Pelica (YC X25)
Pelica builds an AI operating system for value-based care, consolidating claims, EHR, pharmacy, lab, and ADT data into one canonical member record and deploying six role-specific AI copilots plus an outbound Action Layer for health plans, IPAs, MSOs, ACOs, and medical groups.
- Company typePrivate
- Founded2025
- HeadquartersSan Francisco, United States
- Headcount1–10
- GTM typeB2B
- OfferingSoftware
What Pelica (YC X25) does
Pelica Health is a five-person, San Francisco-based software company founded in 2025 by Catherine Zhao and Lalit Kundu, both former Google AI engineering leads, that builds an AI operating system for value-based care organizations. The platform is structured in three layers: a Data Layer ingesting 147 live streams across claims (MMR, MAO-004, MOR, 277CA), EHR (FHIR/HL7 via Epic, Athena, Cerner, and eClinicalWorks), pharmacy (PDE, Surescripts), labs (Quest, LabCorp), ADT (PointClickCare), telephony, and payer SFTP drops; an Intelligence Layer of six role-specific AI copilots (Risk Adjustment, Quality & Stars, Pharmacy & Part D, Provider Network, Care Management, and AI Data Analyst) that all read from and write to a single canonical member record; and an Action Layer capable of 2,184 outbound actions per hour across TCPA-compliant voice, EMR overlays, provider portals, and a coder workspace. The system consolidates what the company estimates as 8-15 fragmented vendor portals into one workflow surface and is positioned to replace retrospective, point-tool-based VBC operations with real-time execution.
Customers are risk-bearing healthcare organizations: Medicare Advantage and dual-SNP health plans, regional Blues plans, IPAs and MSOs taking delegated risk, ACOs (MSSP, REACH, and CINs), and medical groups. GTM is enterprise and founder-led: first conversations with COOs and heads of risk, quality, pharmacy, network, and care management are technical 30-minute working sessions that stand up a copilot on sample data rather than sales pitches; demos are booked via a public Calendly and inbound handled at [email protected]. The platform is delivered via multi-year subscription, is SOC 2 Type II audited and HIPAA compliant with BAAs available at deployment, and is progressing toward HITRUST. Pelica's only named production customer is HealthCare Partners, a physician-led IPA in New York managing 175,000 commercial, Medicare, and Medicaid members, which reports retiring 12 tools and 5 point-vendor contracts, 100% team adoption, +0.4 RAF lift in two quarters, 41% higher gap-closure rate, 96% PDC adherence on triple-weighted Part D measures, and approximately 10 hours saved per user per week.
The company is Y Combinator X25-backed and has raised $2.5 million in pre-seed funding across two 2025 rounds led by Y Combinator, with SurgePoint Capital, Upside Partnership, ISEED Ventures, and Progressive Ventures participating. Marketing is content-led, with operator-grade playbooks on V28 readiness, PDC math, RADV-defensible HCC capture, and the ECDS transition authored by the founders. The company does not publish pricing or revenue, and absolute ARR is inferred to be very small given the five-person team, single flagship customer, and $2.5M total funding base.
Pelica (YC X25) firmographics
Firmographics- Name
- Pelica (YC X25)
- Legal name
- Pelica, Inc.
- Website
- https://pelica.com
- Company type
- Private
- Founded year
- 2025
- Operating status
- Operating
- Headcount range
- 1–10 employees
- Short description
- Pelica builds an AI operating system for value-based care, consolidating claims, EHR, pharmacy, lab, and ADT data into one canonical member record and deploying six role-specific AI copilots plus an outbound Action Layer for health plans, IPAs, MSOs, ACOs, and medical groups.
