Author: Candace Stohs-Krause

Transforming CBO Case Management with Kiip

This blog is guest written by Noah Harlan, Findhelp’s new VP of Community Solutions. Charged with transforming CBO case management, Noah joined us through our 2024 acquisition of Kiip. He has 15 years’ experience creating software products for a broad range of organizations in the B2B, B2C, and government & civic tech spaces. He has a degree in Computer Science from Williams College and lives in Brooklyn, NY with his family.

Hi there—I’m Noah Harlan. In my role as the VP of Community Solutions, I focus on making connections to help simpler, faster, and more human. 

Community-based organizations (CBOs) are the unsung heroes of social services. They do incredible work with limited resources, which can mean juggling multiple tools, mountains of paperwork, and complex client needs.

They’ve told me just how overwhelming it can feel—we’re dedicated to making it easier.


Building a more responsive, client-centered platform

Our latest tool, Kiip, is designed specifically for community organizations and nonprofits. For people using CRMs or HMISes to take care of their clients, Kiip is a client management platform is transforming CBO case management:

Secure document sharing and storage

Integrated referral networks

Client-owned tools for managing their own information 

Designed to simplify your workflow, not complicate it

Completely free for CBOs listed on Findhelp



Why we’re doing it

We believe technology should serve people, not the other way around. Too many referrals fall through the cracks, too many applications get abandoned, and too many people lose access to the services they need. We’re committed to improving outcomes for everyone, from individual clients to CBOs and providers.  


Where you come in

If you want to streamline your case management, reduce administrative burden, and empower your clients, you’re in the right place. We’re rolling out access to Kiip across the entire Findhelp ecosystem, and we’d love to have you join us. 


Kiip isn’t just a tool; it’s a community. You’re invited—join the waitlist, no commitment required.

Join the Kiip waitlist


Kiip demo: Watch our Connect Summit session with partner HOPICS

Partnering with HOPICS, one of the largest housing service providers in South Los Angeles, we demonstrate how modern tools empower both case managers and clients to create more effective pathways to service access and retention. We showcase how emerging technologies, including AI and Large Language Models (LLMs), democratize case management capabilities, enabling CBOs of all sizes to operate more efficiently and proactively. 

See Kiip in action—watch the recording of our session at the Connect Summit social care conference, “Transforming CBO Case Management: Next General Tools for Enhanced Client Outcomes”.


If you have a moment, share your thoughts

I’m interested in hearing what you think. What challenges are you facing? What solutions would make your work easier? Add me on LinkedIn or email me — I’m listening. Thank you for the critical work you do every single day.


Watch | Kīpuka: A Story of Community Resilience in Hawaiʻi

To the rest of the world, Hawai‘i is paradise: a place of rainbows, lush mountains, and shimmering beaches. But beyond the postcard images, a different story is unfolding — one of families struggling to stay connected to land that grows more expensive, inaccessible, and fragile with each passing year. Today, we’re proud to announce the release of Kīpuka, the latest short documentary from Findhelp Films.

Set in Koʻolaupoko, Oʻahu, the 25-minute film follows the work of KEY Project, a grassroots community center that has served its neighbors since 1968. From youth mentorship and food support to senior citizen programming and cultural education, KEY Project doesn’t just provide services—it cultivates a deep sense of belonging.


“If you’re going to take up space within these islands, you need to honor the traditions that were here long before you were.”

Kimberly Jones

Youth Program Coordinator at KEY Project


The high price of paradise

For many local families, especially Native Hawaiians, the cost of living has become a major challenge. What was once a sustainable island economy now relies on imported goods, with nearly 90% of food shipped in from elsewhere, according to the University of Hawaii. As John Reppun, a community elder, notes in the film, “When Hawai‘i became a state in 1959, the doors kind of got blown off. A lot of development muscled its way into communities like ours.”

Today, the impact of that development is undeniable. Local grocery store prices rival those of Manhattan. Tourism continues to expand. Once-sustainable communities are reshaped into playgrounds for visitors, even as long-time residents are priced out of their own neighborhoods.

"Kīpuka" from Findhelp Films tells the story of community resilience in Hawai'i.


The cost of living index for Hawai‘i far exceeds any other state, according to the World Population Review. The index is almost 30% higher than that of Massachusetts and California, the second and third most expensive states to live in.

At the center of Kīpuka is KEY Project’s effort to resist that erasure — not through confrontation, but through restoration. Youth are taught to kilo (observe) the land, to clear invasive species, to rebuild ancient fishponds, and to see stewardship as a living practice. The work is tangible and hard, rooted in hope, focused on community resilience.


“Restoration is a big thing in Hawai‘i. We have to regain our culture, and we have to regain our ʻāina.”

Ryli Kalahiki

Youth Program Assistant at KEY Project


What is a “kīpuka”?

In Hawaiian, a kīpuka is a patch of land left untouched by lava—a refuge where life can take hold again. It’s also the metaphor that guides the film.


