THE COMMUNITY DATA LAYER
Communities already have data. It just doesn’t move together.
Healthcare has information infrastructure. Communities need one too.
One shared layer connects people, services, context and consent.
Turn information into coordinated action — and close the loop.
One whole-person picture. Value for providers, payers and HIEs.
COMMUNITY SERVICES
COMMUNITY + CLINICAL DATA
211 + NAVIGATION
resource discovery • triage • warm handoffs
COMMUNITY SERVICES
housing • food • transportation
HUMAN SERVICES
county services • public health • benefits
ONE PERSON
CLINICAL + HIE DATA
encounters • ADTs • labs • longitudinal records
PROGRAM + OUTCOME DATA
enrollment • utilization • performance • impact
NEEDS + RESOURCE DATA
screening • eligibility • capacity • availability
THE PERSON IS WHOLE. THE SYSTEM SEES PIECES.
Needs, services, clinical context and outcomes are scattered across disconnected systems
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CLINICAL + HIE
COMMUNITY SERVICES
211 + RESOURCE DATA
PEOPLE + NEEDS
PROGRAM + OUTCOME DATA
ONE SHARED LAYER AROUND THE PERSON — NOT ANOTHER SILO
WHOLE-PERSON CONTEXT
SHARED CONTEXT
Housing instability
high priority
Transportation
active barrier
Benefits support
in progress
Primary care
connected
CONSENT-AWARE
ROLE-BASED
INTEROPERABLE
The person stays at the center — with a fuller picture of well-being, needs, supports and care.
NEED IDENTIFIED
screen • intake
REFERRAL SENT
right service • right context
SERVICE DELIVERED
coordination • follow-up
LOOP CLOSED
outcome • evidence
Shared referral status
Cross-sector collaboration
Consent + communication
Outcome visibility
A fuller picture becomes valuable when it helps people get the right support
— and helps teams act together.
VALUE ACROSS THE HEALTH ECOSYSTEM
Providers
See the whole person
Bring social needs, supports and referral status
into the care journey.
BETTER CONTEXT • BETTER FOLLOW-THROUGH
Payers
Understand risk + support
Connect needs, interventions and outcomes
across members and communities.
VISIBLE IMPACT • MEASURABLE OUTCOMES
HIEs
Extend exchange into action
Add community context, consent and outcomes
to the regional data backbone.
MORE USEFUL DATA • STRONGER NETWORKS
Ask us about the financial impacts.