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.
Federal mandates
D-SNP enrollment has tripled since 2018. National carriers spent a decade building the infrastructure to run these plans profitably. Regional and community plans are being given a fraction of that time, under federal mandate, with far fewer resources.
Look-alike plans lose CMS contracts. Non-SNP MA plans that hit 60% dual eligible concentration can no longer crosswalk members into other MA plans — only into D-SNPs. Enter or lose the members.
New enrollment restricted to aligned members only. D-SNPs with affiliated Medicaid MCOs can only enroll members who are simultaneously enrolled in that MCO. One D-SNP per service area per parent organization.
Unaligned member disenrollment required. Plans must disenroll every member not enrolled in the affiliated Medicaid MCO. Approximately 67,000 members face displacement in Wisconsin alone.
States are raising the integration floor. Michigan launched MI Coordinated Health in January 2026, requiring nine contracted plans to cover full LTSS under a capitated contract. Wisconsin, Colorado, California, and New York are moving the same direction.
Where plans struggle most
The operational challenge isn't one thing. It's every function running simultaneously, without the institutional muscle nationals built over years.
Legacy BPaaS vendors (Cognizant/TriZetto, Wipro) were built on mainframes for rigid plan designs. They weren't designed for D-SNP compliance workflows, FQHC coding gaps, or MOC audit readiness. DualWorks is the AI-native BPaaS — from fragmented operations to event-driven workflows.
The platform
Every D-SNP commits to CMS exactly how it will identify, assess, and manage its members. DualWorks operationalizes that commitment across the full MOC-to-P&P-to-workflow stack — so every workflow, every member record, and every audit trail reflects what your plan said it would do. No other vendor in this market connects those three layers for community plans.
DualWorks is a lightweight mission-control platform that opens in your browser. From daily operators to P&L owners, plan teams see gaps and risks, receive next-best actions, and capture evidence as they work.
DualWorks doesn't bring new data to your plan. It brings the operational standard that turns your existing data into outcomes — and the system that holds the standard so it doesn't depend on a particular person, vendor, or audit cycle.
What it's worth
The operational gaps don't compound in the abstract. They compound in dollars — every quarter that goes by without the discipline. Across four economic levers, total addressable impact ranges $4–11M per year for a plan with 5,000 dual lives. Year-one realized impact is typically 30–50% of addressable, as RAF and Stars improvements take 12–24 months to ripple through CMS payment cycles.
The economic case is multi-year by design. RAF and Stars improvements take time to ripple through CMS payment cycles, and Stars in particular rewards plans that hold the discipline year after year. The biggest economic miss is the plan that delays the operational layer by one more cycle.
Who we serve
DualWorks is not for United, Humana, or Centene. It's for the regional Blues plans, health system-owned insurers, and community-rooted plans that hold the member relationships — and are now being asked to build the operational muscle to match.
Regional Blues plans
Single-state or regional Blues affiliates entering D-SNP for the first time or scaling existing programs under consolidation pressure.
E.g. BCBS Michigan, Capital Blue Cross, BCBS Alabama, Premera
Community health plans
ACAP-member plans and FQHCs-owned insurers operating D-SNP under state mandate, often with Medicaid as the core competency — not Medicare.
E.g. LA Care, SCAN, Healthfirst, VillageCare, Jefferson Health Plans
Health system plans
Hospital-owned or provider-sponsored organizations building D-SNP to anchor their integrated care model and retain dually eligible patients.
E.g. UPMC Health Plan, Presbyterian Health Plan, HAP CareSource
County and public plans
County-run Medi-Cal managed care plans now required to unify under a Medicare Advantage contract — entering D-SNP with no institutional infrastructure for it.
E.g. Partnership HealthPlan, San Francisco Health Plan, Alameda Alliance
How we work · Forward-deployed
Our team embeds with yours, not over a vendor SOW. We learn your Model of Care, your workflows, and your provider mix — then ship the first compliant workflow in 6–8 weeks. You own the platform. We own keeping it compliant as CMS rules evolve.
The team
DualWorks was founded on a simple observation: the tools health plans are handed to run complex government programs were not designed for those programs.
Amy Wang
Founder
LinkedIn
Most recently Chief of Staff at Malama Health (YC S22), where she built the operational infrastructure that earned 90+ audit scores across every health plan partner — the same operational discipline plans need for D-SNP. As employee #1, she scaled operations from $120K to $3M+ ARR across 15 Medicaid MCOs in California, Texas, and Colorado, building the care management model, AI-enabled infrastructure, and care delivery team.
Prior to Malama, Amy led enterprise Mental Health Parity governance across legal, clinical, product, and network teams at Health Care Service Corporation. She holds an MPA from the University of Wisconsin-Madison.
See it in action
30-minute walkthrough. We'll run DualWorks live on a sample D-SNP modeled on your plan profile — MOC commitments, FQHC mix, Stars baseline, audit posture. No customer data required.