“Kīpuka are protected spaces where native species thrive. That’s how I imagine KEY Project: a place where people can be safe, feel protected, and thrive.”

Rainbow Uliʻi

Executive Director at KEY Project

In one of the film’s most poignant moments, a mother describes how her daughter, once disconnected and struggling, began to change after joining KEY Project’s programs. “Every day she came home and talked about what they did — the friends she made, the knowledge she gained, the connection she felt.”

"Kīpuka" from Findhelp Films tells the story of community resilience in Hawai'i.


Beyond Findhelp: Amplifying community voices

At Findhelp, our mission is to connect all people in need with programs that serve them, with dignity and ease. But behind every search on our platform is a human story: a person reaching out for support, and a local organization ready to answer.

Our storytelling initiative was created to spotlight the people and communities doing this work every day. We believe a stronger social safety net isn’t built by software alone. It’s built through human relationships, cultural memory, and care that transcends transactions.

Kīpuka is the latest in a growing body of films that includes Filling the Gaps (on dental care access) and Living Positive (on a community united around HIV support). Each film is a tribute to those who consistently show up for others, often without recognition.


Experience Kīpuka: Watch, share, and be inspired

Kīpuka is now available to stream at kipukafilm.com!

We hope you’ll take some time to watch, share, and consider what it means to protect your own kīpuka, wherever you live. Let this film be a reminder that belonging is worth fighting for, that connection is built through care, and that even in the face of great pressure, communities can thrive.


Watch the film


Achieving Social Care ROI: How Findhelp Powers Your Investment

The evidence is undeniable: strategic investment in social care is among the most effective ways to reduce healthcare costs, improve patient outcomes, and truly deliver on the promise of value-based care.

But how do you move from acknowledging the importance of social determinants of health (SDoH) to effectively operationalizing and scaling these efforts? And crucially, how do you ensure your programs can demonstrate a clear return on that investment?

We’re thrilled to launch our new issue brief, The ROI of Social Care Closed-Loop Referral Technology. This paper dives into the compelling evidence that showcases not just the need for social care interventions, but their tangible financial and clinical impact when effectively implemented.

Read on to learn what the data says, and how you can take advantage of existing technology.


The data: Why social care matters 

The data speaks for itself. Our issue brief highlights key findings, including:

✓

Significant cost savings

Studies show that successfully connecting individuals to social services through well-run programs can lead to substantial reductions in healthcare costs. For instance, one study saw a 10% reduction in healthcare costs, equating to $2,443 per person per year, for Medicaid and Medicare Advantage members connected to services.

✓

Demonstrable health improvements

Addressing social needs positively impacts health outcomes, leading to better management of chronic conditions and improved treatment adherence.

✓

Targeted interventions, impressive returns


The Findhelp difference: Power your social care ROI with closed-loop referrals

Understanding the potential ROI of social care programs is one thing; enabling those programs to fully achieve it is another.

While the direct health and financial benefits stem from effective social care interventions and the dedicated people running them, the right technology infrastructure is paramount to realizing that full potential.

Our issue brief explores how closed-loop referral technology, like Findhelp, is an essential backbone. Our platform powers your social care initiatives with unmatched efficiency and ease, ensuring your programs can deliver their maximum impact and demonstrable returns.

Findhelp customers, for example, consistently see referral completion rates up to three times industry norms, laying a strong foundation for their programs’ impact.

Findhelp is critical for:


Investing in Findhelp is investing in your SDoH ROI strategy

Choosing the right technology partner means selecting a system that will effectively power your social care programs, allowing them to operate with maximum efficiency and deliver their intended ROI. It’s not about the tool claiming the dollars, but about the tool enabling your skilled teams and vital programs to achieve those results. We’re proud that the Findhelp platform embodies these principles:


Don’t get left behind: The cost of inaction is too high

Failing to invest in robust social care infrastructure isn’t just a missed opportunity; it incurs significant costs through increased avoidable healthcare use and a heavier chronic disease burden. Closed-loop referral technology is no longer a “nice-to-have” – it’s foundational for enabling your social care programs to reduce total cost of care, deliver value, and meet emerging regulatory expectations.


Ready to realize the full potential of your social care investments with a trusted partner?

Dive into the evidence and learn how to build a powerful business case for social care within your organization: read our new issue brief, The ROI of Social Care Closed-Loop Referral Technology, today! 

Learn about ROI


By working together and leveraging smart technology to power essential social care programs, we can create healthier communities and a more sustainable healthcare system for all.

Connect with us


“Up for the Challenge”: The 2025 Connect Summit

On May 7 & 8, 2025 we hosted our fifth annual user conference, Connect: A Social Care Summit, for a network of more than 1,270 change-makers: leaders from social care, healthcare, government, nonprofits, and more, dedicated to making a difference. We’re excited to share our bold, hopeful vision for what’s next: A smarter safety net, built on trusted infrastructure, powered by technology, and shaped through deep partnership. 


