A new operating standard for D-SNP
Regional and community plans are stuck in their markets — and losing money on D-SNP. DualWorks makes the economics work: launch, comply, 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
Real scenarios from the day-to-day of regional and community plans.
Most of your duals are seen at FQHCs — conditions are treated and documented, but not all coded. The plan is paid below its real risk score.
Data in
DualWorks assist
AI Linked Chart Review
Reviews encounter notes & linked records
Identifies treated-but-uncoded diagnoses
Data & workflow out
Recommended diagnosis codes
Prioritized review queue
Routed to coders & providers
Recaptures tracked, evidence attached
Not upcoding — accurate coding.
Medication adherence misses the benchmark again. Outreach, rewards, and provider education all launch — and nobody can say which one worked.
Data in
DualWorks assist
AI Stars Tracking
Automatic monitoring of
process & outcome measures
Tracks CAHPS survey progress
and analyzes results
Data & workflow out
Recommended next steps
Assigned to the right teams
Documentation evidence captured
Gap closures tracked by intervention
Know what moved the number.
The MOC promises an HRA in 90 days, a care plan, a care team. But evidence lives in notes and spreadsheets — and the member who slipped through surfaces in a survey, after the hospitalization.
Data in
DualWorks assist
AI Evidence Engine
Runs each MOC commitment
as a tracked workflow
Captures evidence as the work happens
Data & workflow out
HRA & care plan completion queues
Evidence file per MOC commitment
Members flagged before they fall through
Audit dry run on demand
Audit-ready every day.
One state letter spawns a chain of deadlines, attestations, postings, and P&P revisions — buried in Word, Excel, and email threads.
Data in
DualWorks assist
AI Policy Mapping
Parses new guidance
against your policy library
Flags every impacted P&P, owner & deadline
Data & workflow out
Recommended P&P changes to owners
Impact analysis to guide decisions
MOC change pushed to impacted functions
Attestations & evidence tracked
A living MOC, not a paper chase.
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.
Intuitive by design
A UI your teams actually want to open — clear queues, plain language, no analyst required.
Not rip-and-replace
Start with one workflow. Prove value and get buy-in before expanding across teams and programs.
Works where your teams work
Recommendations and tasks can route through email, Teams, or Slack — powered by DualWorks.
Amy Wang
Amy built Medicaid operations at Malama Health (YC S22), scaling from zero to $3M+ ARR across 15 Medicaid MCOs within 18 months.
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.