Pearl Health

Pearl Health is a New York-based healthcare technology company that supplies primary care providers, physician networks, and health systems with software, analytics, and operational support for participating in value-based care, beginning with Medicare's risk-based payment models. The company positions its product as an "operating system for value-based care" that combines data, workflows, financial strategy, and incentive alignment. The platform synthesizes claims data, admit/discharge/transfer (ADT) feeds, EHR data, and patient trends to generate signals, then prioritizes patients, recommends next steps, and automates administrative tasks.

Core product capabilities described by the company include patient prioritization, next-step guidance covering follow-ups, care gaps, and chronic condition support, workflow automation for outreach and scheduling, EHR integration, and performance visibility into total cost of care, benchmark accuracy, quality, and site of service. Pearl launched the first version of the Pearl Platform in 2022, providing panel-level performance reporting, patient-level longitudinal views across providers and facilities, and ADT alerts intended to support care coordination after acute and post-acute events. As of 2026 the company was expanding a "Performance Intelligence" capability with chat-enabled, AI-driven analysis for population health leaders and care teams, and was developing "Care Orchestration" AI agents to automate administrative workflows such as annual wellness visit scheduling, post-discharge follow-ups, and care management outreach.

Pearl's offering is organized around Medicare program strategy, covering both Traditional Medicare and, more recently, Medicare Advantage, with a stated portfolio of program options intended to help provider organizations manage revenue and downside risk exposure. The company also describes working with "Specialty Risk Partners" — companies managing distinct patient cohorts — that it aligns with primary care providers through its platform and financial incentives.

Founding story

Pearl Health was founded in 2020 by a team of physicians and public health experts, technologists, healthcare innovators, and risk management professionals with the stated aim of placing providers at the center of healthcare transformation. The company started with Medicare's risk-based payment models, building pathways for physician groups to participate in value-based care without adding administrative burden.

Business model

Pearl enables provider organizations to participate in risk-based Medicare payment models, aligning its own economics with provider clinical and financial outcomes through shared incentives; the company describes rewarding providers for outcomes aligned with value rather than volume. Public sources do not specify pricing or fee structure.

Not specified in the available sources beyond participation in Medicare risk-based payment arrangements and provider-enablement technology and services.

Traction

Company-reported figures include 250,000 beneficiaries, 10,000 providers, and presence in 40+ states, plus $3.6B in healthcare premiums managed, 2x year-over-year growth in lives covered, a stated 1–3% medical loss ratio improvement in year one, and up to 25% potential workload reduction. In the year preceding January 2023, more than 800 primary care providers joined Pearl.

Latest developments

In July 2026 Pearl announced $110 million in funding ($50 million equity led by Andreessen Horowitz with Viking Global Investors, AlleyCorp, and Ulysses Capital; $60 million debt facility led by Trinity Capital) to expand its AI platform, accelerate enterprise health system and payer partnerships, expand into Medicare Advantage, and introduce new risk offerings. It is developing Care Orchestration AI agents and expanding Performance Intelligence.