Data Archives - uniteus.com https://uniteus.com/topic/data/ Software Connecting Health and Social Service Providers Tue, 04 Aug 2026 21:41:11 +0000 en-US hourly 1 https://wordpress.org/?v=7.0.2 https://uniteus.com/wp-content/uploads/2022/06/uniteus-favicon-150x150.png Data Archives - uniteus.com https://uniteus.com/topic/data/ 32 32 Unite Us Acquires Vircho Health, Strengthening its Platform for Health and Community Care Networks https://uniteus.com/press/unite-us-acquires-vircho-health/ Tue, 04 Aug 2026 20:44:58 +0000 https://uniteustailstg.wpengine.com/?post_type=press&p=12679 Deal adds performance analytics and verification tools to Unite Us’ 13-year record of closed-loop care delivery for an added layer of intelligence to help community care networks validate investment; Vircho Health’s full team joins Unite Us. NEW YORK, August 5, 2026 – Unite Us, the nation’s trusted technology partner for integrating health and community-based care,...

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Deal adds performance analytics and verification tools to Unite Us’ 13-year record of closed-loop care delivery for an added layer of intelligence to help community care networks validate investment; Vircho Health’s full team joins Unite Us.

NEW YORK, August 5, 2026 – Unite Us, the nation’s trusted technology partner for integrating health and community-based care, today announced the acquisition of Vircho Health, a technology company whose performance and financial tools help the organizations running community care networks measure, optimize, and validate program performance. Unite Us welcomes the full Vircho Health team, including co-founders Craig Manson and Evan Jones. 

The acquisition comes as the bar for community care networks is rising. Funders no longer want to know only that a service happened; they are demanding evidence that the service was delivered, proof that it worked, data capturing network performance, and confidence that every dollar invested produced the outcome it was funded to solve. By integrating Vircho Health’s capabilities into the Unite Us platform, our customers can unlock deeper insights into network health to help networks validate and accelerate their impact. 

“We earned the trust of the communities we serve by taking on the problem everyone else thought was too complicated: going the last mile to close the loop,” said Taylor Justice, CEO and co-founder of Unite Us. “Vircho’s analytics expertise, combined with what we’ve built over 13 years, gives our network a new layer of intelligence and gets the right insight to the right decision maker, so issues get resolved the first time.”

“We led the first era of integrated health and community care by proving a service happened. We intend to lead the next by providing the intelligent infrastructure that assists the network to determine the next best action, whether it is care navigation or network performance,” Justice added.

Unite Us built the infrastructure to connect sectors and prove community services were received, pioneering the closed-loop referral model and compiling a record of care and outcomes spanning 13 years and nearly 125 million connections to care across every health and economic service that touches a person’s life.

Vircho Health’s platform turns that record into intelligent insights that meet the market’s demand for further validation: performance reporting on every organization within a network, quality analytics that show where performance is strong and where it needs attention, and financial accountability tools that track spending down to the dollar. These tools are already being used with Unite Us technology in North Carolina today.

“Vircho helps us turn network data into decisions. That’s what it takes to run community care with the rigor funders now expect, and what every network in the country will need to meet Rural Health Transformation goals,” said Laurie Stradley, DrPH, CEO of Impact Health, a Western North Carolina nonprofit that serves as both the Network Lead for the Healthy Opportunities Pilot (HOP) and a NC ROOTS Hub for the state’s Rural Health Transformation Program. 

“As a partner of both Vircho and Unite Us, we see their coming together as one organization bringing us closer to a single, trusted source of truth for the outcomes we’re accountable for,” she added.  

The Vircho Health team brings deep expertise in healthcare data, clinical informatics, and integration with leading clinical systems that strengthens Unite Us’ existing healthcare foundation. They will work across the combined company to bring their capabilities together to advance shared priorities.

“Health and community care have run on separate rails for too long: separate data, separate systems, separate definitions of success. Unite Us built the connective tissue between them, and Vircho built the tools that make that connection count,” said Craig Manson, CEO & co-founder of Vircho Health. “Joining forces means we can help every network prove, down to the service and the dollar, not just that care happened, but that it worked. That’s the future we’re building together.”

