N.Y. Social Care Networks Begin Data Connection Work

New York State, as part of its Medicaid Section 1115 Demonstration Waiver, is seeking to integrate healthcare and social care via newly created networks. The $500 million program is one component of a $7.5 billion three-year waiver with nearly $6 billion of federal funding.

The Syracuse-based HealtheConnections health information exchange is partnering with three social care networks (SCNs) across the Hudson Valley, Southern Tier, and Central New York regions to address health-related social needs (HRSNs): Hudson Valley Care Coalition, Care Compass Network, and Healthy Alliance. Each of these SCNs has contracted with UniteUs, a social care coordination company, to host their HRSN screening and referral platform for streamlined coordination and effective data collection.

Working with the New York eHealth Collaborative (NYeC) and the five other Qualified Entities of the Statewide Health Information Network for New York (SHIN-NY), HealtheConnections is participating in coordinated efforts to exchange HRSN data between the SCNs and the SHIN-NY data lake.

Using synthetic data, HealtheConnections and partners across the SHIN-NY recently completed a testing phase to establish reliable processes for seamless data flow between the SCNs and the SHIN-NY data lake. The next phase will be working directly with the three SCNs and UniteUs to exchange their HRSN data.

HealtheConnections said it will also work with hospital-based and ambulatory practices within its service area to collect data from HRSN screenings conducted within their systems. All HRSN data collected through these efforts will be accessible through the HealtheConnections platform for query, which should allow for more comprehensive insights for care providers without the need for additional tools or systems.

HealtheConnections’ health information exchange covers 26 counties in New York State, and surrounding states, supporting more than 11,000 physicians and the millions of patients they serve.

The Medicaid waiver program will seek to address health disparities in low-income communities by leveraging federal funding to facilitate Medicaid members access to nutritional meals, housing supports, transportation and other social services. By integrating social care and health care, this program advances a key initiative under the New York Health Equity Reform (NYHER) waiver amendment. 

The SCNs will be core to facilitating the delivery of health-related social needs, including nutrition, housing supports, transportation, and case management for eligible Medicaid members, with the goal of addressing health disparities and improving population health.


Among their other goals, the SCNs will seek to create a more accessible customer experience for Medicaid Members seeking HRSN services through social care navigation and closed loop referrals. The also plan to build the capacity of community-based organizations (CBOs) to provide high-quality HRSN services and to manage new or increased administrative responsibilities through capacity-building and reliable funding streams.