Every day, communities across the country are stepping up to connect people with the resources they need, and Findhelp is here to support that work at scale. This year’s event may be over but our work to connect all people in need and the programs that serve them, with dignity and ease, continues. It’s not just about referrals. It’s about real outcomes, real people, and a system that grows stronger every time we show up together.


“We know Findhelp is always up for the challenge, and so are we.”

Andrea Wanat

CEO, Value Network of Western NY 



Keep learning: Featured sessions and keynotes

We’re joined in our work to power a smarter social safety net by hundreds of social care innovators who are using people, policy, and technology to address the barriers to care and the challenges faced by organizations who want to help. 

Today we’re spotlighting a few of the forward-looking Connect Summit sessions that envision a smarter safety net. These sessions empowered attendees to advocate for systemic change and inspired them to innovative community solutions to address the social determinants of health (SDoH). 

Want access to watch all the 2025 sessions? Chat with our team!


SDoH scalability and sustainability in a value-based world

Mallory Callahan (Vice President of Value-Based Care) and Adam Schulte (Medicare Programs Manager) discuss Nebraska Health Network’s approach to integrating Community Health Workers (CHWs) into their healthcare initiatives, focusing on screening and addressing SDoH.

Watch the session


“We need to be able to show that coordinated care is impacting our overall per-member-per-month spend, that our emergency department utilization is decreasing for non-emergent needs, and that our inpatient stays are more coordinated with more timely discharge.”

Mallory Callahan

Vice President of Value-Based Care


Leveraging 211 & United Way partnerships

See how United Way of Treasure Valley and Trinity Health West Michigan have leveraged their partnerships with 211 to enhance community outcomes. 

Watch the session


Medicaid transformation: Insights from state directors

In this keynote, Medicaid Directors from Tennessee, New Mexico, and Arkansas provide a deep dive into the evolving landscape of their state programs.

Watch the session


“The way people are showing up isn’t going to change. This is the solution to help people; it’s the right thing to do.”

Dana Flannery

Medicaid Director


Connecting Medicaid members to Section 1115 services

Learn how Community Care Cooperative (C3) ACO partners with federally qualified health centers (FQHCs) to connect members to housing and food services with Findhelp. 

Watch the session


Home is worth fighting for: Kīpuka from Findhelp Films

In the face of soaring costs and rapid development, Kīpuka tells the story of KEY Project, a grassroots community center in Koʻolaupoko, Oʻahu, that offers more than services—it offers belonging.

  • Through the voices of youth, elders, and community leaders, the film reveals a deeper truth: Hawai‘i’s real beauty is the resilience of its people and their commitment to protecting land, culture, and community.
  • Get a sneak peek of this short documentary that explores the deep connections between land, culture, and community in Hawai‘i.
  • Watch a live Q&A session with Jim Tuttle, the film’s director, and Rainbow Uliʻi, Executive Director of KEY Project.
Watch the session


Reducing hospitalizations and disparities in a Medicare ACO

Maureen Pike (Director of Social and Clinical Care Integration), Lauren Smith (Program Consultant), and Zakiya Suleman (Program Consultant) share how diverse Trinity Health divisions have collaborated since 2021 to reduce preventable hospitalization rates among Medicare Shared Savings Program (MSSP) patients. 

Watch the session


Fireside chat with Findhelp’s Customer Advisory Board

Andrea Wanat (CEO of Value Network of Western NY), Jamie Radick (Director of SDoH at Highmark Health), and Luke Harris (Sr. Director of Operations and Population Health at Children’s Mercy) share the strategies, lessons learned, and tips that have made their social care programs successful. 

Watch the session


“Findhelp has come a long way, and we have an opportunity to do great things together and help a lot of people.”

Jamie Radick

Director of SDoH

Highmark Health logo


Integrating SDoH screenings and community partnerships

An expert panel of leaders from NYC Health + Hospitals, Cooper University Health Care, and Star Community Health explore the role of SDoH screening tools in enhancing care for underserved populations. 

Watch the session



The most engaged Connect Summit yet

The Connect Summit is Findhelp’s annual user conference, where our customers, partners, and network of community organizations come together to share ideas and best practices for innovating and improving social care.

Since 2020, we’ve brought together leaders from across industries to discuss strategic initiatives to help the most vulnerable members of our communities. This year, the Connect Summit saw:


2,066 registrations
450+ organizations
512 Expo Hall visits
50 states + D.C. represented


Thank you to this year’s sponsors:



Building a smarter safety net, together

Want to learn how your organization can implement the social care programs and strategies highlighted above? Chat with our team to learn more about how Findhelp’s products, services, and integrations can streamline your workflows so you can help more people. 

Whether you’re just getting started with your social care strategy or looking to expand a successful program, Findhelp is your trusted partner.

