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.
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.