- Ownership category
- akta.pro rank
Pelica (YC X25) industry classification
Industry- Product category
- Value-Based Care AI Platform
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)
- SIC
- Services-Prepackaged Software (7372), Services-Computer Integrated Systems Design (7373)
- akta.pro primary industry
- EHR Extensions, APIs, App Marketplaces & SMART-on-FHIR Apps (HLACAAAN)
Keywords
Where Pelica (YC X25) is headquartered
LocationHeadquarters
- HQ city
- San Francisco
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Pelica (YC X25) business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Marketing or Sales, Infrastructure, Operations
Revenue model
- Platform Subscription: AI operating system platform access with 6 copilots and action layer. Pricing not publicly disclosed. Governed by signed agreement between Pelica and customer organization.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Multi-year contract | Platform access with 6 AI copilots, canonical record, and action layer |
Go-to-market motion2 records
Distribution channels1 record
Marketing channels7 records
Pelica (YC X25) product offering
Product offeringCore offering
Pelica Health is an AI operating system for value-based care that consolidates 8-15 fragmented healthcare vendor portals into a single platform with three layers: a Data Layer ingesting live from 147 streams (claims, EHR, pharmacy, lab, ADT, telephony), an Intelligence Layer of six role-specific AI copilots (Risk Adjustment, Quality & Stars, Pharmacy & Part D, Provider Network, Care Management, plus an AI Data Analyst) sharing one canonical member record, and an Action Layer executing 2,184+ actions per hour via TCPA-compliant outbound voice, SMART-on-FHIR EMR overlays, provider portals, and coder workspace. The platform is sold via multi-year enterprise subscriptions to health plans, IPAs, MSOs, ACOs, and medical groups.
Product overview
Pelica Health is an AI-native operating system for value-based care, organized as a platform-plus-copilots architecture built on three layers: a Data Layer (live ingestion from 147+ sources including claims, EHR, pharmacy, lab, and ADT), an Intelligence Layer (six role-specific AI copilots), and an Action Layer (2,184+ automated actions per hour via voice, EMR overlays, and portals). The six copilots — Risk Adjustment, Quality & Stars, Pharmacy & Part D, Provider Network, Care Management, and AI Data Analyst — all share one canonical member record, eliminating duplicate outreach and enabling cross-team coordination. The platform is delivered as a unified product, not a modular add-on stack, and replaces 8–15 point vendor portals with a single consolidated operating system.
Differentiator
Problem solved
Functional benefit
Products and services
- Pelica Health AI Operating System AI operating system for value-based care sold as a multi-year subscription to health plans, IPAs, MSOs, ACOs, and medical groups. Built on three layers: a Data Layer with 147 live ingestion streams (claims such as MMR, MAO-004, MOR, 277CA; EHR via FHIR/HL7; pharmacy PDE; labs from Quest and LabCorp; ADT feeds; telephony recordings; and payer SFTP drops); an Intelligence Layer running six role-specific AI copilots (Risk Adjustment, Quality & Stars, Pharmacy & Part D, Provider Network, Care Management) plus an AI Data Analyst, all reading and writing to one canonical member record; and an Action Layer executing 2,184+ actions per hour via TCPA-compliant multilingual outbound voice, SMART-on-FHIR EMR overlays (Epic, Athena, eClinicalWorks), provider and staff portal pushes, and coder workspace. The platform consolidates 8-15 point vendor tools into one operating system with SOC 2 Type II, HIPAA, and HITRUST-in-progress compliance.
Quantifiable outcome
- +0.4 RAF lift in two quarters with no new headcount
- +7 more outcomes
Companies that use Pelica (YC X25)
Customer profileNamed customers2 records
Segments4 records
Ideal customer profiles4 records
Pelica (YC X25) technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration12 records
AI capability10 records
Feature9 records
Pelica (YC X25) partnerships and signals
Strategic signalScale indicators14 records
Recent moves6 records
Expansion highlights6 records
Pelica (YC X25) competitors and assessment
Company assessmentBroad incumbents
- Optum (UnitedHealth Group): Diversified health services and technology business offering risk adjustment, analytics, care management, and pharmacy services to payers and risk-bearing providers. Comparable on VBC operating workflows but at vastly greater scale and as part of an integrated payer-services portfolio.
- Health Catalyst: Broad healthcare data and analytics platform serving health systems and payers with population health, risk, and quality modules. Comparable on healthcare data unification for value-based care, but operates at a larger enterprise scale and a wider portfolio beyond VBC.
Direct peers
- Arcadia: Healthcare data platform with deep EHR integration, risk adjustment, quality, and care management analytics for payers and providers. Comparable in target customer (payers, IPAs, ACOs) and core value prop of consolidating fragmented data for value-based care; named in Pelica's comparison content.