Better infrastructure also reduces the administrative burden on community-based organizations. Too much of their time goes to proving they did the work: duplicate reporting, invoicing and documentation requirements that pulls staff away from the people they serve. This acquisition means less time proving and more time serving, and a clearer record of the results these organizations deliver for the communities and funders that count on them.

Terms of the transaction were not disclosed.

For more information about Unite Us, visit www.uniteus.com. Learn about Vircho Health’s products at vircho.com.

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Santa Fe CONNECT: A New Blueprint for Government-Led Community Care https://uniteus.com/case-study/santa-fe-connect-a-new-blueprint-for-government-led-community-care/ Wed, 15 Apr 2026 14:00:20 +0000 https://uniteustailstg.wpengine.com/?p=11835 Santa Fe CONNECT demonstrates how a government-led, technology-enabled approach can transform fragmented social and healthcare services into a coordinated system of community care. By collaborating with local partners to train and embed navigators across clinics, public agencies, and community-based organizations—and unifying them through a shared referral and care coordination platform powered by Unite Us—Santa Fe...

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Santa Fe CONNECT demonstrates how a government-led, technology-enabled approach can transform fragmented social and healthcare services into a coordinated system of community care. By collaborating with local partners to train and embed navigators across clinics, public agencies, and community-based organizations—and unifying them through a shared referral and care coordination platform powered by Unite Us—Santa Fe CONNECT created a single, accountable record of care for individuals seeking health and community services.

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HIMSS 2026 Recap: How Data Standards Power Rural Health Transformation https://uniteus.com/blog/himss-2026-recap-data-standards-and-rural-health/ Thu, 26 Mar 2026 20:53:16 +0000 https://uniteustailstg.wpengine.com/?p=12128 By: Emily Anders, Director, Payments Strategy  Earlier this month at HIMSS, I had the opportunity to represent the Gravity Project at the HL7 International exhibit, presenting alongside Katie Keating, Vice President of Solutions Engineering, on the role shared data standards play in powering rural health transformation.  From Activity to Impact: Shifting How We Think About...

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By: Emily Anders, Director, Payments Strategy 

Earlier this month at HIMSS, I had the opportunity to represent the Gravity Project at the HL7 International exhibit, presenting alongside Katie Keating, Vice President of Solutions Engineering, on the role shared data standards play in powering rural health transformation. 

From Activity to Impact: Shifting How We Think About SDOH Data

For the past decade, there’s been a meaningful shift in how we think about health. Community-based services that address social drivers of health (SDOH)— or the non-medical factors that impact our health like food access, housing support, transportation, and maternal health services—are no longer seen as adjacent to healthcare, but as essential components of it.

We’ve also worked with our customers to build a growing body of evidence showing that when these needs are addressed, we see real outcomes: reduced total cost of care, fewer ED visits, and improved clinical measures like A1C and blood pressure control.

But one of the biggest challenges has remained: proving ROI consistently and at scale.

Moving from activity tracking (“a referral was made”) to outcome attribution (“this intervention improved this person’s health and reduced cost”) requires more than programs and partnerships. It requires a shared language.

Why Data Standards Matter

That’s where SDOH data standards come in.

Standards-based infrastructure,  like the work advanced through the Gravity Project and enabled through HL7 FHIR, allows clinical providers, community-based organizations, payers, and states to speak the same language. It creates consistency in how we:

  • Capture social risk and needs
  • Send and receive referrals
  • Document services delivered
  • Track outcomes and close the loop

Without that shared foundation, even the most well-designed programs struggle to demonstrate impact in a way that is measurable, repeatable, and scalable.

What This Looks Like in Practice

We’re now seeing leading states operationalize data standardization in meaningful ways.

In North Carolina’s Healthy Opportunities Pilots (HOP), the state built a first-of-its-kind program to pay for evidence-based, non-medical services for Medicaid members. In its interim evaluation, the program demonstrated $85 PMPM savings for enrolled members.

That result didn’t happen by chance. It required the ability to connect data across many different stakeholders like managed care plans, clinically integrated networks, and community-based organizations, and to consistently track services delivered and outcomes. 

Similarly, Missouri’s Transformation of Rural Community Health (ToRCH) initiative is showing how a hospital-led, community-based model can improve care coordination while also reducing administrative burden. Connecting hospitals and community organizations through shared, standards-based infrastructure, show the program is enabling more timely follow-up, better visibility into services, and HEDIS gap closures. 

