More Americans than ever—some 30% of the U.S. population—rely on federal and state social safety net programs, like Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and Women, Infants, and Children (WIC) for support.
In this era of shifting policy, changing funding models, and increased scrutiny on government spending, it’s more important than ever to prioritize efficiency, data-informed decisions, and streamlined service delivery.
The solution is to pair modern technology with community-level infrastructure, leveraging efficient tools and scalability to deliver on the promise of the social safety net while maintaining the compassion, dignity, and data security required for the 21st century.
When did compassion become so complex?
The American social safety net was born out of the Great Depression to support Americans struggling with unemployment and low wages in the wake of economic collapse.
Since then, it has evolved into a complex system of disparate and siloed government and state agencies, national and local nonprofit organizations, and private resources all working toward the same goal—but largely independently—to support people in need. Yet these systems remain disconnected, confusing to navigate, and full of redundancies for applicants.
As a result, accessing social services can be extremely difficult, creating barriers to delivery and driving up costs. Many require in-person applications, and individuals might have to contact two or three different programs to get all of their needs addressed. This is made even harder when folks can’t afford to take time off work and lack reliable transportation.
At the same time, we know that social determinants of health—economic conditions, housing, food access and community support—make up 80 percent of our overall health.
Fortunately, that has garnered the attention of the healthcare sector. However, the lack of interoperability between healthcare and social care data makes it difficult to leverage that insight in a meaningful way to improve outcomes. Care and service delivery are episodic and disjointed rather than holistic and comprehensive.
“The notion that our chronic disease burden is partly driven by our lifestyle, and in fact, there are interventions to mitigate that, I think that’s heartening,” said Dr. Pritesh Gandhi, president and founder of Effect Health. “You’re seeing Medicaid start to pay for food to treat diabetes and hypertension, and we should amplify that as much as possible.”
Disconnects drive up costs
The U.S. spends trillions of dollars on health and social care through Medicaid, private philanthropy, and other sources. But our health outcomes don’t reflect that investment.
“Something like $1 trillion is going into the social safety net through private philanthropy, aside from traditional government funding. That’s an enormous amount of money,” said Jaffer Traish, chief operating officer at Findhelp. “But those dollars go through three or four places before the service is delivered to an individual. Technology enables us to be more efficient and deliver those services directly to individuals.”
It benefits us all to ensure that our most vulnerable are cared for and don’t slip through the cracks. Not only is it the right thing to do, but it can also support a robust American economy and solidify our position in the global market. According to one study published in Population Health Management, connecting individuals on Medicaid and Medicare Advantage plans to social services can reduce healthcare costs by 10%, saving over $2,440 per person annually. With over 100 million Americans enrolled in those programs alone, the potential savings could be staggering– more than $2.65 billion a year.
Despite modernizing our view of holistic health, our systems for working across sectors remain antiquated. Referrals are still made through phone calls, pamphlets, and Post-it notes. It’s time-consuming, inefficient, and almost impossible to find available resources and ensure people actually get the help they need.
“One hospital in New York was spending thousands of hours of staff time to recommend the best resources for individuals,” Traish said. “By automating that process, we can significantly improve the efficiency of the work that nurses, helpers, care navigators, and community organizations are doing while maintaining the human touch that allows them to make the right recommendations for each individual with dignity, privacy and trust.”
Digitizing the safety net is the solution
It’s time to adopt modern systems that enable these connections at a lower cost, with easier access, and aligned with current policy.
An adaptable, tech-forward approach increases efficiencies, removes siloes, and improves communications through interoperability, standard workflows, and data sharing to track impact.
Integrating electronic health records (EHRs) with social care referral systems makes it easier for providers to connect patients with the right services and for social workers and service agencies to follow up, while ensuring accountability.
Closed-loop referral systems enable providers to track which interventions are being used, which are (or aren’t) working, and make data-driven decisions to target funds more effectively. We can get the money to people who need it and reduce administrative overhead. We can directly measure outcomes to justify expenditures and shape future services. And we can use data to understand patterns in need while maintaining the human connection at the point of service delivery.
Studies show these platforms improve trust and communication between those making referrals and people seeking assistance[1] and among cross-sector collaborators, such as healthcare, health plan, and social service providers.[2]
Dignity through ease of access
Digitizing social care access also ensures dignity by removing barriers and closing the information gap. Most of us take for granted the digital tools we use every day: With mobile banking, you can send your neighbor $5 instantly. Modern cell networks allow us to text or call anyone, even if they’re using another provider. In retail, we can order anything shipped right to our door.
Yet, we have clung to analog social care systems that make people jump through hoops. Patient-centered digital solutions make it simpler for clients to access what they need without shame, lost wages, and unnecessary complexity.
Efficiency and efficacy are vital in every service, and technology is a proven tool for achieving this at scale. There’s no reason we can’t deliver a digital social safety net infrastructure that complies with HIPAA privacy, evolves with policy, and empowers individuals to use secure, modern tools like those we take for granted in every other part of our lives.
With a tech-forward, person-centric approach, we can support our neighbors more efficiently, maximize ROI, and adapt to shifts in administration and policy.
To learn more about digitizing the social safety net, check out Season 3 of the American Compassion podcast series.
[1] Olson AW, Allen N, Elmayan A, Green K, Harry ML, Kempfert J, Kuenstler E, Maki H, Nelson S, Rapps M, St John R, Witherspoon S, Brown S, Castaldo A, Grimes M, Jenkins T, Mosher K. Getting Inside Closed-Loop Referrals: Exploring the Patient Experience of Finding and Connecting to Social Care With a Community Resource Referral System Using a Community-Based Participatory Approach. Health Serv Res. 2025 Feb 16:e14451. doi: 10.1111/1475-6773.14451. Epub ahead of print. PMID: 39956138.
[2] Sharma S et. al. Design and framework of a technology-based closed-loop referral project for care coordination of social determinants of health. Population Health Management 2024, December 16. https://doi.org/10.1089/pop.2024.0129
Carla Nelson
Carla Nelson is Senior Director of Healthcare and Public Policy for Findhelp.
