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.

“What would normally take about eight hours a week takes fifteen minutes today. Pelica felt like an extension of our team — you don’t just get software, you get partners.”
Alex Wiggall, SVP Quality and Clinical Revenue Integrity at HealthCare Partners

200,000+

Lives managed

~1,000

Providers

2 weeks

To go live

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.

01

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.

02

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.

03

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.

One platform. Six copilots.

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

Each copilot is powered by 80+ specialized AI agents and independently useful on its own. 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.

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, Regional MA plan · 240k members

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

SM, Senior Medicare Stars operator, Top-10 national MA plan

"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, MSSP ACO · 175k attributed lives

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.

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

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.

Quality Coordinator New York
Calls to member 4117 · same week
Before: 3 calls, 0 confirms
After: 1 outreach, coordinated

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.

The team

Built by AI leaders from Google. Focused on patients.

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.

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.

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. Customer data is protected under continuous operational and security controls.