Connect with us


The Unspoken Pillar: Why Social Care is Essential to CMS’s Evolving Health Strategy

The healthcare landscape is in constant motion, and recent activities from the Centers for Medicare & Medicaid Services (CMS) signal a multi-faceted approach to shaping its future. CMS’s evolving health strategy and current federal initiatives point towards a system aiming to be more preventive, patient-empowered, and efficient. But as we examine these components, a crucial question arises: where does social care fit?

We believe it’s the unspoken pillar, essential for the success of this entire endeavor.


In this post, you’ll learn about:

The broad vision set by the “Make America Healthy Again” (MAHA) initiative, and the detailed strategic plan from the Center for Medicare & Medicaid Innovation (CMMI) to translate that vision into action

Specific regulatory proposals like those in the FY2026 Inpatient Prospective Payment System (IPPS) rule

Forward-looking explorations like the recent Request for Information (RFI) on leveraging technology to support seniors

The role of social care to weave it all together


Understanding CMS’s comprehensive approach

To see the integral role of social care, it’s helpful to understand how these different CMS pieces connect.


The vision: “Make America Healthy Again” (MAHA)

The MAHA initiative continues a national ambition to shift from a system primarily managing sickness to one of prevention. It emphasizes tackling root causes related to nutrition, lifestyle, and environmental factors, aiming for a healthier population. 

Implicit in the MAHA vision is the understanding that health starts where we live, learn, work, and play – domains deeply intertwined with social care.


The strategy: CMMI direction

Unveiled earlier this month, CMMI’s updated strategy operationalizes this broader vision for Medicare and Medicaid. Its core components aim to transform healthcare delivery through:

Promoting Evidence-Based Prevention: Focusing on embedding preventive care deeply within payment models.

Empowering People to Achieve Health Goals: Increasing access to information, tools, and predictable cost-sharing.

Driving Choice and Competition: Simplifying provider participation in new models and reducing burdens.


Regulation in practice: The IPPS proposed rule example

Rules like the FY2026 IPPS proposal demonstrate how strategic goals translate into payment policies and quality expectations for hospitals. While discussions around specific health equity measures or SDOH data collection may evolve within these rules, the underlying drive for better patient outcomes, reduced readmissions, and improved patient safety remains.

  • Achieving these clinical goals is significantly harder, if not impossible, when patients’ critical social needs go unaddressed.
Read our analysis of the FY2026 IPPS rule proposal


Looking ahead: The RFI on health technology

CMS’s recent RFI on the health technology ecosystem shows a proactive approach to leveraging innovation. It seeks input on how technology can help older adults  manage their health, navigate care, and access their data more effectively.


Social care: The essential thread weaving it all together

While CMS’s evolving health strategy may not always headline terms like “social determinants of health” or “social care integration” in every new initiative, the success of the agency’s broader vision fundamentally relies on addressing these factors:

  1. Improving Outcomes: The MAHA initiative’s goal to combat chronic disease hinges on addressing upstream social factors. Nutritious food, stable housing, safe environments, and community support are the bedrock of prevention. Social care organizations are the front lines in providing these necessities.
  2. Enabling Strategic Goals: As highlighted above, each pillar of the CMMI strategy is strengthened and made more achievable when social care is integrated. Prevention efforts are more effective, patient empowerment becomes more meaningful, and the overall value proposition of new care models is enhanced.
  3. Driving Clinical Outcomes: Regardless of specific regulatory language in payment rules, hospitals and health systems know that unaddressed social needs lead to poorer health outcomes, longer stays, and higher readmission rates. Addressing SDOH is simply good clinical practice and smart operational strategy.
  4. Amplifying Technological Advancement: The potential of health technology, as explored in the CMS RFI, can be significantly amplified if it’s designed to also identify and bridge gaps in social care.


Moving forward: Recognizing the integral role of social care

CMS is clearly steering towards a healthcare system that values prevention, empowers patients, and seeks greater efficiency and value. While the language and specific mechanisms may evolve, the underlying truth remains: You cannot achieve these ambitious health goals without systematically addressing the social conditions that shape people’s lives.

The work of identifying social needs and connecting individuals to community-based resources is not a peripheral activity but a core component of this comprehensive strategy. 


As CMS’s evolving health strategy unfolds, it’s crucial for healthcare providers, payers, policymakers, and community organizations to continue building and strengthening the bridges between clinical care and social care. 


Findhelp: Your partner for policy insight and care integration

Successfully forging these vital connections and navigating the evolving policy landscape requires robust tools, deep expertise, and collaborative partnerships. At Findhelp, we are dedicated to this very challenge. Our comprehensive solution is specifically designed to facilitate integration across sectors – seamlessly connecting healthcare, social care, education, government, and other community entities – to ensure individuals can easily access the support they need. 

We closely follow policy developments, analyzing their implications and striving to equip our partners with the insights and technology to adapt effectively. As your organization works to enhance social care integration and align with these strategic directions from CMS and beyond, know that Findhelp is here to be a resource, supporting your efforts to build healthier, more connected communities.