In both cases, standards-based infrastructure t makes it possible to link actions to outcomes, with proven results. 

Why Data Standards Matter for Rural Health

This conversation is especially timely as states begin preparing for the Rural Health Transformation Program (RHTP), a significant, time-bound federal investment aimed at strengthening rural health systems.

At its core, the opportunity is not just to fund new programs, but to build systems that are sustainable. 

That means:

  • Supporting rural providers under financial strain
  • Expanding workforce capacity, including community health workers and doulas
  • Investing in infrastructure that connects clinical and community care
  • Demonstrating measurable improvements in cost and outcomes

But across all of these priorities, one requirement stands out: the ability to measure impact.

And in rural communities, where care often involves a complex network of providers, community organizations, and support services, that measurement challenge is even more pronounced.

Bringing It Back to the Individual: A Maternal Health Impact Story

Maternal health is a key priority across many states’ RHTP strategy. During our session, we used this as a lens to illustrate why standards-based infrastructure is critical to achieving meaningful, measurable outcomes.

Pregnancy-related mortality is up to 50% higher for rural individuals compared to their urban counterparts, and in some analyses, rates are nearly twice as high in rural areas. We also see higher rates of severe maternal morbidity, infant mortality, and complications like preterm birth in rural communities.

At the same time, access to care is declining. Over two-thirds of rural counties lack hospital-based obstetric services, and many patients are traveling 30–50+ minutes to reach care, if it’s available at all.

Imagine a pregnant patient in a rural community. She may be enrolled in Medicaid and receiving clinical care from a provider located over an hour away, without access to transportation and fresh produce. So when states set goals like improving maternal health outcomes as part of their rural health strategies, this is the reality they need to help individuals overcome. 

States may employ strategies to meet the pregnant mom where she is – connecting her to a community health worker to navigate access to transportation and food, and a doula to provide important prenatal education, supportive services, and advocacy. These non-clinical supports might be approved to be reimbursed by Medicaid within their state. Meanwhile, her provider is documenting in an EHR, the birthing hospital is documenting in another system, and the CHW/doulas in a third system, or using spreadsheets. At the policy level, a state Medicaid analyst who has never met the member, is trying to answer a critical question:

What actually improved outcomes for this patient, and what should we scale in order to positively impact more pregnant individuals?

That’s where standards-based infrastructure becomes essential. By understanding the social risk data the individual was experiencing (LOINC, snomed), what referrals were sent and what supportive services the individual was able to access and what outcome occurred (FHIR), what billable services were provided and reimbursed (Z-codes, HCPCs codes, X12 EDI), and enabling all of these stakeholders to be able to support this pregnant individual on their journey to receiving care (FHIR APIs), the analysts at the policy level are able to understand how programs on the ground are running and whether those interventions are making the impact they need. Without a shared language across all of these actors, it’s incredibly difficult to connect interventions to outcomes. This is why the work the Gravity Project does to create shared language and exchange is fundamental for programs to be scalable, replicable, and sustainable.

The Path Forward: Leveraging Data Standards to Power Better Rural Health Outcomes

Rural health transformation isn’t just about funding or new programs. It’s about building the infrastructure to enable providers to coordinate care across the continuum through secure data exchange, speak the same language through shared terminology, and measure the impact of programs in order to ensure sustainability. Standards are the foundation of that work, turning fragmented data into coordinated systems, and uncovering insights on impact.

Thanks to the important work done by the Gravity Project, technology infrastructure can adopt these shared standards and leverage interoperable exchange through HL7 FHIR to connect clinical care, community services, and policy analysis. This is what makes it possible to measure, scale, and sustain interventions.

When everyone is speaking the same data language, we don’t just track one-off activities. We can see what works and expand it to improve care for more people in rural communities.

Learn more about partnering with Unite Us for rural health transformation

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How Intermountain Health Drove $7M in Cost of Care Savings and Gained 2,150+ Hours With Unite Us https://uniteus.com/case-study/intermountain-health/ Fri, 27 Feb 2026 20:38:58 +0000 https://uniteustailstg.wpengine.com/?p=11743 Intermountain Health, the largest nonprofit health system in the Intermountain West, partnered with Unite Us in 2019 to build a coordinated, statewide network addressing patients’ non-medical needs. Through measurable gains in household income, administrative efficiency, healthcare cost savings, and expanded network reach, the partnership demonstrates how integrated care coordination infrastructure can improve outcomes for patients...

