Pearl Health

What Pearl Health does

Pearl Health is a value-based care enablement platform that helps primary care providers succeed in Medicare risk-bearing arrangements. Founded in 2020 and headquartered in New York, the company operates as both a risk-bearing ACO entity (Pearl ACO under ACO REACH and MSSP) and a SaaS technology provider, allowing customers to choose between full risk partnerships, technology-only deployment, or a hybrid. Pearl targets three customer segments: health systems and IDNs (e.g., BayCare, Holzer, Hudson Headwaters), physician networks and IPAs/MSOs (e.g., Santé IPA, Virginia Care Partners/HCA, MDX Hawaii, PraxisCare/Adaugeo), and independent primary care practices. As of February 2026, the platform supports 275,000+ Medicare beneficiaries across 5,000+ providers, 3,000+ facilities, and 40+ states, with $3.4 billion in Medicare healthcare premiums managed.

Pearl's core technology is the "Pearl Platform," an AI-native operating system that ingests structured healthcare data (Medicare Advantage claims, ADT feeds, and EHR records) and feeds it through its proprietary Signal-Action Framework — an algorithm that converts data signals into prioritized, EHR-embedded next-best actions for clinicians. Named proprietary models include the post-discharge predictive AI (validated to reduce readmissions 17% and identify high-risk patients 4x more effectively) and an applied mean reversion forecasting model that reduces forecast error by 63 basis points versus naive trend-forward approaches. The platform integrates ambient AI documentation through a DeepScribe partnership and embeds STARS/HEDIS quality measures for Medicare Advantage workflows. Pearl is HITRUST r2 certified (March 2025) and HIPAA-compliant.

Pearl generates revenue through three streams: aligned risk contracts and shared-savings arrangements under ACO REACH and MSSP (managed services); SaaS technology enablement contracts (recurring subscription); and performance-aligned incentive distributions, with implementation advances and predictable monthly payments. Pricing is custom and quote-based, scaled to provider network size and selected Medicare program. The company employs roughly 135 people across hubs in New York, Boston, and Seattle, and is backed by Andreessen Horowitz (lead investor across Series A and Series B) and Viking Global Investors, with $93 million in total disclosed funding (an $18M Series A in September 2021 and a $75M Series B in January 2023). Pearl has also built a flagship thought-leadership franchise through its annual Top 50 Value-Based Care Thinkers Report (in its fifth year in 2026) and annual Primary Care Pulse surveys.

Name

Pearl Health

Legal name

Pearl Health, Inc.

Website

https://pearlhealth.com

Company type

Private

Founded year

2020

Operating status

Operating

Headcount range

51–100 employees

Short description

Pearl Health is a value-based care enablement platform that helps primary care providers succeed in Medicare risk-bearing contracts through AI-powered patient prioritization, workflow automation, and aligned financial incentives. It serves health systems, physician networks, and independent primary care practices across 40+ U.S. states.

Ownership category

akta.pro rank

Product category

Value-Based Care Platform

NAICS

Health Care and Social Assistance (62), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (5182)

SIC

Services-Health Services (8000), Services-Prepackaged Software (7372)

akta.pro primary industry

Software as a Medical Device (SaMD) – Clinical Decision & Diagnostic Software (HLACANAD)

akta.pro secondary industry

EHR/EMR Integration & Interoperability Middleware (HL7/FHIR) (HLALAKAD)

Keywords

• Value-based care platform
• Primary care enablement
• Medicare risk management
• Population health technology
• AI clinical workflows

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Marketing or Sales, Operations

Revenue model

1. Aligned Risk Contracts / Shared Savings (Risk-Bearing ACO Operations): Pearl enters into aligned risk partnerships where it shares in savings and downside with providers in ACO REACH and MSSP programs. Pearl manages both ACO REACH and MSSP populations; receives implementation advances, predictable monthly payments, and performance-aligned incentives; uses actuarial modeling to match providers to risk tracks. Geographic scope: 40+ U.S. states.
2. SaaS Technology Enablement: Pearl also offers the platform as a SaaS technology deployment (separately or combined with risk contracts) to health systems, physician networks, and primary care practices. The "Partnership Design" stage explicitly offers "SaaS technology deployment" as an option. Revenue is recurring/contract-based.
3. Performance-Aligned Incentive Distributions: Pearl's incentive structure rewards performance directly and predictably — transparent distribution rules ensure top performers capture the full value of their results, building accountability and trust. Also provides implementation advances and predictable monthly payments.

Pricing tiers

Go-to-market motion4 records

Distribution channels5 records

Marketing channels11 records

Core offering

Pearl Health provides an AI-native value-based care platform that ingests claims, ADT feeds, and EHR data to surface prioritized patient signals and embed next-best actions into provider workflows. It sells the platform as SaaS technology enablement to health systems, physician networks, and primary care practices, and also participates as a risk-bearing ACO in ACO REACH and MSSP arrangements, sharing savings and downside with partner providers across 40+ U.S. states.

