Unified live data layer
Combines claims, EHR, pharmacy, labs, ADT, telephony recordings, and payer file drops into one canonical member or patient record so different teams work from the same source of truth.
Pelica Health
BeanspruchenPelica Health provides an AI workforce for value-based care teams, combining a shared data layer, role-specific copilots, and action tools for outreach, documentation, and review. It helps organizations coordinate quality, risk adjustment, pharmacy, and care management work from one record.
What Pelica Health does
Pelica Health is an AI workforce for value-based care operations. The site positions it as an operating system for quality, risk, and care teams that need to work from one canonical record instead of separate spreadsheets, portals, and vendor tools.
The product combines a live data layer, role-specific AI copilots, and action tools for outreach, documentation, and review. In the source examples, that means surfacing HCCs at the point of care, closing quality and pharmacy gaps, coordinating providers, and helping care teams reduce manual coordination across the workflow.
Core capabilities
Multiple copilots on one record
Provides role-specific copilots for risk adjustment, quality and Stars, pharmacy and Part D, provider network, and care management, plus an AI Data Analyst for plain-English analysis and SQL generation.
Point-of-care opportunity detection
Surfaces suspected HCCs, quality gaps, and other opportunities while the member is still in scope, with V28-aware trumping and RADV-defensible documentation attached to captures.
Execution across channels
Moves work into action through outbound voice, SMS, EMR overlays such as Epic SMART-on-FHIR and Athena marketplace, a portal, and a coder workspace for encounter and claim review.
Prioritized team workflows
Builds ranked worklists and rebalances them as new reports arrive, so teams can prioritize outreach, review the highest-value opportunities first, and avoid duplicate work across functions.
Common ways teams use Pelica
Risk adjustment and HCC capture
Risk teams use the platform to compare claims against charts, surface suspected HCCs during the care window, and keep documentation attached for RADV defensibility.
Quality gap closure
Quality and Stars teams use one ranked worklist to close care gaps, coordinate outreach, and reduce duplicate calls across teams working from different systems.
Pharmacy and adherence workflows
Pharmacy teams use the shared record to support adherence work and Part D gap closure, while updates flow back to other copilots and projections.
Care management and transitions of care
Care management teams use ADT-driven worklists, follow-up planning, and outreach support to coordinate post-discharge and transition-of-care tasks.
Provider network coordination
Provider network teams use EMR overlays and provider-facing actions to surface care already delivered and capture credit closer to the point of care.
Pros and Cons
Pros
- Unifies multiple operational teams around one shared member or patient record.
- Connects data, AI recommendations, and downstream actions in the same workflow.
- Supports several value-based care functions, including risk adjustment, quality, pharmacy, provider network, and care management.
- Provides source-backed documentation and auditability for captured opportunities.
- Customer story indicates a relatively fast go-live of about two weeks.
Cons
- The public pages do not provide pricing details.
- Integration coverage is described at a high level, but the site does not publish a full list of supported systems for every workflow.
FAQ
Who is Pelica for?
Pelica is designed for value-based care teams that need to coordinate quality, risk adjustment, pharmacy, care management, and provider workflows from one shared record. The source shows use across health plans, IPAs/MSOs, ACOs, and risk-bearing medical groups.
What data does Pelica work with?
The source describes a deployment that uses live data from claims, EHR, pharmacy, labs, ADT, telephony recordings, and payer SFTP drops. It presents those inputs as part of a canonical record that multiple copilots can read and write.
How do teams use the product day to day?
Pelica includes role-specific copilots and action surfaces such as outbound voice, EMR overlays, a provider and staff portal, and a coder workspace. The goal is to move work from analysis into outreach, documentation, and review.
How long does implementation take?
The customer story says HealthCare Partners went live in about two weeks, and the risk-adjustment page gives a similar two-week go-live claim. The site also says Pelica deploys forward by embedding with the team and learning the workflow.
How is data protected?
The customer story states that Pelica is HIPAA compliant and SOC 2 Type II, with tenant isolation, end-to-end encryption, a full audit trail, and zero-retention agreements with LLM providers. It also notes that HITRUST certification is in progress.
Quick Facts
- Category
- AI workforce for value-based care
- Primary users
- Health plans, IPAs/MSOs, ACOs, and risk-bearing medical groups
- Core workflow
- Shared canonical record for quality, risk, pharmacy, and care management
- Deployment
- Cloud software with live data and action layers
- Source domain
- delty.ai
- Pricing
- Not published on the site
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