Connect with us


Decoding Social Care: Understanding Available Data Standards

In the evolving landscape of health and social care integration, the ability to effectively communicate impact using data is paramount. For community-based organizations (CBOs) and their partners on the front lines, understanding the language of data is becoming more critical than ever. That’s why we’re eager to guide you through our comprehensive paper on decoding social care: Leveraging Data Standards in the CBO Setting. 

Welcome to Part 3 of our Social Care Data Series, where Carla Nelson, Findhelp’s Senior Director of Healthcare and Public Policy, shares foundational knowledge on how social care data standards help clearly demonstrate the value of health-related social needs interventions, secure sustainable social care funding, and enhance healthcare partnerships.

Read Carla Nelson's social care data paper.



Inside the paper: Your roadmap to understanding social care data standards

Leveraging Data Standards in the CBO Setting is for community-based organizations (CBOs) navigating the integration of social care within broader healthcare frameworks. It unpacks the complexities of social care coding, offering clarity and actionable insights. Here’s a closer look at what you’ll discover:


The critical role for CBOs of coding and documentation in healthcare

Standardized coding is crucial for CBOs seeking to partner with healthcare providers and plans. But coding and claims submission are new territories for CBOs, and it is important for these organizations to recognize that adopting data standards enables them to: 


About today’s social care coding systems 

Healthcare providers use standardized coding systems to create a common language for documenting and communicating patient information within the complex healthcare system. This standardization allows for seamless information exchange between providers, hospitals, and payers, ensuring that everyone understands the patient’s condition and the services provided. Ultimately, these codes help healthcare organizations track outcomes, improve quality, and receive appropriate reimbursement. 

Over the past several years, new codes have been developed as part of healthcare’s coding systems that standardize social care screening, diagnosis, and service delivery information. CBOs participating in Medicaid waiver programs and other initiatives that reimburse CBOs using a healthcare framework will likely need to implement these codes.  In practice, these codes come together to provide a robust view of people’s needs and how they are addressed. Below are examples of how these codes are working together today as part of New York’s section 1115 Medicaid waiver.


1

LOINC (Logical Observation Identifiers Names and Codes)

Discover how to use LOINC codes to standardize HRSN screening questions and answers, ensuring consistency in how needs are initially identified. For instance, the paper details how tools like the Accountable Health Communities (AHC) screener use specific LOINC codes for each question-answer pair related to domains like housing or food security.

Decoding social care - LOINC codes


2

ICD-10 Z Codes

Delve into how these codes from the ICD-10-CM diagnosis system are used to document individual HRSNs—the specific social challenges your clients face (e.g., Z59.0 for homelessness, Z59.41 for food insecurity). Z codes provide invaluable context for health outcomes and are often required for claims.

Decoding social care - ICD-10 codes


3

HCPCS and SNOMED-CT

Learn how these systems are used to code the actual social care service delivery. Use HCPCS codes for services like case management or community health worker interventions. SNOMED CT offers a comprehensive vocabulary to describe services and findings in a way that is compatible with electronic health records, such as “Referral to food pantry program.”

Decoding social care - SNOMED and HCPCS codes


Practical and simple application with Findhelp

To support this critical work, Findhelp integrates social care code libraries and mapping functionalities directly into our platform. This allows CBO staff to more easily add standardized codes based on screening and service delivery, and even automate the flow of selected codes to a claim for submission to payers, freeing them to focus on client care.

Our invoicing and claims capabilities



Why this paper is an essential resource for CBOs

Embracing data standards is a transformative step for any CBO. Read the paper to demystify the process and understand how coding works. The future of social care is data-informed. Equip your organization with the insights to navigate this future successfully.

Read our data paper


Bridge health and social care

Our platform provides an integrated and seamless closed-loop referral system that bridges the health and social care sectors. While social care data capabilities improve, organizations can take action now to understand your population’s needs and plan for the future. 

Connect with us to learn how your organization can use social care data to identify strategies, make decisions, and assess performance.


Watch | ‘Who’s Doing it Best’ from “American Compassion LIVE”

We recently wrapped up season 3 of American Compassion: LIVE, our 4-part conversation about the state of the modern safety net, in partnership with the LBJ School of Public Affairs at the University of Texas-Austin. “Who’s Doing it Best”?, Season 3, Episode 4 is available now! This episode features leaders who are actively working to improve the experience of poverty and social care through technology and innovation.



American Compassion Season 3, Episode 4: Who’s Doing it Best?

Erine Gray, Findhelp CEO and Founder, was joined by:

The conversation, moderated by Rebecca McInroy, highlighted the role of technology and innovation to manage data, empower individuals, and enhance the human experience of care. The panelists shared their personal stories and discussed the challenges and opportunities of using technology to address gaps in the safety net.

