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 problem
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.
The result: D-SNP is no longer a product filing. It is an operating model.
Legacy BPaaS vendors were built for enrollment, claims, and core administration — not MOC-to-workflow execution, leaving gaps:
Revenue at risk
Missed documentation means missed compliant RAF opportunities.
Stars rating
Stars gaps become visible only after workflows have already drifted.
Audit readiness
MOC commitments are hard to prove when evidence lives across systems.
Policy & workflow updates
Policy changes break execution when updates stay trapped in email and SharePoint.
The platform
Every D-SNP commits to CMS how it will identify, assess, manage, and coordinate care for its members.
DualWorks turns those commitments into an orchestrated Model of Care-to-P&P-to-workflow stack — so every workflow, every member record, and every audit trail reflects what your plan said it would do.
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.