.

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.

Common questions

Care management leaders ask us this.

How does Pelica handle transitions of care?
Pelica ingests ADT feeds in real time, so the moment a member is admitted, discharged, or transferred, it creates a transitions-of-care task, drafts the follow-up, and tracks the 5-day window to close. The coordinator gets a prepared outreach with the full member context instead of finding out about the discharge days later.

How does Pelica stop duplicate outreach to the same member?
Quality, pharmacy, and care management all work from one canonical record and one outreach queue. Pelica surfaces the whole picture of the member, so the questions that used to be fragmented across multiple calls in multiple departments get answered in a single call, and the same member is never called three times in a week.

Does Pelica make care management proactive instead of reactive?
Yes. Because the data is live rather than retrospective, teams catch the discharge in real time and close the follow-up inside the window that drives readmissions, instead of discovering it at quarterly reconciliation. The goal is preventative care: catching illness early so the team can act, not react, and reduce avoidable readmissions.

What results has Pelica delivered for care management?
At HealthCare Partners, a physician-led IPA managing 200,000 lives across 1,000 providers, more than 70 percent of transitions-of-care gaps were closed within 30 days and 75 percent of members received a 7-day follow-up after an ED visit, with one outreach queue eliminating duplicate calls across teams. Pelica was live within two weeks of signing.

Who is Pelica's care management workflow built for?
It is built for VP, SVP, and Directors of Care Management, Population Health, Clinical Operations, Utilization Management, and Transitions of Care at risk-bearing organizations: health plans, IPAs, MSOs, ACOs, and medical groups. It is designed for small teams managing large panels who need to be proactive without adding coordinators.

“It really focuses on that holistic member approach. Not a piecemeal quality closure opportunity, we're looking at the member and their full picture.”
Charlotte Buckley Charlotte Buckley on LinkedInDirector of Quality Performance · HealthCare Partners

See it in action

See Pelica on data that looks like yours.

30-minute walkthrough. We'll run the Care Management copilot live on a sample book of business tailored to resemble your portfolio. No customer data required.