American Compassion S3E4: Who's Doing it Best? Panelists


From Personal Journeys to Social Innovation

The panelists discussed how their personal experiences significantly shaped their commitment to addressing gaps in the American safety net. For instance, experiences in Haiti profoundly influenced both Adrian and Amber, and helped them recognize their passion for serving people in need. This fueled Adrian to establish CarePortal, connecting children and families in crisis with essential resources, and inspired Amber to found Mainely Teeth, delivering community-based dental care.

Similarly, Julian’s firsthand experience working in a long-term care facility revealed the challenges of patient transitions, motivating him to develop AIDA Healthcare to streamline care coordination. Erine’s desire to improve access to social services was sparked, in part, by his work at the Texas Health and Human Services Commission. He recognized the need for better information and coordination, leading him to create Findhelp.

These personal experiences across the panelists serve as a driving force, highlighting the importance of empathy and connection in developing effective solutions.


Technology as an Enabler

Technology plays a vital role in each of the panelists’ organizations, serving as a powerful enabler for change. While the technology itself may not always be cutting-edge, its innovative application is key to bridging gaps in the social sector. The panelists emphasized the importance of balancing technological innovation with the human element of care.

“I can’t wait to see how we’re going to leverage it [technology] to create as many meaningful connections as possible, because the more technology gets embedded in all of what we do, the more essential, meaningful connections between one person and another are going to become.”

Adrien Lewis

President & Founder, CarePortal

As technology becomes more integrated into their work, the need for meaningful human connections becomes even more critical. Technology should enhance these connections, not replace them, to ensure that the focus remains on the people being served.  

“I said, ‘I think there’s better way to do it than an Excel file,’ and we built a prototype to start engaging local providers. A lot of these long-term care providers are people like my parents: immigrants who are not tech-friendly. So they needed a platform that is super easy to use, yet HIPAA compliant.”

Julian Paraschiv

CEO & Co-Founder, AIDA Healthcare

Findhelp’s integration with AIDA


Collaboration and Community

The theme of collaboration was weaved throughout the discussion. Panelists emphasized the importance of working with other organizations, community members, and even each other to maximize impact. They also highlighted the vital role of community involvement and the power of connecting people to resources and support. By fostering collaboration and strengthening community bonds, they are building a more resilient and responsive safety net.  

“And everything I do is with the help of community. I think that’s my most favorite thing about what I do.”

Amber Lombardi

CEO & Founder, Mainely Teeth 


Advice for Aspiring Social Innovators

The panelists offered valuable advice for those seeking to create their own solutions to social challenges. They emphasized the importance of learning from the efforts of others and encouraged thorough research into existing solutions. The panelists highlighted starting with a focused approach, and suggested concentrating on one specific problem and developing a targeted solution. Finally, they stressed the necessity of perseverance in the face of challenges and setbacks, urging aspiring innovators to remain committed to their mission.

American Compassion S3E4 Erine Gray

“Find a problem that you can’t stop thinking about. And I think that is the thing that gives you meaning.”

Erine Gray

CEO & Founder, Findhelp 



Catch Up on American Compassion Season 3 

Listen to previous Season 3 episodes focusing on the modernization of the social safety net:

Feb. 12, 2025 | “Social Care in the Digital Age”

Nov. 13, 2024 | “What Happens Now?”

Sept. 18, 2024 | “The Broken U.S. Safety Net”


Navigating Proposed CMS Changes for Inpatient Payments

The Centers for Medicare & Medicaid Services (CMS) recently released its proposed rule for the 2026 Inpatient Prospective Payment System (IPPS), outlining potential changes to Medicare payment policies, quality programs, and other requirements for inpatient hospitals. 

While the full impact will be clearer when the rule is finalized this summer, several proposed changes related to social determinants of health (SDoH) are particularly noteworthy for organizations committed to holistic patient care and community well-being.

These proposed shifts have significant implications for how healthcare organizations approach patient care and address the critical social factors influencing health outcomes.


Proposed CMS changes related to SDoH

This year’s proposed rule suggests a notable evolution in CMS’s approach to social determinants of health (review our 2024 analysis). Citing concerns about reporting burden and a desire to focus on measures directly impacting healthcare outcomes, CMS is proposing the following key changes:


The proposed changes indicate a reprioritization by CMS, emphasizing outcome-focused measures while seeking to reduce administrative burden associated with certain SDoH data collection and reporting.

However, the underlying imperative to address patients’ social needs for positive health outcomes and efficient healthcare delivery remains.



Increased focus on safe discharges and readmission reduction

The proposed rule also includes a change to the Hospital Readmissions Reduction Program by expanding the denominator to include Medicare Part C (Medicare Advantage) patients. This expansion means hospitals will be held accountable for readmissions across a broader spectrum of their Medicare patient population, further emphasizing the critical need for safe and effective discharge planning. 

This aligns with the principles of models like the Transitions, Effectiveness, and Appropriateness Management (TEAM) Model, which focuses on improving care transitions and ensuring positive patient outcomes after discharge. 