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Intermountain Health, the largest nonprofit health system in the Intermountain West, partnered with Unite Us in 2019 to build a coordinated, statewide network addressing patients’ non-medical needs. Through measurable gains in household income, administrative efficiency, healthcare cost savings, and expanded network reach, the partnership demonstrates how integrated care coordination infrastructure can improve outcomes for patients while reducing the total cost of care.

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How the Georgia Department of Veterans Service Used Data-Driven Outreach to Target 5,000 Veterans in Need https://uniteus.com/case-study/georgia-department-of-veterans-service/ Wed, 25 Feb 2026 15:00:43 +0000 https://uniteustailstg.wpengine.com/?p=11580 The Georgia Department of Veterans Service (GDVS) serves more than 700,000 Veterans and their families, helping them navigate benefits, healthcare, employment, and essential resources. By partnering with Unite Us, GDVS modernized its outreach and care coordination model through predictive analytics, proactive engagement, and a closed-loop referral network. This transformation enables Veterans to receive timely, high-quality...

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The Georgia Department of Veterans Service (GDVS) serves more than 700,000 Veterans and their families, helping them navigate benefits, healthcare, employment, and essential resources. By partnering with Unite Us, GDVS modernized its outreach and care coordination model through predictive analytics, proactive engagement, and a closed-loop referral network. This transformation enables Veterans to receive timely, high-quality support, preventing crises, reducing barriers, restoring trust, and improving whole-person outcomes across the state.

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Why Data-Driven Member Insights Are the New Foundation of Meaningful Member Management https://uniteus.com/blog/why-data-driven-member-insights-are-the-new-foundation-of-meaningful-member-management/ Sat, 10 Jan 2026 21:39:22 +0000 https://uniteustailstg.wpengine.com/?p=11479 Health plans today operate in an environment that is more competitive, more complex, and more consumer-driven than ever before. Members have more choices, greater access to information, and higher expectations for support and simplicity. In this landscape, the organizations that succeed are the ones that truly understand their members, not just at a demographic level,...

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Health plans today operate in an environment that is more competitive, more complex, and more consumer-driven than ever before. Members have more choices, greater access to information, and higher expectations for support and simplicity. In this landscape, the organizations that succeed are the ones that truly understand their members, not just at a demographic level, but at a behavioral, emotional, and experiential level.

This is where data becomes the backbone of modern member management. Data is not simply helpful. It provides clarity in a system full of moving parts. When plans rely on strong member insights, they can anticipate what comes next. They can also focus on the right markets, design benefits that align with member priorities, create meaningful engagement at the moments that matter, and intervene early when members begin to drift away.

Member insights shift member management from something transactional to something strategic and human-centered.

Turning Insight Into Growth: Introducing Unite Us Growth Insights

The challenge for many plans is not a lack of data. It is a lack of actionable intelligence. Growth decisions are often made with partial visibility, outdated assumptions, or siloed information that obscures how members actually behave.

This is where Growth Insights, part of the Unite Us Predictive Analytics suite, comes in.

Growth Insights brings together Medicare-specific market data, competitive intelligence, and predictive modeling to help plans clearly understand where to grow and where retention risks are emerging. Rather than reacting after annual enrollment period (AEP) outcomes are finalized, teams gain forward-looking insight that supports smarter planning and more confident decision-making.

By combining historical trends with predictive signals, Growth Insights helps plans identify opportunities and risks before they fully materialize. This allows leaders to adjust market strategy, benefit design, and engagement efforts earlier in the planning cycle, when change is still possible and impactful.

With Growth Insights, plans can:

  • Identify where member movement is occurring across markets and segments
  • Understand which benefits and experiences matter most to members
  • Detect emerging risks earlier, before disenrollment accelerates
  • Prioritize growth and retention opportunities with the greatest potential impact

By grounding strategy in predictive insight, Growth Insights enables plans to move from reactive course correction to proactive, intentional growth.

