Two people,
one
care plan.
When someone has dementia, the family caregiver is doing the work of a full care team — alone, and unpaid. We care for both of them. And we help your health plan spend less by preventing hospital visits before they happen.
What really drives the cost is two people.
But the system only pays attention to one.
When someone is living with dementia, the thing that most often sends them to the hospital isn't a lab result. It's whether the family member taking care of them at home is still able to cope.
Today's care system doesn't see that caregiver. She shows up as a phone number on a form. She isn't on anyone's patient list. No one is watching her health. When she breaks down — from exhaustion, depression, or an injury of her own — the person she cares for ends up in the emergency room. The plan sees the hospital bill, but not the six weeks of warning signs before it, when help would have been far cheaper.
That's Dyad Health. A dementia-care team that takes care of both of them — and is measured on whether the health plan actually spends less as a result.
Real care, delivered by real people.
Built on smart software.
We find the families who need us most.
Working with the health plan's data, our software identifies which families are most likely to end up in the emergency room in the next three months — so we can reach them first.
- Works with plan records
- Focused on dementia
We care for both of them.
A bilingual care navigator works with the whole family. The person with dementia gets a dementia specialist. The caregiver gets her own check-ins, help finding benefits, and a break from caregiving when she needs one.
- Medical and social support
- Spoken in the family's language
We're paid on what the plan saves.
The first year, the plan pays us a flat monthly fee. In year two, we share the savings. Every contract is measured on the real numbers: fewer hospital visits, fewer emergency room trips, better caregiver assessments.
- Monthly fee, year one
- Shared savings, year two
The numbers are simple enough
to explain to the CFO.
Here's what one member with dementia typically costs a plan in one year — and what changes when Dyad Health takes care of them and their caregiver together.
Illustrative — figures shown are modeled, not historical results. Actual savings depend on the partner plan's book of business and will be re-scoped at contract.
Based on hitting 60% of our target — a conservative estimate.
Our model was tested against real data from a health plan's dementia population in 2024 — with all personal information removed — as a joint analysis with our first plan partner. New policy changes (like Medicare's upcoming caregiver-support programs) help us sign contracts faster. But they don't make the math work. The math already works under today's rules.
Questions people ask us.
What is Dyad Health?
Dyad Health is a dementia-care program for families. We work with Medicare and Medicaid health plans to care for two people at once: the person who has dementia, and the family member taking care of them. That's what the word "dyad" means — a pair of two people who belong together.
Who is this for?
Families where one person is living with dementia or serious memory loss, and another family member is the main caregiver. To join, the person with dementia usually needs to have both Medicare and Medicaid, and be enrolled in a health plan that partners with us. If you aren't sure what insurance they have, join our waitlist anyway — we can help figure it out.
How much does it cost families?
Nothing. Our services are free to families, always. The health plan pays us. We are not paid by, and never will be paid by, the families we care for.
What does "dual eligible" mean?
"Dual eligible" means a person qualifies for both Medicare (federal health insurance for older adults and people with certain disabilities) and Medicaid (state health insurance for people with lower incomes). About 12 million Americans are dual eligible, and they often have the most complex health needs.
What is a D-SNP?
"D-SNP" stands for "Dual Eligible Special Needs Plan." It is a special kind of Medicare Advantage plan designed for people who have both Medicare and Medicaid. These plans usually cover more benefits than regular Medicare. Dyad Health works with D-SNPs to care for their members with dementia. Read our full plain-English D-SNP explainer →
What services will the family actually receive?
A care team you can call any time, made up of:
- A care navigator who speaks your language and works with your family directly.
- A dementia specialist (a doctor trained in memory and brain conditions) when you need advice.
- A plan for the caregiver — check-ins, help with benefits, and breaks from caregiving when they're needed.
- Help making the home safer (things like preventing falls).
- Regular medication reviews so nothing harmful is being prescribed.
What is "respite care" — and why does it matter?
Respite care means giving the family caregiver a break from caregiving — a few hours, a day, or sometimes longer. Someone else stays with the person who has dementia while the caregiver rests, runs errands, or sees a doctor themselves. Caregivers who get regular respite are much less likely to burn out and end up needing medical care of their own. At Dyad, we schedule respite before the caregiver is at her breaking point, based on how she's doing on our weekly check-ins.
How does Dyad save health plans money?
When the caregiver is struggling, the person with dementia usually ends up in the emergency room or admitted to the hospital within a few weeks. Those visits are extremely expensive. By supporting the caregiver before she breaks down, we prevent many of those visits. We estimate that for every $1 a plan spends on our program, the plan saves about $7.60 on medical costs it no longer has to pay for. Those savings come from fewer hospital admissions, fewer emergency room trips, and less time in skilled nursing facilities after discharge.
