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Data sharing alone is insufficient to improve healthcare; the future lies in collaborative, team-based care that integrates diverse expertise. Digital health tools must evolve beyond data aggregation to enable real-time, seamless communication and coordination among care teams, ensuring holistic, patient-centered care that leads to better outcomes and more sustainable healthcare systems.

Social Determinants of Health (SDoH), define non-medical factors that have an important impact on health outcomes. They are the conditions in which people are born, grow, live, work, and age, and the wider set of forces and systems that shape the conditions of daily life. Addressing SDoH requires a complete understanding of the patients' socioeconomic and environmental considerations. This includes assessing safe housing, nutritious food, access to reliable transportation, and access to education—each of which impacts the patient's health outcomes and the overall health of society that the patient represents.

SQuality data around SDoH is necessary to accurately identify, act on, and measure social risks, needs, and health disparities. Additionally, it is essential to formulate a common standard for SDoH information exchange and to use interoperable, standardized data to represent SDoH.

At the heart of this ambitious initiative lies a recognition that addressing social determinants of health is crucial for achieving better health outcomes and reducing disparities. The waiver lays out a comprehensive strategy to invest in Health Related Social Needs (HRSN) services, such as housing supports, case management, and nutritional assistance, to tackle non-medical factors that profoundly impact individual and community health.