pelica.com

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      "name": "How HealthCare Partners Runs Value-Based Care on AI",
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              "description": "Plain-English questions answered in seconds with citations and the SQL it ran. Replaces the BI ticket queue."
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          "@type": "Question",
          "name": "What does Pelica Health do?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Pelica Health is the operating system for value-based care. The platform unifies claims, EHR, pharmacy, lab, and ADT data into one canonical record per member, then runs six role-specific AI copilots on top: Risk Adjustment, Quality and Stars, Pharmacy and Part D, Provider Network, Care Management, and an AI Data Analyst. It replaces 8 to 15 fragmented point vendors with a single integrated stack."
          }
        },
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          "@type": "Question",
          "name": "Is Pelica Health HIPAA-compliant?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Yes. Pelica Health is HIPAA-compliant and SOC 2 Type II certified. Every system we build is designed for healthcare's highest security standards, with BAAs, audit logging, and enterprise-grade access controls. Full details are available at our Trust Center at https://www.pelica.com/trust."
          }
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          "@type": "Question",
          "name": "Who founded Pelica Health?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Pelica Health was founded by Catherine Zhao (CEO) and Lalit Kundu (CTO), former Google engineers who left to build AI at Google scale for healthcare. The company is backed by Y Combinator, SurgePoint Capital, Upside Partnership, ISEED Ventures, and Progressive Ventures."
          }
        },
        {
          "@type": "Question",
          "name": "What kinds of healthcare organizations does Pelica Health work with?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Pelica Health works with physician networks, value-based care organizations, ACOs, and digital health companies that have a real operations problem to solve. We keep our client list deliberately small so each engagement gets deep, senior engineering attention."
          }
        },
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          "@type": "Question",
          "name": "How is Pelica Health different from point vendors and BI tools?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Most VBC teams stitch together 8 to 15 single-purpose vendors: a risk adjustment tool, a Stars dashboard, a separate pharmacy adherence app, a care management system, plus payer portals and shared spreadsheets. Each vendor sees only its slice of the member, so teams duplicate outreach and miss cross-cutting gaps. Pelica replaces that stack with one canonical record per member that all six copilots read and write to. Insight compounds across teams instead of fragmenting."
          }
        },
        {
          "@type": "Question",
          "name": "What EMRs does Pelica Health integrate with?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Pelica Health integrates with all major electronic medical records including Epic, Cerner (Oracle Health), athenahealth, eClinicalWorks, NextGen, and Elation. We also build against FHIR, HL7v2, and direct database connections when needed."
          }
        },
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          "@type": "Question",
          "name": "How do I start working with Pelica Health?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Book an introductory call at https://cal.com/pelica/pelica. The first conversation is a real discussion of your operations problem, with no decks and no canned demos. If there's a fit, we scope a focused engagement that starts delivering value within weeks, not quarters."
          }
        },
        {
          "@type": "Question",
          "name": "What is the operating system for value-based care?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Pelica Health is the operating system for value-based care: a single live data layer that unifies claims, EHR, pharmacy, lab, and ADT data into one canonical record per member, an AI workforce of six role-specific copilots that read and write to that record, and an action layer that closes the loop with members and providers via voice, EMR overlays, provider portal, and coder workspace. It replaces 8 to 15 fragmented point vendors with a single integrated stack."
          }
        },
        {
          "@type": "Question",
          "name": "What are the six AI copilots in Pelica's platform?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Pelica's platform includes six AI copilots, each serving a specific value-based care function: (1) Risk Adjustment Copilot for real-time HCC capture and RADV-defensible documentation; (2) Quality and Stars Copilot for unified HEDIS and Medicare Star Ratings gap closure; (3) Pharmacy and Part D Copilot for PDC lift on triple-weighted adherence measures; (4) Provider Network Copilot for EMR overlay and practice agendas; (5) Care Management Copilot for ADT-driven transitions of care; and (6) AI Data Analyst for plain-English answers from the canonical record. All six share one canonical record, so insight compounds across teams."