By prioritizing comprehensive discharge planning that addresses medical needs and SDoH, hospitals can better support patients in their return to home and community, thereby reducing the likelihood of costly readmissions across all Medicare beneficiaries.



The intersection of SDoH and healthcare outcomes: Why Findhelp is essential

These changes underscore the enduring need to address patients’ social needs. Findhelp’s technology and network are indispensable tools for effectively meeting these ongoing challenges and opportunities.


Ensuring safe and effective discharges


With the expanded Readmissions Reduction Program now including Medicare Part C, the pressure for successful discharges is amplified. Findhelp is crucial in facilitating comprehensive discharge planning by efficiently connecting high-risk patients with vital community-based services, directly mitigating readmission risks across a broader patient population and aligning with models like TEAM.

Powering targeted and efficient SDoH strategies


As broad reporting measures evolve, the need for focused and impactful SDoH interventions grows. Findhelp’s platform is essential for developing tailored strategies, enabling precise outreach, providing comprehensive resource navigation, and seamlessly integrating SDoH support into existing clinical workflows.

Facilitating critical data interoperability


CMS’ increasing interest in data sharing across systems highlights the importance of Findhelp’s interoperability work, which makes SDoH information readily available across the care continuum, supporting informed decision-making and coordinated care.

Driving improved patient outcomes and enhanced quality of care


In an environment of increased accountability for readmissions and a broader focus on patient wellbeing, Findhelp is a key enabler of improved outcomes and enhanced quality by facilitating access to community-based organizations that directly address social needs impacting health.



Let’s drive impact, together

Findhelp remains committed to providing the technology and network to efficiently address SDoH, supporting safe discharges, tailored SDoH strategies, and ultimately contributing to a more efficient and effective healthcare system. We’re your partner in navigating these evolving regulations and ensuring your patients have access to the resources they need to thrive.

Solutions for payers
Solutions for providers

Find Help Minnesota: Statewide Behavioral Health Program Locator

Findhelp and the Minnesota Department of Human Services (DHS) are partnering to roll out a statewide behavioral health program locator—Find Help Minnesota.


This innovative platform will enable organizations to seamlessly coordinate referrals and expand access to critical mental and behavioral health resources for Minnesotans. 

Read our press release


Connecting Minnesotans in crisis to care

Find Help Minnesota will go beyond basic social needs like food and housing by prioritizing real-time inpatient bed capacity tracking for mental and behavioral health facilities.

Minnesotans in crisis will be able to search for and connect with life-saving services faster than ever before, including:

  • Mental health resources
  • Substance use treatment
  • Supportive services
  • Inpatient residential facilities

The platform provides a comprehensive, user-friendly network for individuals of all ages—including children, families, and culturally-diverse communities. 


“This initiative is about removing barriers to care when people need it most. We’re grateful for this opportunity to support Minnesotans and providers by increasing access to behavioral health services. In partnership with local service providers, this platform will build on the life-changing work that’s already being done and ensure that individuals in crisis can quickly access the right services.”

Erine Gray

Founder & CEO, Findhelp


A streamlined, coordinated network of service providers

By integrating electronic referral capabilities, Findhelp Minnesota will streamline care coordination between healthcare providers, social service agencies, and community-based organizations.


Update your programs’ eligibility requirements to ensure high quality referrals

Streamline your incoming and outbound referral processes to better address whole-person health

Update your daily bed capacity to improve communication and reduce patient diversion


Providers: Join the Find Help Minnesota network!

Get connected in 2 simple steps:

  1. Claim your programs on the platform—this gives you access to update your information (eligibility, website, description, bed capacity, and more) in real time. 
  1. Attend our introductory training on May 6 to learn more about Find Help Minnesota and the free case management tools available to you and your organization.


RSVP to learn more



A long history of supporting Minnesotans

Minnesotans trust Findhelp to connect them with the social care services they need. In the last few years, our platform has seen:


Findhelp has been partnering with Minnesota-serving organizations since 2018. We work with customers across the state, including Mayo Clinic, Essentia Health, Children’s Minnesota, the Minnesota Association of Community Mental Health Programs, Gundersen Health system, and more.


Over the past few years, the number of searches made by Minnesota residents for mental and behavioral health-related resources has increased 86%, showing a growing need for these specific resources.

Grown in searches for mental and behavioral health-related resources in Minnesota on Findhelp platforms


“At Essentia Health, we recognize the importance of making behavioral health resources more accessible and easier to navigate, especially for people in rural communities. A centralized locator tool has the potential to be a valuable asset for our entire state. Strong community engagement in its development and implementation will be key to its success, and we look forward to continued collaboration on this effort.”

Emily Kuenstler

Community Health Director, Essentia Health



Ready to support your communities

Findhelp continues to expand its relationships with more than 650 of America’s largest health plans, hospital systems, government municipalities, educational institutions, and cause organizations to address the social determinants of health (SDoH). Connect with our team to explore how you can bring social care to your patients, members, students, constituents, and communities.    

