Core Clinician Assist: SDOH Tracking

AI Enabling Timely Interventions to Address Social Determinants of Health Issues

With Core Clinician Assist: Social Determinants of Health (SDOH) Tracking, you can leverage artificial intelligence (AI) to quickly flag SDOH — i.e., health-related social needs (HRSN) issues — and make that information readily available to care management teams and clinicians at the point of care. Use these insights to achieve targeted interventions that eliminate barriers to care and access to resources, then effectively track and respond to how client HRSNs change over time.

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Built To Reduce Risk and Improve Value- and Measurement-Based Care

Early Identification and Tracking of Health-Related Social Needs to Advance Equity

SDOH Tracking gives providers focused on value- and measurement-based payment arrangements — including health plans, population health management organizations, health information exchanges, integrated delivery systems, and primary care providers — immediate insight into HRSNs that can negatively influence outcomes and increase healthcare utilization and costs.

Actionable SDOH Information for Care Management and at the Point of Care

Discover SDOH issues faster with natural language processing (NLP) tools that data mine provider and other caregiver notes across the healthcare ecosystem and then efficiently render the information to care management or to a provider at the point of care.

Powered by Data from CMS

Our SDOH Tracking AI emulates and incorporates tools, data, and standards from the Centers for Medicare & Medicaid Services' Accountable Health Communities HRSN Screening Tool and other HRSN indicators, helping ensure the most accurate identification of SDOH barriers is available to clinicians at the point of care or within their care management programs.

Ongoing Tracking for Impactful Support

SDOH Tracking changes the paradigm of screening social determinants of health, providing a more fluid assessment and identification of indicators across time and across all providers. This empowers earlier identification of SDOH barriers to care, allows quicker access to appropriate resources, provides ongoing tracking of SDOH issues to incorporate in measurement-based care initiatives, and assists targeted SDOH efforts that ultimately help address HRSNs.

Interventions That Deliver Meaningful Return on Investment

Better understand when and how to engage with individuals struggling with SDOH, including those facing multiple barriers to care. Proactive interventions improve adherence with treatment plans and recommendations while decreasing emergency room visits, hospitalizations and readmissions, and other avoidable medical services.

API Enables Seamless Integration with Any Software

With our easy-to-implement application programming interface (API), add SDOH Tracking to any EHR or care management platform.

Included in Core's Cx360 Behavioral Health EHR

SDOH Tracking can be used as a standalone solution that works with any EHR or other software solution. This AI tool is also included in the Cx360 EHR as one of many embedded technologies, providing users of this advanced and intuitive behavioral health EHR with another way to identify and meet client needs to further strengthen care coordination and outcomes.