Why Now Is the Time for All Plan Types to Prioritize Member Insights

The need for stronger insights is not hypothetical. It is immediate and industry-wide. Every segment of the health plan market is feeling pressure to understand and engage members more intelligently. Member expectations continue to rise, and organizations that fail to adapt risk falling behind in ways that are difficult to recover from.

When plans fail to engage members, the consequences are measurable: increased plan switching, lower satisfaction and quality ratings, and higher financial costs to the plan.

For Medicare Advantage plans, the timing is particularly important. As plans reflect on AEP, they must make decisions that influence acquisition, retention, benefit design, and market positioning for the year ahead. Without a clear understanding of what drives member movement and which benefits matter most, plans often fall back on guesswork. This introduces unnecessary risk during the most critical period of the Medicare Advantage calendar.

Growth Insights directly supports this moment by helping Medicare Advantage teams analyze AEP outcomes alongside predictive indicators of future enrollment and disenrollment. This clarity enables plans to translate AEP learnings into targeted action for the year ahead.

Other plan types are experiencing equally rapid change.

  • Medicaid plans are managing fluctuating eligibility as redeterminations continue.
  • Commercial plans are facing increased member choice and rising expectations for personalized experiences.
  • Dual plans require more coordinated support and deeper insight into community-based and non-medical needs.

Across these plan types, Growth Insights provides a consistent, data-driven foundation for understanding member movement, benefit preferences, and market dynamics, regardless of product mix or population complexity.

Across all plan types, predictive, real-time intelligence is no longer optional. It is essential.

The Shift From Managing Members to Understanding Them

For many years, member management focused primarily on enrollment cycles, benefit updates, and annual reviews. These activities remain important, but they no longer provide a full picture of member behavior. They offer limited insight into how members actually utilize their benefits, navigate the healthcare system, and gain timely access to care. Plans now need continuous visibility into how members move, behave, and make decisions throughout the year.

Understanding what motivates someone to join, why they stay, why they switch, and which factors influence engagement gives plans a deeper and more actionable view of member behavior. These insights reveal patterns that may otherwise go unnoticed:

  • A gradual rise in disenrollment within a specific demographic
  • Shifts in benefit preferences across counties or regions
  • Populations showing early indicators of disengagement
  • Prospective members who resemble a plan’s most engaged current members

Growth Insights surfaces these patterns through predictive modeling and market-level intelligence, helping plans see not only what is happening, but what is likely to happen next. This foresight allows teams to respond with precision rather than broad, one-size-fits-all strategies.

Each member is a whole person shaped by clinical needs, non-medical needs, financial pressures, and lived experience. Plans that recognize this full picture can support members with far greater precision and empathy.

From Data to Action Across the Member Lifecycle

Insights only create value when they inform meaningful action. When plans understand what is happening with their members, they can respond in ways that improve experience, reduce friction, and strengthen loyalty.

Teams can:

  • Design benefits that better match member priorities
  • Allocate marketing resources toward markets with stronger growth potential
  • Tailor engagement strategies to match real behavior patterns
  • Personalize outreach to feel supportive and relevant
  • Intervene earlier when members begin to drift toward disenrollment

Growth Insights enables these actions by translating complex data into clear, decision-ready insights that teams across growth, marketing, product, and retention can align around.

Organizations that take this approach move beyond simply managing membership. They support it holistically.

The Human Impact of Better Member Insights

Better understanding leads to better support. When plans know what their members value, they can design offerings that feel meaningful. When they understand the barriers members encounter, they can help remove them. When they detect early signs of frustration or attrition, they can act quickly to rebuild confidence.

This is where strong data strategy intersects with human-centered care. Plans are not only guiding people through enrollment or navigating clinical services. They are also supporting access to community based and non-medical care and addressing non-medical needs that influence health, well-being, and quality of life.

By connecting growth intelligence with a broader understanding of member needs, Unite Us helps plans align growth strategy with care strategy, reinforcing trust while driving sustainable enrollment and retention.

Better insights create the conditions for better support. Better support leads to better outcomes. Better outcomes strengthen loyalty over time.

Take the Next Step

If your organization is ready to build a clearer, more predictive, and more human approach to member management, Growth Insights can help. Explore how this solution supports smarter acquisition, stronger retention, and more meaningful member engagement.

