Pearl Health raises $50M to bring AI to Medicare value-based care

Key Takeaways

• Pearl Health raised $50M in Series C equity plus $60M in debt, led by Andreessen Horowitz
• The company manages $3.6B in annualized Medicare spend across 10,000+ providers in 40+ states
• Pearl reached profitability in 2025, rare for value-based care startups at this scale

Pearl Health has closed a $50 million Series C round led by Andreessen Horowitz, with an additional $60 million debt facility from Trinity Capital. The company builds AI tools that help primary care practices manage Medicare patients under value-based contracts, where providers get paid for keeping patients healthy rather than for the number of procedures they perform.

Viking Global Investors, AlleyCorp, and Ulysses Capital also participated in the equity round. Pearl hit profitability in 2025, a threshold that few value-based care companies at comparable scale have crossed.

What Pearl Health actually builds

The company provides what it calls an "operating platform" for primary care practices taking on financial risk in Medicare. That means the practice agrees to be accountable for the total cost of care for a group of patients. If they keep patients healthy and costs low, they share in the savings. If costs run high, they absorb some of the loss.

Most practices want this model in theory. In practice, they lack the infrastructure to pull it off. Pearl's platform combines three capabilities: predictive risk modeling to flag which patients are likely to deteriorate, workflow automation to handle scheduling and follow-ups, and real-time dashboards tracking quality metrics and financial performance.

The company now manages approximately $3.6 billion in annualized medical spend across a network of more than 10,000 providers in over 40 states. Its tools work across both Traditional Medicare and Medicare Advantage, giving health systems a single platform for outcomes-based payment programs.

The staffing problem in value-based care

Steven Duque, Pearl's Chief Business Officer, framed the company's approach against the dominant playbook in the industry. Most value-based care companies solve coordination problems by hiring more people: care coordinators, phone staff, outreach specialists. That model is expensive and difficult to scale.

"You can't cost-effectively hire your way to delivering consistently great care across an entire patient population," Duque told AlleyWatch.

Pearl takes the opposite approach. Its AI automates the routine operational work, flagging at-risk patients, scheduling annual wellness visits, managing post-discharge follow-ups. Clinicians then focus their limited time on the patients who most need direct attention. The bet is that this creates operating leverage: better outcomes without proportionally increasing headcount.

Why this market is massive and growing

Medicare covers more than 70 million Americans and now exceeds $1 trillion in annual spending. The Centers for Medicare and Medicaid Services (CMS) has been steadily pushing providers toward value-based contracts, with a stated goal of tying roughly 40% of Medicare payments to value-based models.

That policy tailwind creates demand for exactly what Pearl sells. Every independent primary care practice considering an ACO REACH contract or Medicare Advantage risk arrangement needs infrastructure to manage that risk. Building it in-house is prohibitively expensive for most.

Pearl generates revenue through software subscriptions and performance-based shared savings. Organizations pay to license the platform, and when they succeed under value-based contracts, Pearl takes a cut of the upside.

The founding team's background

CEO Michael Kopko previously worked at Oscar Health, the venture-backed health insurer. There, he saw how difficult it was to align provider incentives with patient outcomes from the payer side alone. When Medicare introduced new payment models with richer claims data, he and co-founders Dr. Jeff De Flavio, Kevin Ryan, and Ankit Patel saw an opening.

Their thesis: build the operating system on the provider side. Give practices the data, predictions, and automation they need to actually succeed under risk contracts, rather than just hoping they figure it out.

Where the capital goes

Pearl plans to invest the new funding in two core capabilities. Performance Intelligence gives care teams a real-time, natural language view of quality, utilization, and financial performance across their patient population. Care Orchestration applies AI to automate scheduling, follow-ups, and outreach workflows.

The $60 million debt facility, led by Trinity Capital, likely provides working capital flexibility as the company scales its provider network and shared savings arrangements.

Frequently Asked Questions

What is value-based care in Medicare?

Value-based care ties provider payments to patient health outcomes rather than the volume of services delivered. Under these models, practices share in savings when they keep patients healthy and costs low.

How does Pearl Health make money?

Pearl generates revenue through software subscriptions and performance-based shared savings. Practices pay to license the platform, and Pearl takes a percentage of the savings achieved under risk contracts.

Who are Pearl Health's competitors?

Major competitors include Aledade, Agilon Health, and Privia Health. All provide infrastructure for primary care practices to participate in value-based care arrangements.

How much has Pearl Health raised in total?

With this $50M Series C and $60M debt facility, Pearl's total funding now exceeds $110M in equity and debt combined, though the company has not disclosed its full fundraising history.

Source: AlleyWatch