Pelica (YC X25)

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.

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

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

• Value-based care software
• AI healthcare platform
• Risk adjustment copilot
• HEDIS quality management
• Care management AI

Headquarters

HQ city

San Francisco

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. 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

Go-to-market motion2 records

Distribution channels1 record

Marketing channels7 records

Core 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

Named customers2 records

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration12 records

AI capability10 records

Feature9 records

Scale indicators14 records

Recent moves6 records

Expansion highlights6 records

Broad 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

• Xx.com/pelica_ai
• LinkedInlinkedin.com/company/pelica-health

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds2 records

Investors2 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 Pelica (YC X25)