Product overview

Pearl Health operates as a single integrated platform-plus-modules architecture centered on the Pearl Platform, an AI-native "operating system for value-based care." The Pearl Platform is the foundation that powers the Signal-Action Framework, which ingests claims, ADT feeds, and EHR data to generate prioritized clinical signals and automate next steps. Layered on top are Pearl's three customer-facing program offerings — Pearl for Traditional Medicare, Pearl for Medicare Advantage, and Pearl ACO risk pools — which are delivered through role-specific solutions for Health Systems, Physician Networks, and Primary Care Practices. Annual editorial publications (the Top 50 Value-Based Care Thinkers Report and the Primary Care Pulse Report) and complementary programs like the Insight Partner Program extend the platform's reach into thought leadership and provider co-creation. All are accessed through the secure Pearl Health web application at app.pearlhealth.com.

Differentiator

Problem solved

Functional benefit

Products and services

• Pearl Platform AI-native value-based care platform that combines claims, ADT feeds, and EHR data with predictive analytics and workflow automation to help providers identify high-urgency patients, automate next steps, and improve performance across risk-bearing Medicare contracts. Sold to health systems, physician networks, IPAs/MSOs, and primary care practices across 40+ U.S. states.
• Pearl for Traditional Medicare Program offering that helps providers succeed in Traditional Medicare ACO REACH and MSSP risk arrangements through portfolio design, cash-flow smoothing via implementation advances and predictable monthly payments, shared savings maximization, and AI-powered care enablement. Targeted at health systems, physician networks, and primary care practices.
• Pearl for Medicare Advantage Program offering that integrates MA claims with real-time data feeds to surface prioritized patient insights, embedded STARS/HEDIS measures for gap closure, point-of-care EMR integration, and multi-pronged benchmark accuracy support for risk adjustment. Designed for providers and payers serving Medicare Advantage populations.
• Pearl ACO REACH / Pearl MSSP (Risk-Bearing ACO Programs) Risk-bearing ACO programs operated by Pearl Health that allow primary care providers to participate in ACO REACH and MSSP under Pearl's ACO entity, sharing in savings and downside while accessing implementation advances, predictable monthly payments, and the Pearl Platform.

Quantifiable outcome

• 1–3% medical loss ratio improvement in year one
• +7 more outcomes

Named customers15 records

Segments5 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

AI capability4 records

Feature9 records

Partnerships

19 partnerships are on record, tiered flagship regional partner, integration partner, regional expansion partner, flagship customer-partner, flagship payer partner, specialty partner, thought leadership partner and partner network.

• Virginia Care Partners (HCA Virginia Affiliate)flagship regional partnerChannel Partner/ Reseller/ Distributor · 28 January 2025Pearl Health and Virginia Care Partners (an HCA Virginia Affiliate) established a partnership to expand access to value-based care, providing technology, insights, and financial tools for primary care providers in the Richmond area. Quote from Gerard Filicko, Executive Director.
• DeepScribeintegration partnerTechnology or Integration · 1 January 2025DeepScribe and Pearl Health announced a partnership to bring ambient AI documentation and point-of-care intelligence to value-based care providers, particularly primary care clinicians participating in ACO REACH and other risk-bearing models.
• PraxisCareregional expansion partnerChannel Partner/ Reseller/ Distributor · 13 August 2024Pearl Health partnered with PraxisCare and Adaugeo Healthcare Solutions to expand its value-based care network in the Pacific Northwest, enhancing value-based care for Medicare ACOs with cutting-edge technology to improve patient outcomes. Quote from TK Kennedy, CEO of PraxisCare.
• Adaugeo Healthcare Solutionsregional expansion partnerChannel Partner/ Reseller/ Distributor · 13 August 2024Joint partnership with Pearl Health and PraxisCare to expand value-based care network in the Pacific Northwest, enhancing value-based care for Medicare ACOs with technology to improve patient outcomes.
• MDX Hawaiiregional expansion partnerChannel Partner/ Reseller/ Distributor · 30 July 2024Pearl Health partnered with MDX Hawaiʻi to enhance primary care in Hawaii, providing data insights, financial tools, and value-based services for better patient outcomes and lower costs. Quote from Dr. Manoj Mathew, CEO of MDX Hawaii.
• BayCare Health System (BayCare Plus)flagship customer-partnerStrategic or Co-development PartnerPearl Health partnership deepens BayCare Plus's tech enablement capabilities, allowing its network of clinicians to deliver quality patient care. Quote on homepage from Shawn Armstrong, President of BayCare Plus.
• Holzer Health Systemflagship customer-partnerStrategic or Co-development PartnerPartnered with Pearl Health to increase access to value-based care in Ohio and West Virginia through advanced data insights, financial tools, and provider enablement technology. Quote from Rodney Stout, MD, President & CEO.
• Santé Physicians / Santé IPAflagship customer-partnerStrategic or Co-development PartnerPearl Health's technology platform enables Santé Physicians to better identify and manage high-risk and rising-risk patients, improve quality performance, and optimize PCP revenue potential. Quote from Dr. Michael Synn, CMO.
• Hudson Headwatersflagship customer-partnerStrategic or Co-development PartnerPearl partnership supports Hudson Headwaters' whole-person health innovation and community partnerships to improve health outcomes, patient satisfaction, and overall care coordination. Quote from Brittany Silvestri, EVP & COO.
• Wellcare (Centene Corporation)flagship payer partnerGTM or Marketing PartnerPearl Health (a leading technology company focused on physician enablement and risk-bearing in value-based care) and Wellcare (the Medicare brand of Centene Corporation, NYSE: CNC) announced a partnership to advance value-based care in collaboration with primary care physicians.
• Synapticurespecialty partnerStrategic or Co-development PartnerSynapticure and Pearl Health partnered to provide specialized neurologists and personalized patient and caregiver support to Medicare patients with dementia through the CMS GUIDE program, offering behavioral health support and comprehensive caregiver services nationwide.
• Isaac Healthspecialty partnerStrategic or Co-development PartnerIsaac Health and Pearl Health announced a strategic partnership to deliver the CMS GUIDE Model, streamlining dementia care for patients and supporting unpaid caregivers to improve quality of life.
• MNSspecialty partnerStrategic or Co-development PartnerPearl Health and MNS partnered to equip skilled nursing facilities for success in value-based care by combining technology, virtual oversight, and aligned reimbursement to improve outcomes and reduce hospitalizations.
• Vimintegration partnerTechnology or IntegrationPearl and Vim partnered in a hackathon to integrate Pearl Platform insights into EHR workflows, creating a new Vim feature in 72 hours. Vim Connect is a developer platform and application marketplace for integrating healthcare solutions into care team workflows.
• Conduce Healththought leadership partnerStrategic or Co-development PartnerPearl Health featured Conduce Health in a Q&A on building bridges between PCPs and specialists in value-based care — spotlighting innovative specialist engagement models.
• Shore Quality Partnerspartner networkChannel Partner/ Reseller/ DistributorPearl Health partner — listed among "world's top companies" trust logos on Pearl Health's homepage and partner pages.
• Praxis Healthpartner networkChannel Partner/ Reseller/ DistributorPearl Health partner — listed among "world's top companies" trust logos on Pearl Health's homepage and partner pages.
• BlueSky MDflagship customer-partnerStrategic or Co-development PartnerBlueSky MD uses Pearl's model to utilize care teams more effectively and get credit for activities performed. Quote from Dr. David LaMond, CEO & Medical Director.
• Odibo Medical Groupflagship customer-partnerStrategic or Co-development PartnerIndependent primary care practice partnered with Pearl to improve patient outcomes, reduce costs, and grow the practice. Quote from Dr. Michael Odibo, Physician & Owner.