How is Dyad different from regular care management?
Regular care management works with one person — the patient. The family caregiver is treated as a phone number on a form. Dyad works with two people — the patient and their main caregiver — as one care plan. We also have smaller caseloads per navigator (one navigator for 75 families, instead of 200 or more), and we specialize in dementia rather than trying to cover every condition.
Is my private health information safe?
Yes. Dyad follows federal HIPAA rules that protect your health information, and we only use it to take care of you and your family. We never sell it, and we never use it for marketing. You can read the details in our HIPAA Notice and Privacy Policy.
Where and when are you available?
We are starting in select California counties in the summer of 2026, with one health plan partner. We plan to expand to more plans and more states in 2027. Join our waitlist and we will reach out when we can help in your area.
What is the LEAD Model?
The Long-term Enhanced ACO Design (LEAD) Model is the Centers for Medicare & Medicaid Services' successor to ACO REACH. It launches January 1, 2027 and runs for ten years through 2036 — the longest performance period CMS has ever tested in an ACO model. Key changes include embedding high-needs and dual-eligible beneficiaries across all participating ACO panels, a prospective payment track for ACOs whose attributed population is 40%+ high-needs, and a two-state Medicare-Medicaid alignment pilot that will formally test ACO-Medicaid partnerships.
How does Dyad Health help ACOs prepare for LEAD?
We provide the segment-specific operating model for the highest-cost, highest-impact population in the LEAD panel: dual-eligible beneficiaries with dementia. Specifically, we supply:
- High-needs attribution infrastructure — systematic prospective identification of dementia-affected dyads, which compounds toward the 40% threshold that unlocks prospective payment.
- GUIDE-compliant clinical delivery — care navigation, 24/7 line, structured caregiver education, and respite; layered under LEAD accountability.
- CARA-ready specialist relationships — geriatric neurology, geriatric psychiatry, and palliative care partners with episode definitions aligned to community stabilization.
- HCC / RAF / Star-measure capture — household-level visibility surfaces documentation your clinicians never saw, without adding workflow.
What is FHIR, and how does Dyad Health use it?
FHIR (Fast Healthcare Interoperability Resources) is the modern standard for exchanging structured clinical data between health systems, plans, and care providers. Under the CMS Interoperability and Prior Authorization Final Rule (effective April 2026), FHIR is the required substrate for prior authorization, Patient Access, Provider Access, and Payer-to-Payer APIs — with 24- and 72-hour decision clocks by 2027.
Dyad Health is FHIR-native from day one, conformant with HL7 FHIR R4, US Core, and the Da Vinci PAS and CRD implementation guides CMS named in the rule. Every clinical submission is assembled from canonical resources and reviewed by a former managed-care clinical reviewer before it leaves our system, so plans receive complete, first-pass-ready packets. Read the full FHIR explainer →
How does Dyad Health make first-pass prior authorization approvals possible?
Most prior-auth submissions fail on first pass because documentation is incomplete — a missing cognitive assessment, an unspecified functional status, a medication reconciliation that never made it to the referring provider. Dyad Health's home-based, dyadic care model generates that documentation as a byproduct of care, and our FHIR-native platform keeps it in canonical form. Before any submission leaves our system, a former managed-care utilization-management reviewer — a nurse or clinical pharmacist who previously adjudicated these requests inside a health plan — pre-flights the packet against the exact payer criteria. They know what complete looks like because they spent years returning the incomplete ones. The result: submissions cleared on first pass, inside the 24/72-hour windows the CMS ePA rule will require.
Does Dyad Health integrate with our EHR?
Yes. Our clinical coordination is HL7 FHIR R4 native, bidirectional. Updates from the dyad — home risk signals, caregiver burden scores, completed respite, behavioral changes, medication adherence — flow back into Epic, Cerner, Athena, or any FHIR-capable EHR alongside your own notes. Your clinicians see our activity without logging into a separate portal. No new workflow, no parallel documentation.
Can Dyad help us capture HCC, RAF, and Star measures?
Yes — and that's a direct consequence of how we work, not an add-on. Because our care navigators see the dyad in their home and community, they surface conditions (especially cognitive impairment, mood, frailty, polypharmacy, and caregiver-driven medication non-adherence) that clinic and hospital encounters miss. That visibility flows back to your care team through our FHIR exchange, so your clinicians can document conditions they're already treating but may not be capturing. Quality measures — especially Part C medication adherence and Part D measures on dual-eligible populations — move on the same visibility loop.
Can Dyad and the GUIDE Model work together?