Learn More

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10 Questions: Turn Tech Investments into Community Impact https://uniteus.com/10-questions-to-turn-tech-investments-into-community-impact/ Thu, 08 Jan 2026 19:13:15 +0000 https://uniteustailstg.wpengine.com/?p=11383 Selecting a technology partner is about more than features. It’s about impact you can prove. This guide breaks down 10 critical questions to ask when choosing an infrastructure partner across health and community care. It’s designed to help you cut through the noise to select a platform that predicts needs, closes the referral loop, powers...

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Selecting a technology partner is about more than features. It’s about impact you can prove. This guide breaks down 10 critical questions to ask when choosing an infrastructure partner across health and community care. It’s designed to help you cut through the noise to select a platform that predicts needs, closes the referral loop, powers reimbursements, and proves ROI—so you can invest with confidence and scale real impact.

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Introducing Dynamic Scoring for Self-Sufficiency and Stronger Community Care Outcomes https://uniteus.com/blog/introducing-a-dynamic-social-needs-system/ Tue, 04 Nov 2025 15:00:17 +0000 https://uniteustailstg.wpengine.com/?p=7741 By: Jens Lillehei, Senior Director, Analytics Solutions & Innovation | Morgan Olsen Jaciuk, Senior Product Manager Equipping healthcare stakeholders with the precision and insight to address community and individual-level needs. As healthcare increasingly embraces integrated care models that address both medical and non-medical drivers of health, organizations need data that goes deeper—data that reflects real...

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By: Jens Lillehei, Senior Director, Analytics Solutions & Innovation | Morgan Olsen Jaciuk, Senior Product Manager

Equipping healthcare stakeholders with the precision and insight to address community and individual-level needs.

As healthcare increasingly embraces integrated care models that address both medical and non-medical drivers of health, organizations need data that goes deeper—data that reflects real people, real circumstances, and the evolving nature of need.

Traditional measurement tools often fall short. They rely on aggregated, outdated datasets that miss the complexities within communities, leaving organizations without the precision required to design effective interventions or measure lasting impact.

Unite Us’ Self Sufficiency models bridge that gap by delivering insights at both the individual and community levels that capture the complex and evolving realities of people’s lives. Instead of merely identifying where needs exist, these models estimate an individual’s ability to meet their own needs over time while uncovering broader patterns and trends within the community.

Why Granularity Matters

Across the country, communities are building systems of care that aim to foster long-term self-sufficiency—networks that empower residents to access resources, reduce dependency, and achieve long-term stability. To make those systems work, leaders need individual-level, predictive insights that reveal where barriers exist, how they intersect, and which interventions will make the greatest difference.

The Self Sufficiency Score offers exactly that. Instead of relying on broad geographic averages, it uses person-level data to help healthcare systems, payers, and community organizations:

  • Identify at-risk individuals earlier—before needs escalate into crises.
  • Target interventions more effectively, ensuring resources reach those who will benefit most.
  • Measure long-term progress toward self-sufficiency, not just short-term needs fulfillment.

When it comes to understanding community health, granularity matters. Unite Us’ models go beyond traditional frameworks by combining social, clinical, and behavioral data to give organizations the clearest possible view of their populations and the individuals within them.

How Traditional Tools Fall Short

Tools like the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI) have advanced understanding of community needs but remain limited.

The Area Deprivation Index (ADI)?
First developed by the Health Resources and Services Administration and later refined at the University of Wisconsin-Madison, the ADI measures socioeconomic conditions such as income, education, employment, and housing quality, using annual data. While useful for assessing neighborhood-level deprivation, it provides a static snapshot and lacks the flexibility to track individual or community change over time.

The Social Vulnerability Index (SVI)?
Developed in 2003 by the Centers for Disease Control and Prevention, the SVI identifies communities most at risk during disasters or public health emergencies. It aggregates five-year census data to assess social, economic, and demographic vulnerability at the census tract level—offering a broad but generalized view that doesn’t account for individual variability.