Scale indicators15 records

Recent moves6 records

Expansion highlights7 records

Direct peers

• Aledade: Aledade operates the largest independent network of primary care ACOs, providing ACO REACH/MSSP enablement technology, risk-bearing infrastructure, and practice transformation services to PCPs — the closest functional and business-model analog to Pearl.
• Agilon Health: Agilon Health partners with primary care physicians to take global risk for Medicare Advantage populations via a capitated, technology-enabled model — directly comparable to Pearl's risk-bearing, PCP-anchored VBC enablement motion.
• Privia Health: Privia Health enables physician networks and IPAs to participate in value-based care arrangements across multiple payers, combining practice enablement technology with risk-sharing — overlapping Pearl's IPA/MSO and physician network customer segments.
• Stellar Health: Stellar Health provides a VBC enablement SaaS platform that translates payer data into EHR-embedded, point-of-care actions for PCPs in risk contracts — a direct functional competitor to Pearl's Signal-Action Framework for ACO REACH/MSSP providers.
• Wellvana: Wellvana partners with independent primary care practices to take on Medicare risk through ACO REACH and MSSP, offering technology, care management, and shared-savings economics — competing head-to-head with Pearl in the same end markets.
• VillageMD: VillageMD (a Walgreens Boots Alliance portfolio company) operates value-based primary care clinics and provider enablement for risk-bearing Medicare contracts — a competing model for PCP-led VBC, particularly in risk-bearing ACO arrangements.
• Astrana Health (formerly Apollo Medical Holdings): Astrana Health partners with independent medical groups and IPAs to manage Medicare Advantage and ACO risk populations, combining capitated arrangements with technology-enabled care management — a direct competitor in the VBC enablement space.

Broad incumbents

• Evolent Health: Evolent Health is a publicly traded value-based specialty care and population health company serving health plans and providers — a broader incumbent with overlapping VBC enablement capabilities but at much larger scale and payer-led.

Emerging players

• Innovaccer: Innovaccer offers a healthcare data activation platform and value-based care suite for providers, payers, and ACOs, intersecting with Pearl's data aggregation, risk stratification, and care management workflow capabilities.

Others

• Vim: Vim is a developer platform and EHR-integrated application marketplace for value-based care point-of-care workflows; Pearl has integrated with Vim Connect via a hackathon, and Vim is an adjacent/partner player in the same EHR-embedded VBC workflow ecosystem.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/pearlhealth_
• Facebookfacebook.com/PearlHealthCares
• LinkedInlinkedin.com/company/pearl-health

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles10 records

Funding overview

Funding rounds7 records

Investors9 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Pearl Health