Pelica
AI operating system for value-based care: live data, six role-specific copilots, automated action.
If you manage 50,000+ lives under value-based contracts, Pelica's action layer delivers demonstrable ROI—this isn't just another analytics dashboard. Smaller teams may pause at enterprise onboarding and contact pricing, but the reduction in duplicate outreach alone justifies a demo.
Verified 6d ago · liveness 47/100 · cite: rightaichoice.com/tools/pelica
- Medicare Advantage health plans managing Stars and risk adjustment (RADV-defensible)
- IPAs and MSOs with delegated risk-bearing contracts — unify duplicate outreach
- ACOs (MSSP, REACH, CINs) needing care coordination and quality closure
- Medical groups and DSOs automating provider network meetings and EMR documentation
- Fee-for-service practices not tied to value-based contracts
- Organizations without a dedicated risk adjustment or quality team
- Small clinics under 1,000 lives — ROI may not justify cost
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Skip Pelica if you're a fee-for-service practice, a clinic under 1,000 lives, or lacking a dedicated risk adjustment or quality team—the enterprise pricing and onboarding won't fit.
There is no public pricing, so you'll need a sales call to get a quote, and the contract likely includes implementation fees that are unclear upfront.
Pelica's pricing is contact-based and typically suits enterprises managing 50,000+ lives. For smaller teams, lighter-weight standalone analytics dashboards may be more cost-effective, but Pelica's action layer can replace 8-15 point vendors, potentially lowering overall cost.
In short
Pelica — AI operating system for value-based care: live data, six role-specific copilots, automated action. Best for Medicare Advantage health plans managing Stars and risk adjustment (RADV-defensible), IPAs and MSOs with delegated risk-bearing contracts — unify duplicate outreach, ACOs (MSSP, REACH, CINs) needing care coordination and quality closure. Contact Sales pricing.
Viability Score
How well maintained and how widely used is Pelica? Built from what the vendor actually publishes (docs, changelog, tutorials, integrations, pricing), whether the site is live, and how much real users discuss it. How we calculate this
Last calculated: August 2026
How we score →Key Features
- Live data ingestion from 147+ streams (claims, EHR, pharmacy, labs, ADT)
- Risk Adjustment Copilot with real-time HCC capture and trumping logic
- Quality & Stars Copilot unified across payers with glide-path forecasting
- Pharmacy & Part D Copilot for PDC lift on triple-weighted measures
- Provider Network Copilot auto-generates practice agendas (90 min to 15 min prep)
- Care Management Copilot creates ADT-driven TOC worklists and tracks 5-day follow-ups
- AI Data Analyst answers plain-English questions from the canonical record
- TCPA-compliant outbound voice actions (multilingual) for member outreach
- EMR overlays via Epic SMART-on-FHIR and Athenahealth marketplace
- Coder workspace with encounter-and-claim review and RAF pre-claim flagging
- RADV-grade chain-of-custody and audit trail for every action
- Cross-team coordination surfaces blind spots across risk, quality, pharmacy, care
- Tenant-isolated, BAA-covered, encrypted in transit and at rest
- Supports ECDS volumes: 35-75x supplemental data over hybrid sampling
- All copilots read/write to one shared canonical record
About Pelica
Pelica is an AI operating system for value-based care organizations—health plans, IPAs, ACOs, and medical groups. It unifies live data, intelligence, and action across the care continuum. The platform ingests data from 147+ live streams (claims, EHR, pharmacy, labs, ADT) into one canonical record per member, then deploys six role-specific AI copilots—Risk Adjustment, Quality & Stars, Pharmacy & Part D, Provider Network, Care Management, and AI Data Analyst—to turn insights into automated actions like TCPA-compliant outbound voice, Epic SMART-on-FHIR overlays, and coder workflows. Each action cites evidence and maintains a RADV-grade audit trail. Built by former Google AI leads and backed by Y Combinator, Pelica is designed for ECDS-scale data volumes (35-75x supplemental data) and replaces 8-15 point vendors. It helps teams close quality gaps, lift adherence, coordinate providers, and reduce avoidable utilization—like cutting duplicate outreach by working from a shared record.
