Hey everyone 👋 we're Lalit & Catherine, co-founders of Pelica Health.

TL;DR

🚀 Pelica is the operating system for value-based care. One canonical record across claims, EHR, pharmacy, lab, and ADT, with six AI copilots reading and writing to it. Risk adjustment, Stars, pharmacy, network, care management, plus an AI Data Analyst. HIPAA-compliant, RADV-defensible, real-time.

Use Pelica to:

• Capture HCCs in real time, before the submission window closes
• Close Stars gaps once, across every payer, with no duplicate outreach
• Lift PDC on the three triple-weighted measures that move Stars more than anything else
• Replace 8 to 15 point vendors with one shared record
• Cut per-practice meeting prep from 90 minutes to 15

VBC teams using Pelica run risk, quality, pharmacy, and care management from one record. A physician-led IPA in New York went from three uncoordinated calls per member to one outreach in the right language that closed three gaps at once. No new headcount.

If you run risk-bearing contracts at a health plan, IPA, MSO, ACO, or medical group, email lalit@pelica.com or book a demo at cal.com/pelica.

🚩 The Problem

VBC teams own the contracts that decide whether the org makes money. They cannot operate. Today:

• Data lives in 12 places. By the time a problem surfaces, the submission window has closed.
• Risk calls a member. Quality calls the same member. The practice calls again. Sometimes in a language the member doesn't speak.
• The best predictive model is useless if it never reaches the provider.
• Hybrid HEDIS is retiring. ECDS volumes run 35 to 75 times higher per measure. The old infra was not built for it.
• V28 phase-in finishes in 2026. The average MA plan loses roughly 3% of RAF.

Point vendors keep stacking up. One for retrospective coding. One for HEDIS. One for adherence. One for ADT. Each with its own portal, its own data model, its own login.

VBC teams need more than another point tool. They need an operating system.

🛠️ Our Solution

We built Pelica, an AI operating system for value-based care. Three layers, six copilots, one canonical record.

• 🌐 HIPAA + SOC 2 Type II: Tenant-isolated, encrypted end-to-end, zero-retention with every LLM provider in use.
• 🔌 Connects to every system: Epic, Cerner, Athena, eCW, payer SFTP, PBM feeds, ADT, labs. SMART-on-FHIR overlays in Epic and Athena.
• ⚡ Live in weeks, not quarters: A new data source onboards in days. Copilots start working the day after.

What Pelica can do:

• 🧾 Risk Adjustment Copilot: Real-time HCC capture with trumping logic, MAO-004 awareness, and RADV-defensible chain-of-custody on every code.
• ⭐ Quality & Stars Copilot: Unified gap closure across every payer, with year-round glide-path forecasting for the post-hybrid HEDIS world.
• 💊 Pharmacy & Part D Copilot: PDC lift on the three triple-weighted measures. The 5 points that separate 4-star from 2-star.
• 🤝 Provider Network Copilot: Auto-generated practice agendas. Meeting prep from 90 minutes to 15.
• 🏥 Care Management Copilot: ADT-driven TOC worklists, 5-day follow-up tracking, no duplicate calls across teams.
• 📊 AI Data Analyst: Plain-English questions against the canonical record. Replaces the BI ticket queue.

A Director of Risk Adjustment told us: "Our data lives in twelve places. By the time we know there's a problem, the submission window has closed." A Stars Program Manager told us: "We are solving the same problem five times." Same root cause. One shared record fixes both.

👫 The Team

Catherine and Lalit met at YouTube and have been building large-scale systems together ever since. They saw the same gap from two sides: clinical AI that could not operate, and operations AI that could not reason clinically.

Catherine led AI work on Gemini and enterprise AI agents at Google. She did clinical AI research at Stanford School of Medicine and saw front-line patient care at clinics in California and New Hampshire. BA in Computer Science from Dartmouth.

Lalit spent 8 years building software for regulated industries at Google and YouTube. He was Engineering and ML lead on YouTube Payments, running a 45-plus person team in Commerce Billing on products driving $16B+ in revenue. Wharton MBA. ACM-ICPC World Finalist.

Backed by Y Combinator, SurgePoint Capital, Upside Partnership, ISEED Ventures, and Progressive Ventures.

Asks

• Intros to VPs of Risk Adjustment, Stars, Quality, or Pharmacy at MA plans, IPAs, MSOs, or ACOs.
• Intros to ACO executive directors running MSSP or REACH.
• Follow us on LinkedIn, X, and learn more at pelica.com.