They're designed to complement each other. The GUIDE Model (Guiding an Improved Dementia Experience) is an eight-year CMS payment model that reimburses comprehensive dementia care — navigation, 24/7 access, caregiver training, up to $2,500/year in respite. Our care delivery is GUIDE-compliant; health systems can participate in GUIDE and use Dyad as their delivery partner. Under LEAD, GUIDE's per-beneficiary payments layer underneath the ACO's shared-savings upside, giving you both fee-for-service stability on the dementia-care infrastructure and LEAD's longer-horizon performance incentives on total cost of care.
How do I get in touch?
Email hello@dyad-health.com. Families, health plans, partners, press, and anyone else — all at the same address.
Are you caring for someone with dementia? We'd like to help.
We're starting in a few California counties this summer, with one health plan partner. If the person you care for has both Medicare and Medicaid (sometimes called "dual eligible"), leave your name and we'll reach out when we can help in your area. Our services are free for families — always.
We don't sell your information. It goes only to our care team.
Built for the rules that are coming,
not the ones that just left.
Three policy shifts are converging on dual-eligible dementia care in the next 18 months. Dyad Health is designed to sit exactly where they overlap.
Medicaid changes (including Medi-Cal in California) narrow what plans can directly pay for under "in lieu of services." Care-management programs that keep the determination authority become the access layer to what remains. We're built as that layer.
New federal proposals fund bilingual, community-based navigators to help dually-eligible members understand exemptions, benefits, and enrollment choices. Our care navigator model was designed this way from day one — same staffing, same scope, same languages.
Standardized, FHIR-based prior authorization with 24/72-hour decision clocks by 2027. Our clinical tooling is FHIR-native already — every submission assembled from canonical resources, reviewed by a former managed-care clinician before it leaves our system, and cleared on the first pass. What is FHIR? →
Dyad Health is not dependent on any of these shifts — our economics hold under today's rules. What the shifts do is make the sell faster: plans that were weighing dementia programs for 2028 are now asking for 2027 go-lives.
- We hold the determination authority required under H.R. 1
- We field the community-navigator workforce without you staffing it
- We integrate with FHIR-native records your clearinghouse already supports
The dementia dyad is the segment that most rewards LEAD-era investment.
Dyad Health is built for the accountable-care architecture taking shape between 2026 and 2036 — CMS's LEAD Model, the GUIDE Model, the Medicare-Medicaid alignment pilot, and California's Future-of-Medicaid roadmap. We extend your clinical team into the home and the community, so dementia-affected dyads stabilize before they escalate, and so the documentation and quality lift you already earn shows up on the right contracts.
Care that extends beyond the clinic.
Your doctors, nurses, and care managers can only see what happens inside a visit. We see what happens the other 8,700 hours of the year — medication adherence, caregiver strain, the fall risks in the hallway, the cognitive decline that shows up as a missed refill before it shows up as an ER visit.
- Home-based navigation, 7 days
- Weekly caregiver check-ins
- Community-based, bilingual
FHIR-native, first-pass prior auth.
Prior authorization is the top pain point providers and patients cite — and under the April 2026 CMS rule, it's about to run on FHIR with 24/72-hour decision clocks. We're FHIR-native from day one. Every clinical documentation submission is assembled from canonical resources and reviewed by a former managed-care clinical reviewer before it leaves our system — so plans receive complete, payer-ready packets on the first pass. What is FHIR? →
- HL7 FHIR R4, bidirectional
- Former UM reviewers pre-flight every submission
- Da Vinci PAS & CRD conformant
Quality lift and revenue capture.
Household-level visibility uncovers conditions that well-intended discharge plans were never told about. That's HCC capture you'd have missed, RAF accuracy, and Star measures (Part C & D) that move on documentation you're already entitled to — without asking your clinicians to do anything differently.
- HCC / RAF accuracy
- Star measure attainment
- GUIDE-compliant documentation
The Long-term Enhanced ACO Design (LEAD) Model launches January 1, 2027 with a ten-year performance period and no rebasing — the longest horizon CMS has ever tested. High-needs and dual-eligible beneficiaries are embedded across all LEAD panels (not siloed into a separate track), and concurrent risk adjustment finally rewards organizations that serve complex populations.
What health systems have been missing is not screening tools. DHCS 2025 data show that cognitive assessments were completed for 4.1% of eligible D-SNP members at one of California's largest plans — against a dementia prevalence of roughly 18%. The gap is not detection. It's the absence of a structured, dyadic pathway that makes detection consequential. That's what we operate.
Do you run a Medicare
or Medicaid plan?
We should talk.
Our first plan partner signs in the spring of 2026. We're already contracting for 2027 enrollments — starting with one group of members, measured on your data, using the numbers you already track. Partner with us early and we'll shape the clinical program around the members you already serve.
Start a conversation →