Pelica
The AI workforce for value-based care.
Pelica is an AI operating system for risk-bearing healthcare organizations, designed to bring claims, EHR, pharmacy, lab, and ADT data into one canonical member record. It addresses the coordination problem created when quality, risk, pharmacy, provider network, and care management teams work from separate systems and duplicate outreach, while submission windows close before gaps are addressed.
The platform includes role-specific copilots for Risk Adjustment, Quality & Stars, Pharmacy & Part D, Provider Network, and Care Management, plus an AI Data Analyst that answers plain-language questions against the canonical record. Action capabilities include outbound voice outreach, EMR overlays via Epic SMART-on-FHIR and Athena marketplace, a provider and staff portal, and a coder workspace. Integrations cover claims formats such as MMR, MAO-004, MOR, and 277CA, FHIR/HL7 EHR data, PDE pharmacy data, labs, ADT, telephony recordings, and payer SFTP drops. Security features include tenant isolation, encryption in transit and at rest, audit logging, role-based access control, SAML/SSO, and zero-retention agreements with LLM providers; SOC 2 Type II and HIPAA compliance are listed, with a BAA available.
Pelica is built for health plans, IPAs and MSOs, ACOs, and risk-bearing medical groups. The pages describe a demo-based engagement model with a 30-minute walkthrough on a sample book of business, and note that SOC 2 Type II, HIPAA, and a BAA are available before any PHI is exchanged. Specific plan tiers, seat-based pricing, or usage-based pricing are not stated.
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