- Stellar Health: Value-based care platform that uses EMR-embedded prompts to drive gap closure and quality performance at the point of care. Comparable on EMR-overlay distribution model and VBC primary-care focus; named in Pelica's comparison content.
- Innovaccer: Healthcare data platform providing a unified patient record and value-based care analytics/AI layer to health systems, payers, and ACOs. Directly comparable to Pelica on data unification and AI for risk/quality, though larger and more established; named in Pelica's own comparison content.
- Reveleer: Risk adjustment and quality platform combining NLP, medical record retrieval, and provider engagement tools for payers and risk-bearing entities. Comparable on HCC capture, RADV defensibility, and payer/MSO customer base; named in Pelica's comparison content.
- Navina: AI platform for primary care that synthesizes patient data into actionable clinical insights for risk adjustment and quality. Comparable on AI-driven synthesis of fragmented data for VBC workflows; named in Pelica's comparison content.
- Pearl Health: Value-based care enablement platform for primary care groups, providing risk adjustment, quality, and network performance insights. Comparable on target segment (PCPs/medical groups with risk contracts) and on analytics for VBC; named in Pelica's comparison content.
Emerging players
- Cohere Health: AI-driven prior authorization and utilization management platform for health plans. Tangential peer — both apply AI to payer-side clinical workflows, but Cohere focuses on authorization rather than risk/quality/care operations.
Others
- Datavant: Healthcare data connectivity and de-identification platform that links records across providers, payers, and vendors. Comparable on the underlying problem Pelica addresses (data fragmentation across claims, EHR, labs) but does not compete in the VBC action-layer; rather a potential upstream enabler.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks5 records
Key highlights6 records
Customer concentration
Pelica (YC X25) social profiles
Digital presencePelica (YC X25) compliance and trust
Trust signalCompliance3 records
Pelica (YC X25) financial estimates
Financial estimateRevenue estimate
Valuation estimate
Pelica (YC X25) leadership team
Management profileNumber of profiles
Profiles2 records
Pelica (YC X25) funding detail
Funding detailFunding overview
Funding rounds2 records
Investors2 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Pelica (YC X25) M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Pelica (YC X25)
What does Pelica (YC X25) do?
Pelica Health is an AI operating system for value-based care that consolidates 8-15 fragmented healthcare vendor portals into a single platform with three layers: a Data Layer ingesting live from 147 streams (claims, EHR, pharmacy, lab, ADT, telephony), an Intelligence Layer of six role-specific AI copilots (Risk Adjustment, Quality & Stars, Pharmacy & Part D, Provider Network, Care Management, plus an AI Data Analyst) sharing one canonical member record, and an Action Layer executing 2,184+ actions per hour via TCPA-compliant outbound voice, SMART-on-FHIR EMR overlays, provider portals, and coder workspace. The platform is sold via multi-year enterprise subscriptions to health plans, IPAs, MSOs, ACOs, and medical groups.
Is Pelica (YC X25) a public or private company?
Pelica (YC X25) is a private company. It is classified as venture growth investor backed and is currently operating.
When was Pelica (YC X25) founded?
Pelica (YC X25) was founded in 2025. It employs 1 to 10 people.
Where is Pelica (YC X25) based?
Pelica (YC X25) is headquartered in San Francisco, United States, in the North America region.
How does Pelica (YC X25) make money?
One revenue line is on record: platform Subscription.
Who are Pelica (YC X25)'s main competitors?
Broad incumbents on record are Optum (UnitedHealth Group) and Health Catalyst. Direct peers are Arcadia, Stellar Health, Innovaccer, Reveleer, Navina and Pearl Health. Cohere Health is listed as an emerging player. Datavant is listed as an others.
Does Pelica (YC X25) have an API?
No public API is recorded for Pelica (YC X25).
What industry is Pelica (YC X25) in?
Pelica (YC X25)'s product category is Value-Based Care AI Platform. Its primary akta.pro industry code is HLACAAAN, EHR Extensions, APIs, App Marketplaces & SMART-on-FHIR Apps. Its NAICS code is 524292 and its SIC code is 7372.