Shared Limitations
Both indices have proven useful but share limitations that can obscure true need and opportunity:

  • Overgeneralized Data: Census block- and tract-level data can mask disparities within small areas or specific demographic groups.
  • Lack of Cultural Considerations: Indicators such as housing or employment may hold different meanings across cultural and regional contexts.
  • Lagging Data: Reliance on inconsistently refreshed census surveys means risk assessments may be based on outdated information.
  • Misuse in Resource Allocation: Policymakers may over-rely on these indices, overlooking local insights and community expertise.
  • Focus on Deficits Over Strengths: These measures highlight vulnerabilities but fail to capture assets, strengths, and resilience—the factors that drive self-sufficiency.

A Smarter, More Dynamic Solution: The Self Sufficiency Score


Introduced in 2018, Unite Us Population Insights is a proprietary predictive analytics solution that helps organizations understand and strengthen both individual and community self-sufficiency. By leveraging comprehensive person-level data—including social, economic, and health-related factors—it uses advanced modeling to reveal the drivers of need and opportunity, and turn those insights into strategies that build stability, enhance community resilience, and reduce healthcare and benefits costs.

How it Works

Powered by Population Insights, the Self Sufficiency Score is an individual-level composite score that evaluates how 10 factors—including food security, childcare needs, housing stability, employment, and other personal circumstances—affect an individual’s self-sufficiency. While derived at the individual level, these scores can also be aggregated to reveal patterns and trends at the community level, helping identify where support and resources are most needed.

Beyond pinpointing areas of vulnerability, the score also highlights where individuals and families are making progress towards stability and independence—helping communities focus not only on addressing needs but also on nurturing long-term self-reliance.

How It’s Used

Population Insights measures both individual needs and broader community trends—from housing and employment to engagement patterns and outcomes. Organizations use these insights to design personalized care plans, guide policy and funding decisions, and ensure every action moves individuals and communities closer to lasting stability. By connecting individual and community insights, Population Insights helps partners move beyond short-term relief toward long-term well-being and resilience.

Benefits of Unite Us’ Dynamic Predictive Analytics

With Population Insights and dynamic scoring, organizations can drive better health outcomes for both individuals and communities with:

  • Tailored Interventions: Individualized insights enable targeted care plans that address root causes and accelerate progress toward self-sufficiency.
  • Operational Efficiency:  Scores integrate seamlessly into existing workflows, helping teams prioritize interventions and coordinate across healthcare and social service systems.
  • Strategic Decision-Making: Actionable data supports smarter programming, funding, and policy decisions that strengthen community capacity.
  • Improved Communication: Data-driven insights foster trust-based conversations between care providers and clients, empowering individuals to take ownership of their care journey.

Together, these capabilities build stronger, more coordinated systems of care that promote sustained resilience and well-being.

How We Made Our Predictive Models Even Better

To make Population Insights even more powerful, Unite Us introduced dynamic scoring—a major leap forward in understanding how needs evolve over time. Unlike static indices, dynamic scoring updates continuously as individuals engage with services and as community conditions shift. This provides a living measure of both personal progress and community resilience.

By applying advanced data science, Unite Us models accurately predict non-medical needs at both the individual and community levels. Healthcare systems, government agencies, health plans, and community-based organizations can use these insights to optimize resources, improve outcomes, and strengthen local systems of care.

Ultimately, these models do more than measure need—they empower communities to build the capacity, resilience, and independence required for a healthier, more sustainable future.

Building a Healthier, More Self-Sufficient Future

The future of community care depends on precision, adaptability, and collaboration. Unite Us’ dynamic scoring equips organizations with the insights they need to anticipate needs, design effective interventions, and measure real progress over time.

Learn how Unite Us can help your organization harness dynamic, person-centered data to strengthen communities and drive long-term well-being.

Learn more about Insights

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Government Benchmarking or Bust: The Power of Knowing Where You Stand https://uniteus.com/blog/the-power-of-government-benchmarking/ Fri, 31 Oct 2025 14:00:07 +0000 https://uniteustailstg.wpengine.com/?p=9562 The post Government Benchmarking or Bust: The Power of Knowing Where You Stand appeared first on uniteus.com.

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What is FHIR? https://uniteus.com/blog/fhir/ Wed, 20 Aug 2025 20:54:49 +0000 https://uniteustailstg.wpengine.com/?p=9377 The post What is FHIR? appeared first on uniteus.com.

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