A new operating standard for D-SNP
Regional and community health plans are being forced into D-SNP by federal mandate — without the infrastructure to run it. DualWorks is the operating standard they need to launch, comply, and compete.
The Gap
Look-alike plans phase out as CMS lowers the threshold to 60%, forcing plans toward compliant D-SNP paths.
Medicare growth becomes tied to Medicaid alignment, making enrollment coordination a core operating requirement.
Alignment becomes the floor, requiring plans to operate Medicare and Medicaid as one integrated model.
States are raising expectations through SMACs, deeper integration requirements, and stronger operational accountability.
Plans lose margin when D-SNP work stays fragmented.
Care management, compliance, Stars, risk adjustment, provider data, and policy teams all own pieces of the operating model, leaving gaps:
Per 1,000 Lives · RAF Leakage
FQHC undercoding leaves risk-adjusted revenue on the table.
Stars Drag
Coordination breaks down when ownership is split across teams.
Audit Exposure
Evidence gets lost across assessments, care notes, and disconnected systems.
Policy Updates
CMS changes keep moving while plans track execution in Word, Excel, and email.
The platform
Every D-SNP commits to CMS how it will identify, assess, manage, and coordinate care for its members. Most plans file that commitment and never operationalize it.
DualWorks makes the Model of Care a living system — connecting those commitments to the provider networks required to deliver them, the care teams responsible for executing them, and the Stars and audit outcomes CMS comes back to measure.
Click a capability to see how it runs in practice ↓
Use Cases
Scenarios drawn from how regional and community plans operate duals today — the fragmented version, and the DualWorks version, side by side.
The situation
Most of your duals are seen at FQHCs, where conditions documented in the chart never make it onto the encounter. Every uncaptured HCC understates member acuity — and next year's bid is built on the understated number.
On DualWorks
The platform reconciles chart documentation against submitted codes, builds a prioritized linked chart review queue, routes it to coding staff and provider follow-up, and tracks every recapture through submission with its evidence attached.
Revenue that reflects the acuity you're actually managing — with an audit trail behind every code.
The situation
Medication adherence misses the benchmark two years running. Stratified data shows exactly who is driving it — down to language and age band — so the team launches outreach, member rewards, provider education. Next year, nobody can say which one worked.
On DualWorks
Every intervention is tied to a measure, a subpopulation, and a measurement window. Gap-closure tasks route to care teams before windows close, and the tracker shows which cohorts actually moved.
Stop funding interventions on faith. Know what moved the number.
The situation
Your Model of Care promises an HRA within 90 days, an individualized care plan, an interdisciplinary care team. But completion lags, evidence lives in care notes and spreadsheets — and the member who slipped through only surfaces in a survey, after the hospitalization.
On DualWorks
MOC commitments run as tracked workflows: HRA completion queues, care plan evidence captured as the work happens, and an audit dry run that assembles the record on demand.
Audit-ready every day — and fewer members falling through the gaps between systems.
The situation
One state letter spawns a chain: a plan document due by year-end, implementation on January 1, committee attestations, website postings, P&P revisions citing exact contract provisions — tracked across Word, Excel, and email while the policy's revision history quietly falls behind.
On DualWorks
New guidance is parsed against your policy library. Impacted P&Ps, owners, deadlines, attestations, and postings land on one compliance calendar, with evidence attached as each step closes.
Every mandate mapped to a policy, an owner, and a date — nothing tracked in someone's inbox.
Illustrative scenarios based on documented regional-plan operations — not client engagements.
Built to Compete
Regional, community-rooted, health system-owned, and public plans are being asked to run D-SNPs with the complexity of United or Humana.
DualWorks gives them the operating layer to capture revenue, lift Stars, prove compliance, and reduce administrative burden — with $4–11M in addressable annual impact per 5,000 dual lives.
Amy Wang
Amy built Medicaid operations at Malama Health (YC S22), scaling from $120K to $3M+ ARR across 15 Medicaid MCOs while maintaining 90%+ audit scores across health plan partners.
Previously managed enterprise Mental Health Parity governance at Health Care Service Corporation across legal, clinical, product, UM, and network teams. She holds an MPA from the University of Wisconsin-Madison.
We'll run a live demo using a sample plan profile. No customer data required.