Health tech startup Pearl Health has raised $110 million in a combination of debt and equity funding to build an artificial intelligence platform for Medicare providers that includes an AI agent to handle administrative tasks.
Founded in November 2020, the company provides technology that helps healthcare providers deliver preemptive care to Medicare patients through AI-powered predictive insights, financial risk modeling, and streamlined workflows. Pearl said it supports a network of more than 10,000 health care providers in more than 40 states, including health systems such as University of Vermont Health and MDX Hawaii, and cares for more than 250,000 Medicare beneficiaries.
The financing consisted of a $50 million equity investment led by Andreessen Horowitz and a $60 million credit facility led by Trinity Capital, with participation from Viking Global Investors, Alleycorp and Ulysses Capital.
Pearl has raised a total of $125 million in equity to date, including a Series B round in 2023.
The company currently manages approximately $3.6 billion in annual medical expenses, up from $2.4 billion a year ago and $1.6 billion two years ago, with growth accelerating. Pearl is expected to triple its patient numbers from 2024 to the end of 2026, executives said.
According to the company, Pearl will reach profitability in 2025 while maintaining rapid growth.
More than 70 million people are enrolled in Medicare, which costs more than $1 trillion, according to data from the Centers for Medicare and Medicaid Services (CMS). Reimbursement is increasingly tied to outcomes rather than utilization, creating strong incentives for health care providers to prevent avoidable disease, intervene early, and manage patient populations.
Pearl Health plans to use the new capital to expand its AI platform and accelerate growth across the company’s health systems and payer partnerships.
The company is investing in performance intelligent AI-powered software tools that turn clinical data into actionable patient-level insights.
“Performance Intelligence provides population health teams and care managers with a real-time natural language interface and inference engine for data on total cost of care, quality and utilization, so they can see which patients need their attention first,” Pearl Health co-founder and CEO Michael Kopko said in an email.
The company is also developing a care orchestration AI agent that automates administrative workflows such as annual health visit schedules, post-discharge follow-up, and care management assistance.
“Beyond the platform, we are growing through partnerships with new enterprise health systems and payers, expanding across the Medicare market, and building new risk offerings.The benefit for providers is that they can learn faster which patients are at highest risk and prioritize next steps. For payers and other risk-bearing partners, this means improved quality of care, utilization, and overall cost coordination. For patients, it means more quality time with their providers and more affordable care.”
“We’re looking at whether our technology can help healthcare teams identify high-risk patients faster, close care gaps more reliably, and reduce avoidable downstream costs,” he said. Pearl Health is projected to generate $500 million in total healthcare cost savings by 2026. “The combination of lower costs and better care is our definition of success,” he said.
Pearl Health is also expanding into Medicare Advantage and plans to roll out new risk products.
“Medicare Advantage enrollment continues to grow, and its providers face many of the same risk management challenges that we already help solve in traditional Medicare. By entering now, we will be able to offer the same solution to more patients,” Copko told Fierce Healthcare.
“We are also seeing strong customer demand for a unified approach across Medicare that allows organizations to use the same workflows, technology and operating models across a broader panel of patients, rather than maintaining separate processes in traditional Medicare and Medicare Advantage,” he said.
Advances in automation and agent AI create new opportunities to scale AI-enabled workflows with greater operational capacity, enabling care teams to provide more personalized and preventive care while reducing administrative burden, Copko asserted.
“This strategy aligns with what Medicare Advantage requires: deeper claims integration, strong risk adjustment support, and point-of-care tools built around the Medicare Advantage plan structure. Rather than starting from scratch, we are extending a system that already works.”
For the remainder of 2026 and into 2027, the company will focus on leveraging its technology to help care organizations “consistently deliver better clinical outcomes and stronger financial performance across evolving payment models,” Copko said.
“That means growing our business, expanding our network of providers, entering Medicare Advantage, and making our AI tools even more useful in the orchestration of daily care. Our vision is to become the leading technology platform for Medicare, delivering better health outcomes at meaningful lower costs,” he said.
Investors are showing strong interest in technology-enabled value-based care and VBC enablement companies. Honest Health raised $140 million in funding in February to expand partnerships and expand programs to support Medicare members. Chamber Cardio generated $60 million in revenue earlier this year by building infrastructure and AI-powered tools to help cardiologists successfully implement value-based treatment plans. Artificial intelligence startup Keebler Health has raised $16 million in Series A funding to build an AI-powered infrastructure for value-based care.
In December, value-based care enablement company Aledade secured a $500 million senior secured credit facility to support the company’s continued expansion. In September, value-based kidney care company Strive Health raised $300 million in a Series D equity round and secured $250 million in debt financing.
As noted in the Strive Health and Chamber Cardio funding rounds, investors are moving beyond broad primary care VBC operations to specialty-specific, value-based care.
Pearl Health’s latest funding shows investors believe that technology-enabled value-based care can scale as a real business, Kopko said.
“Value-based care requires new technologies and capabilities that help organizations operate more efficiently while keeping patients at the center. Pearl AI is an enabler. Expanding clinical capabilities, connecting workflows, and enabling early intervention. That’s what infrastructure providers need to successfully implement value-based care,” he said.
“Pearl has demonstrated that managing risk across large patient populations in many different healthcare settings can improve patient outcomes, generate meaningful savings, and support sustainable business models at scale,” Vinita Agarwala, MD, general partner at Andreessen Horowitz, said in a statement. “Pearl’s ability to help providers successfully participate in value-based payment programs, and to do so through technology rather than expanding the clinical workforce, is a testament to both the vision and execution of the Pearl team.”
