How DUOS’ Early Commitment to AI Resulted in Improved Health Outcomes for Medicare Members

By Kelsey Jarrett and Anna Rumer

In the United States, Medicare and Medicaid members have long had access to a wide range of benefits and services to support stronger health outcomes and improved quality of life. However, the patients with access to these resources often have a hard time finding them.

Even for the most technologically-advanced, healthcare-savvy person, government applications can be confusing and time consuming. More importantly, these program participants are often unaware of the wide range of benefits available to them. The resources exist to help these people improve their quality of life; members often simply don’t know what those resources are or how to access them.

DUOS, an SJF Ventures portfolio company, exists to close the gap in healthcare between identifying a member’s need and completing the action that resolves it. DUOS recognized that health plans have long had the data to know which members are eligible for benefits, which ones are due for screenings, and which ones are at risk of losing Medicaid coverage. DUOS uses AI to provide the operational infrastructure to reach those members directly, walk them through the process of accessing benefits, and close the loop end-to-end.

Following an early commitment to AI through participation in an OpenAI startup program, DUOS is now scaling its impact to hundreds of thousands of Medicare and Medicaid members.

Here’s how they did it and what it has meant for their members.

The impact

Before digging into the history, let’s start with the impact:

• DUOS serves one in five U.S. adults across more than 10 leading Medicare Advantage, D-SNP, and PDP health plan client populations. DUOS partners with national and regional Medicare health plans across multiple states.
• Members have submitted more than 20,000 government program applications through DUOS across all program categories. DUOS estimates that these applications have unlocked or preserved more than $40 million in annual government benefits.
• DUOS has supported more than one million Healthcare Effectiveness Data and Information Set (HEDIS) care gap closures, as well as nearly half a million Annual Wellness Visits.

What does that mean in real terms?

It means that more Americans are able to address some of the most common health issues plaguing Medicare and Medicaid members: helping them to control their blood pressure, adhere to their prescriptions for conditions like high cholesterol and diabetes, and screen for diseases like breast cancer and colorectal cancer.

DUOS also helps improve enrollment in government programs by assisting with complex applications. Where it would typically take someone 60–90 minutes to apply for SNAP benefits or a Medicaid redetermination, a DUOS-assisted call takes roughly 13 minutes. DUOS takes a process that would normally be complex, confusing, and frustrating, and makes it  manageable. These aren’t just efficiency gains for members; they directly protect and unlock revenue for health plans. When a D-SNP member loses Medicaid coverage through a missed redetermination, the plan loses the associated Medicaid capitation and the member faces a disruption in care that can trigger costly downstream utilization. When an eligible member isn’t enrolled in the Low Income Subsidy, the plan absorbs drug costs that CMS would otherwise cover, and the member is more likely to skip doses or abandon therapy altogether. DUOS’ ability to identify at-risk members and complete these applications at scale turns government program enrollment into a measurable financial return for plan partners while preserving the continuity of care that keeps members healthier and costs lower.

Ahead of the game on AI

DUOS’ remarkable impact outcomes are the result of an early, sustained focus on AI.

Art Petrossian is DUOS’ Chief Product and Technology Officer, and he has steered the company through the ongoing AI revolution. In 2023, DUOS was accepted into OpenAI’s startup program and awarded a grant to develop on the company’s platform. This direct access to OpenAI’s team and technology gave DUOS a head start on building with the emerging GenAI tech stack. DUOS consulted regularly with OpenAI experts as they developed their own AI tools.

By 2024, DUOS was already showing significant progress. The company won the Accenture HealthTech Innovation Challenge by showcasing their AI workflows based on retrieval-augmented generation (RAG). DUOS’ RAG-based workflows were already deployed at production scale to members and Member Services teams.

Years later, that early investment shows. Today, DUOS applies AI across every layer of their platform. AI supports member-facing voice and chat agents, and AI copilots support Member Services. Autonomous cloud agents complete tasks like web application submissions and administrative calls, while AI performs conversational analytics across millions of member interactions. These functions all work together to deliver the efficiency gains that allow a member to complete a government application in under 15 minutes.

DUOS’ AI strategy has also improved equity for those whose first language isn’t English. The company has identified more than 40,000 Medicare members whose preferred language is Spanish; the company’s AI chat automatically detects member language and seamlessly switches the experience across the app. Supporting members in the language they trust improves outcomes, particularly as data shows that some Hispanic Medicare populations drop off at the first English-only touchpoint.

Scaling care gap closures

DUOS’ AI success story offers a model for other companies in the health sector. Yes, the company was an early adopter of AI. However, two aspects of the company’s AI strategy should underpin all AI efforts in the health sector.

First, DUOS focused on deploying AI in areas that allowed their technology to scale. Applications for government benefits often include overwhelming volumes of paperwork and repetitive processes; these were perfect targets for AI automation, and they allowed DUOS employees to focus on the human moments that make a difference for health outcomes. These automations offer durable efficiency gains, and they will help DUOS accurately, efficiently meet the needs of its members regardless of whether the company is serving 400,000 or 4 million people.

Second, DUOS recognized the importance of human connection even while increasing its use of AI. DUOS aims to support each member in the modality they trust most, whether that’s by phone, by chat, or by mail. When human intervention is required, DUOS employees jump in to guide members through the process and lead them to the best possible outcomes. It’s human connection with AI-amplified scale.

DUOS is an excellent case study of how AI can be applied to drive deeper impact at scale. At SJF, we started investing in software businesses over two decades ago, recognizing the potential for technology to drastically, quickly improve outcomes for learners, patients, workers and the environment. In this latest cycle, we’re similarly excited for AI to drive positive results for people and the planet, more deeply and broadly than was possible before.