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Embedding SDOH Insights into Provider Workflows to Close Care Gaps
Points of Light 2026 Case Study 24
Author
Mac Boyter
Author
Aurene Wilford
Centene, Veradigm, Insiteflow, and Healthcare Organization 24 partnered to close care gaps by integrating payer-derived SDOH data into provider workflows. Previously, these data points were siloed from independent practices, limiting whole-patient visibility and reducing the effectiveness of quality initiatives. The collaborators embedded SDOH-triggered reminders directly within the EHR, supported referral connections to community resources, and provided structured provider training and embedded care management. As a result, providers gained greater awareness of social barriers, increased engagement during patient encounters, and improved care gap closure among members with identified SDOH challenges.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved Through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2026 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.