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Who’s Doing it Best? | Findhelp’s “American Compassion: LIVE”

As part of our mission to power a better social safety net, Findhelp fosters conversations about the state of modern social care and what can be done to improve it. We’re collaborating with The LBJ School of Public Affairs at the University of Texas-Austin to co-host a discussion panel series for the current season of American Compassion: The Safety Net Podcast. On April 22, we’re filming episode 4: “Who’s Doing it Best?”, exploring social care access and delivery innovations.

American Compassion: The Safety Net Podcast

Video podcast episodes are filmed in front of a live audience at The LBJ School. This series is free and open to the public, featuring experts from academia, the public and private sectors, and practitioners who are innovating social care access and delivery.

Register to attend


“We’re working to use technology to bring dignity to that experience, protecting their privacy, ensuring they know who’s using their information and how, and really changing the experience of finding and accessing the help that people need.”

Jaffer Traish

COO, Findhelp

Episode 3: “Social Care in the Digital Age” 



Season 3, episode 4: “Who’s Doing it Best?” panelists

We’ll be filming the fourth episode, titled “Who’s Doing it Best”, on April 22, 2025, from noon to 1:30pm Central. We’re talking to people who are at the forefront of providing better care to underserved populations and helping to build a better safety net. The discussion will explore how emerging best practices and creative uses of technology are shaping social care access and delivery. The panelists are:


Adrien Lewis began his career as a business development professional, spending a decade working in healthcare, technology, and education. In 2007, a mission trip to Haiti with his wife, Cynthia, transformed his perspective and deepened his calling. Over the next three years, he volunteered with The Global Orphan Project, where he witnessed firsthand the power of connection in caring for vulnerable children. In 2010, Adrien felt a clear call from God to leave the business world and fully dedicate himself to advocating for orphaned and abandoned children. This journey led him to become a foster and adoptive parent and, ultimately, to develop CarePortal—a Care-Sharing technology that mobilizes communities to take action for children and families in crisis, creating meaningful connections that change lives.


Amber Lombardi is a graduate of the University of New England, and a Master of Public Health candidate. She started Mainely Teeth, a non-profit mobile dental clinic, to bring community access to quality dental care. Mainely Teeth’s mission is to break down barriers to oral health care and provide access to quality, compassionate dental care to individuals, families, and communities. Core to this mission is the belief that quality oral health care should be a basic human right, not a privilege. Amber never wavers in her commitment to serving those left out of the traditional medical system due to systemic issues of racism, socioeconomic privilege, or the gap between private and public health insurance.


Julian Paraschiv is committed to improving healthcare quality and access, ensuring every patient receives compassionate care with dignity. As a leader at AIDA Healthcare, he focuses on developing innovative solutions that help hospitals, post-acute providers, and risk-bearing entities coordinate care more effectively. He is dedicated to breaking down silos and creating a more connected environment where all parties involved in a patient’s healthcare journey can work together seamlessly. Before AIDA, Julian co-founded and led a long-term care organization, managing compliance, admissions, and operations. That experience reinforced his commitment to creating a healthcare system that is more transparent, humane, and patient-centered. He believes that when designed with empathy and purpose, technology can play a key role in building a more just and effective healthcare system.


Erine Gray has dedicated his career to advocating for the underserved. He founded Findhelp in 2010 and leads the company’s vision. Erine is a 2019 TED Senior Fellow and has deep expertise in eligibility programs for public healthcare services. Prior to starting Findhelp, he helped the Texas Health and Human Services Commission streamline their public benefits enrollment process.


American Compassion Season 3 episodes are available on Findhelp’s YouTube channel, Spotify, and Apple Podcasts shortly after the live events. They will also air on KUT, Austin’s Public Radio station.



Previous episodes: The origins of the safety net

In the first two seasons of American Compassion, we dove into the history behind the safety net. From FDR’s New Deal to LBJ’s Great Society, host Rebecca McInroy spoke with prominent historians like Robert Caro, H.W. Brands, and Mark Updegrove to explore the origins of foundational government programs which still exist today. Rebecca returns to the series as host and moderator for season 3, bringing more than 20 years of experience in journalism and public radio.


“Over and over again, we were reminded that the safety net and the systems that we think today are impenetrable were imagined and built by individuals with empathy, creativity, passion, and vision. And as we attempt to mend and reimagine and rebuild our safety net for the 21st century and beyond, we look to individuals with those same qualities, that same drive, and that same mission.”

Rebecca McInroy

Executive Producer & Host


Season 3, episodes 1 -3: Available now! 

Watch previous episodes to catch up on the conversation ahead of episode 4.



Be part of the conversation!

We invite you to join the live recording session of American Compassion LIVE on UT-Austin’s campus. Register today to claim your free spot. Hear directly from our featured experts and innovators, and enjoy a light lunch following the discussion.

Register now!