Behind the Verdict
Pelica positions itself as an 'AI workforce' rather than a passive analytics tool. The key differentiator is the action layer: it doesn't just show you gaps; it initiates TCPA-compliant calls, syncs EMR overlays, and routes work to coordinators. The six copilots share a single canonical record, so an HCC captured by Risk Adjustment automatically updates the Provider Network agenda and the Stars projection—this cross-team coordination is a genuine strength, reducing duplicate outreach and blind spots. Strengths: Live data ingestion from 147 streams including claims, EHR, pharmacy, labs, and ADT; real-time HCC capture with trumping logic; RADV-grade audit trail; built-in submission-window awareness; multilingual outbound voice; EMR overlays (Epic SMART-on-FHIR, Athena); AI Data Analyst replaces BI ticket queue; designed for ECDS-scale volumes (35-75x supplemental data). Weaknesses: No public pricing, so budget planning requires a sales call. Enterprise-focused—smaller organizations may find onboarding heavy. Specific AI model versions and rate limits are not disclosed, which may concern technically-minded buyers. The platform is complex; the breadth of features requires a dedicated cross-functional team to fully leverage. Where it fits: Medicare Advantage plans, IPAs/MSOs with delegated risk, ACOs (MSSP, REACH, CINs), medical groups, and quality/pharmacy teams chasing PDC lift. Where it doesn't: fee-for-service practices, small clinics under 1,000 lives, teams wanting a standalone analytics dashboard without execution automation. Overall, Pelica is for organizations serious about value-based care execution, not just reporting.
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Real-world workflow fit
Concrete scenarios for the personas Pelica actually fits — and what changes day-one when you adopt it.
Daily HCC gap review before MAO-004 submission window closes
Outcome: Pelica scans claims and EHR, applies trumping logic, flags 2,471 open HCCs, routes top opportunities to coder queue, and tracks pre-claim RAF lift—all in one dashboard with audit trail.
Improve PDC adherence on triple-weighted measures (diabetes, RAS, statins)
Outcome: Pharmacy & Part D Copilot generates adherence lists, initiates TCPA-compliant outbound calls, and updates the Stars glide-path forecast after each successful intervention.
Manage transitions of care for discharged patients
Outcome: ADT-driven TOC worklists automatically assign follow-ups, draft outreach scripts, and track 5-day post-discharge calls; cross-team communication eliminates duplicate outreach.
Use Cases
- Automate HCC gap closure before submission windows close using trumping logic
- Generate provider-specific agenda and quality reports to reduce meeting prep time from 90 to 15 minutes
- Initiate TCPA-compliant outbound calls for medication adherence and follow-up appointments
- Track 5-day post-discharge follow-ups with ADT-driven care management worklists
- Query member data in plain English using the AI Data Analyst, bypassing BI ticket queues
- Forecast Star Ratings glide-path for HEDIS and PDC measures year-round
Limitations
- No posted pricing, so budget planning requires a sales call.
- The platform is enterprise-focused; smaller organizations may find the onboarding heavy.
- Specific AI model versions, context window, or rate limits are not disclosed.
as of 2026-08-17
Verification history
We have re-verified Pelica 4 times since . Each pass re-reads the vendor's own pages and re-checks every listed field against that evidence; passes where nothing had changed are marked as such.
- — re-verified summary, description, our verdict, our analysis, pricing model, pricing tiers, features, integrations, who it suits, who should skip it
- — re-verified summary, description, our verdict, our analysis, pricing model, pricing tiers, features, integrations, who it suits, who should skip it
- — re-verified summary, description, our verdict, our analysis, pricing model, pricing tiers, features, integrations, who it suits, who should skip it
- — re-verified summary, description, our verdict, our analysis, pricing model, pricing tiers, features, integrations, who it suits, who should skip it
Free to cite with attribution — this page re-verifies continuously.
Where the pricing makes sense
The company stage and team size where Pelica's pricing actually pencils out — and where peers do it cheaper.
Pelica's pricing is contact-based and typically suits enterprises managing 50,000+ lives. For smaller teams, lighter-weight standalone analytics dashboards may be more cost-effective, but Pelica's action layer can replace 8-15 point vendors, potentially lowering overall cost.
Setup time & first value
How long it actually takes to get something useful out of Pelica — broken out by persona, not the marketing-page minute.
Go-live in as little as 2 weeks for an entire health plan with 200,000+ lives, per customer story. Individual copilots can be deployed faster (days) but full integration with all 147 data streams may take longer depending on source complexity.
Switching to or from Pelica
How to bring data in from common predecessors and how to get it back out — written for the switcher, not the buyer.
- →From Excel trackers and manual reports: Pelica's AI Data Analyst replaces BI ticket queues, so you can query the canonical record directly in plain English.
Integrations
Resources & Guides
Tutorials & Learning
Official links
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Featured Head-to-Head Comparisons
Pelica vs Codametrix
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Pelica vs Isomorphic Labs
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