          }
        },
        {
          "@type": "Question",
          "name": "How does Pelica support the ECDS transition for HEDIS measures?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "NCQA is phasing out hybrid HEDIS measures by 2029 in favor of ECDS (Electronic Clinical Data Systems), increasing supplemental data volumes by 35 to 75 times per measure. Pelica's data layer is built for ECDS-scale operations from day one: continuous full-population evidence gathering rather than seasonal chart abstraction, with native support for FHIR, HL7, payer SFTP drops, and provider-submitted supplemental data feeds. Plans deploying Pelica are positioned for 2029 ECDS compliance without rebuilding their data infrastructure."
          }
        },
        {
          "@type": "Question",
          "name": "What kind of RAF lift can Pelica deliver for risk-bearing organizations?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "A physician-led IPA in New York managing 175,000 patients on a risk-bearing contract used Pelica to drive RAF lift in two quarters with no new headcount, alongside a 41% improvement in gap closure rate and a 3x increase in outreach capacity per coordinator. The platform retired 12 separate tools and portals in the process. Real-time HCC capture, V28-aware trumping logic, and submission-window awareness drive the lift; documentation already attached to each captured HCC ensures RADV defensibility."
          }
        },
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          "@type": "Question",
          "name": "Who is Pelica Health for?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Pelica serves risk-bearing healthcare organizations: health plans (Medicare Advantage, Dual-SNP, regional Blues), IPAs and MSOs (delegated risk-bearing), ACOs (MSSP, REACH, CINs), and medical groups (primary care, multi-specialty, DSOs in value-based contracts). Typical buyers include COO, SVP Stars, SVP Risk Adjustment, SVP Pharmacy, ACO Executive Director, VP Population Health, VP Provider Network, and Chief Medical Officer."
          }
        },
        {
          "@type": "Question",
          "name": "How does Pelica unify data across claims, EHR, pharmacy, and labs?",
          "acceptedAnswer": {
            "@type": "Answer",
            "text": "Pelica ingests data at its native cadence: real-time event-driven where supported (HL7, FHIR, ADT, audio forking via DMCC for telephony), hourly polling for SFTP drops, and batch nightly for everything else. It normalizes everything to a canonical schema for member, provider, encounter, claim, diagnosis (with full ICD-to-HCC mapping for V24, V28, and HHS-HCC), gap, contract, and event. Identity resolution matches members across plans, providers across NPI/TIN/contract entities, and encounters to claims."
          }
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      "description": "AI copilots and operating system for value-based care quality teams. Unifies claims, EHR, pharmacy, lab, and ADT data into one live canonical record. Replaces 8 to 15 point vendors with a single integrated stack covering risk adjustment, Quality and Stars, pharmacy and Part D, provider network, care management, and a cross-cutting AI Data Analyst.",
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        "Real-time risk adjustment with V28-aware HCC capture and RADV-defensible documentation",
        "Unified Quality and Stars gap closure across HEDIS and Medicare Star Ratings",
        "Pharmacy and Part D PDC lift on triple-weighted adherence measures",
        "Provider Network EMR overlay (Epic SMART-on-FHIR, Athena, eClinicalWorks)",
        "ADT-driven Care Management with five-day TOC follow-up tracking",
        "AI Data Analyst with plain-English to SQL across the canonical record",
        "Outbound voice AI (TCPA-compliant, multilingual)",
        "ECDS-ready supplemental data infrastructure for the 2029 NCQA transition",
        "HIPAA Security and Privacy Rule compliance, SOC 2 Type II certified, BAA available",
        "Tenant isolation, end-to-end encryption, zero-retention LLM agreements"
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      "headline": "Two-quarter RAF lift at a 175,000-patient physician-led IPA in New York",
      "description": "How a physician-led IPA in New York running risk on 175,000 patients used Pelica Health to lift RAF, improve gap closure 41%, and triple outreach capacity per coordinator without adding headcount, while retiring 12 tools and 5 point vendors.",
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