This week, FTV Capital announced our $130 million strategic growth investment in DUOS, a leading AI-powered digital health platform that helps health plans activate and automate member engagement and benefit navigation.
To understand why DUOS matters, it’s important to understand the forces reshaping healthcare and what’s driving DUOS’ growth.
A pivotal moment for the American healthcare system
Our country is aging. By 2034, adults aged 65+ will outnumber children under 18 for the first time, according to the Census Bureau, and our healthcare system is not ready for it.
Medicare is the predominant health plan for older Americans, and because enrollees are often managing multiple health conditions and have high utilization, this population drives a disproportionate share of healthcare costs. Given the scale and complexity of the group (which today comprises ~17% of the U.S. population representing ~37% of health spending), Medicare Advantage (MA) has emerged as a plan that must align incentives across cost, quality and member experience. More than half of eligible Medicare beneficiaries, about 34 million people, are now enrolled in MA.
MA plans are highly motivated to offer strong member experiences and high-quality care; in fact, their revenue depends on it. MA plans earn bonuses or rebates tied to Star Ratings (quality metrics) and CAHPS scores (member satisfaction), plus additional payments by closing HEDIS gaps (e.g., preventive care, chronic disease metrics). But members often struggle to understand or access their benefits. Plan materials are confusing, and even known benefits can feel impossible to use. Food subsidies might require multi-page applications, or transportation benefits could be buried behind call-center queues. The result: underused benefits, higher costs and worse health outcomes.
While MA was built to align incentives between member and plan, what’s been missing is a reliable way to turn awareness into action – to ensure intent leads to impact.
Meet DUOS: final-mile system of action for high-impact member actions
This is precisely the problem DUOS tackles. DUOS is an AI-driven, multilingual digital health platform that helps health plans activate member engagement and benefits. It surfaces benefits to health plan members and automates the “last mile” – actually completing tasks on a member’s behalf (e.g., wellness visit scheduling, Medicaid redetermination, SNAP enrollment) through an agentic workflow – a system that doesn’t just remind members what to do, but actually does it for them. That shift – from outreach to execution – is what makes DUOS uniquely powerful.
For plans, this means closing HEDIS gaps, improving Stars and CAHPS scores, capturing risk and increasing member retention – outcomes that directly translate into revenue lift and lower medical costs. For members, it means fully utilizing their benefits and improving health outcomes.
Clear attribution: ROI and member experience
What initially drew FTV in: DUOS’ clarity of attribution and magnitude of outcomes. DUOS tracks gaps closed, wellness visits scheduled, plan conversions and subsidies paid; activated members typically complete around five of these actions with DUOS assistance.
Each action has a quantifiable impact on retained premium or revenue for the health plan, translating to gross ROI of 10-30x and net ROI of 2-6x. Member experience follows suit: 98% success rate pairing members with SDOH (Social Determinants of Health) resources, NPS of 87 and 89% of members say they’d stay with their plan if they can access DUOS.
This data serves as proof that DUOS is the missing link between member and plan – helping members use their benefits and helping plans improve quality.
Relevance beyond MA
Similar challenges exist beyond MA. DUOS is extending its platform to Medicaid, automating the complex redetermination process on behalf of members who might otherwise lose coverage due to administrative complexity or to Prescription Drug Plans – in both cases leveraging its core agentic workflow to act on behalf of members.
Strong leadership
Karl Ulfers, founder and CEO of DUOS, has worked with health plans for 20 years, having begun his career at UnitedHealth Group and later serving as CEO of Rally Health prior to its acquisition by UnitedHealth Group. Under Karl’s leadership, Rally tackled challenges of member engagement, care gaps and behavior change. That experience, paired with personal experience caring for older adults, exposed the friction between intent and execution in benefit usage and laid the foundation for DUOS’s focus on action. Few executives have a deeper understanding of the payer landscape or a clearer vision for how technology can drive member action.
We first met Karl at a conference nearly three years ago. Since then, we’ve watched the business scale revenue greater than 5x, expand into new markets and bring on incredibly talented executives like Jenn Kerfoot, Art Petrossian, and Carah Campini .
Bringing it all together: Why we invested
We invested in DUOS because it represents exactly what we look for: a clear system of action, measurable outcomes, multiple growth levers and a team we know and trust.
- Clear, differentiated system of action: A RAG-powered platform that executes member actions and ties every workflow to financial value for the plan and tangible benefit for the member
- Outcomes clients can underwrite: Transparent dashboards, hard-dollar ROI, and experience metrics that matter for Stars, member retention and risk
- Multiple growth levers: Continued expansion within existing clients, new product lines (PDP, Medicaid) and new logos
- Team we know and trust: We’ve known CEO Karl Ulfers for years. He’s a second-time CEO and has built an incredible team across product, go-to-market and operations
As the healthcare system navigates this demographic tipping point, DUOS is building the infrastructure to make care activation scalable. With MA enrollment at historic levels and evolving Stars dynamics, plans need partners that reliably activate members into the right care, at the right time. DUOS does exactly that and proves it in the numbers. We’re thrilled to partner with Karl Ulfers and the DUOS team on their next phase of growth.
Our investment in DUOS continues FTV’s long heritage investing in best-in-class businesses serving health plans, including VPay, 6 Degrees Health and EXL. We look forward to supporting DUOS in accelerating product and AI innovation, deepening payer partnerships, scaling operations and driving commercial introductions through our Global Partner Network®.
