HARTFORD, CT — As New York State continues to implement its Medicaid 1115 Waiver reform, Hyphen is supporting a 40,000-patient screening initiative aimed at identifying unmet social needs across New York City through its connected-care infrastructure. In partnership with Public Health Solutions (PHS) and Yuvo Health, the initiative embeds health-related social needs screenings, real-time eligibility identification, and secure cross-organizational data exchange directly into frontline clinical workflows. The goal is not only to identify unmet social needs such as food or housing insecurity, but to track and document successful connections to services, a core performance requirement under the waiver, by June 30, 2026.
If successful, the 40,000-patient target would represent one of the most significant coordinated social-needs screening efforts tied to New York’s Medicaid transformation to date, presenting an example of how health systems can operationalize the state’s health equity and social care initiatives.
“This is about moving from simply asking patients about their needs to actually closing the loop,” said Suzanne Wogelius, Vice President of Product Management, Hyphen. “The state’s waiver creates accountability for results, and that requires infrastructure that can operate at scale. We’re proud to provide the infrastructure needed for organizations to share data in real time across systems and workflows so patients receive the support they need to access care and stay healthy.”
Federally Qualified Health Centers (FQHCs) serve some of New York City residents facing social and economic barriers to care, many of whom face challenges outside the exam room that directly affect their health. By combining screening, referral management, and real-time data exchange, the partners say the initiative is designed to create a repeatable model for integrating social care into primary care delivery.
Leveraging Yuvo Health's technology platform and care navigator workflows, Hyphen's HRSN screening tool will be integrated within the Yuvo environment, enabling care navigators to identify whether patients scheduled at participating FQHCs are eligible for a screening. Through its Independent Practice Association (IPA) network, Yuvo Health will support an initial cohort of New York City FQHCs that include Joseph P. Addabbo, Housing Works, and Boriken Neighborhood Health Center. Screenings are available in English, Spanish, Chinese, Korean, and Bengali, ensuring broad accessibility for the diverse patient population served by FQHCs in New York City. Hyphen also facilitates secure, real-time data sharing between Yuvo Health and PHS, helping organizations coordinate follow-up services and track outcomes.
This initiative builds on Hyphen’s broader partnership with PHS to support integrated social and medical care across New York. That collaboration expanded in November 2025 to include CAIPA, connecting more than 300 independent providers to the WholeYouNYC social care network. Since that launch, the organizations have completed more than 14,000 health-related social needs screenings — a 750% increase in screening activity — highlighting growing momentum behind New York’s effort to integrate social and medical care.
About Hyphen
Hyphen is a healthcare technology company that makes it easy for health plans, providers, and community organizations to share data and work together to deliver connected-care. The composable Hyphen platform is payer agnostic and uses real-time FHIR-based integration to enable access to critical information when and where it’s needed most — so all healthcare stakeholders can align care coordination efforts around the patient. Hyphen was built with deep experience in value-based care, a focus on health equity, and a steadfast commitment to ensuring value flows in ways that benefit the whole healthcare system. Learn more at hyphencare.com.
About Yuvo Health
Launched in January 2021, Yuvo Health is an industry-leading healthcare organization that partners with community health centers to help them gain an advantage in value-based care, a healthcare model that prioritizes patient-provided quality and outcomes of care over the quantity of services delivered. Founded in New York City by a fully BIPOC team that has experienced the power of quality care firsthand, the entire company shares a common goal of bringing fair, quality care to underserved communities. Yuvo Health empowers health centers to succeed in value-based care arrangements by leveraging new revenue opportunities without downside risk, scalable infrastructure, and a committed partner network. Learn more at yuvohealth.com.
About Public Health Solutions
Health disparities among New Yorkers are large, persistent, and increasing. Public Health Solutions exists to change that trajectory and support underserved New Yorkers and their families to achieve optimal health and build pathways to reach their potential. As the largest public health nonprofit serving New York City, we improve health outcomes and help communities thrive by providing direct services to low-income families, supporting community-based organizations through our long-standing public-private partnerships, and bridging the gap between healthcare and community services. Learn more at healthsolutions.org.