SDOH Data & Community Resource Intelligence

MedTells SDOH Intelligence

MedTells helps healthcare systems connect social needs, community resources, referrals, outcomes, and population health data into one smarter intelligence layer.

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Turn Social Needs Into Actionable Healthcare Intelligence

Social Drivers of Health data is only valuable when it leads to action. MedTells helps healthcare organizations identify patient needs, connect individuals to community resources, track referrals, monitor outcomes, and support better population health decision-making.

SDOH Screening Data

Capture and organize social needs data related to food, housing, transportation, safety, utilities, financial stress, and access barriers.

Resource Matching

Match patients, members, and families to local community resources based on need, location, eligibility, language, and program availability.

Closed-Loop Referrals

Track referrals from screening to resource connection, confirmation, follow-up, and measurable outcome.

Population Insights

Turn SDOH activity into dashboards, reporting, risk patterns, service gaps, and measurable community impact.

How MedTells SDOH Intelligence Works

1. Identify Social Needs

Screen and collect structured data around social drivers that affect care access, patient stability, utilization, and outcomes.

2. Connect to Resources

Match individuals to local support services such as food assistance, transportation, housing support, behavioral health, and community programs.

3. Track Outcomes

Follow the referral lifecycle, confirm whether services were received, and connect community support activity to measurable health and operational outcomes.

Built for Healthcare Systems, FQHCs, and Community Programs

MedTells SDOH Intelligence is designed for organizations that need to understand patient risk beyond the exam room and coordinate resources across clinical, social, behavioral, and community-based systems.

FQHCs and community health centers
Healthcare systems and provider groups
Rural health and outreach programs
Behavioral health and care coordination teams
Medicaid and value-based care programs
Nonprofits and community resource partners
Grant-funded population health initiatives

Why Organizations Need SDOH Intelligence

Screening Without Action Many organizations collect SDOH data but lack a system to close the loop and prove what happened next.

Fragmented Resources Community resources are often disconnected from care teams, workflows, patient records, and reporting tools.

No Outcome Visibility Organizations need to know whether referrals were completed, services were received, and outcomes improved.

Better Risk Stratification Combining clinical, behavioral, and social data gives leadership a better view of real patient and population risk.

Core SDOH Intelligence Capabilities

MedTells helps organizations move from fragmented social-needs activity to an integrated intelligence layer for screening, referral tracking, community resource matching, reporting, and measurable population health impact.

SDOH Screening Capture structured social-needs data that can support care coordination, outreach, and population risk analysis.

Community Resource Directory Organize community partners, eligibility rules, service categories, locations, and referral pathways.

Closed-Loop Referrals Track whether referrals were accepted, completed, declined, pending, or require follow-up.

Risk Intelligence Combine social, clinical, behavioral, and utilization indicators to better understand patient and population risk.

Outcome Reporting Report on referral volume, service completion, unmet needs, resource gaps, utilization impact, and community benefit.

Grant & Value-Based Support Support HRSA, Medicaid, payer, community benefit, and grant reporting with measurable social impact data.

A Smarter SDOH Layer for Modern Care Delivery

MedTells gives healthcare organizations a more complete view of the patient by connecting social needs, community resources, referral activity, outcome tracking, and population health intelligence into one coordinated system.

Ready to Connect SDOH Data to Real Outcomes?

Learn how MedTells can help your organization identify social needs, connect patients to resources, close referral loops, and measure community impact.