THE PATH WE TAKE TOGETHER
Walk Through Cora's Journey
How It Works
Identifying Cora's Unique Social Needs
Cora begins her journey by filling out KokuaNet's Social Needs Questionnaire, a straightforward and confidential form designed to assess her challenges related to housing, transportation, nutrition, and more. This step allows us to understand her unique situation and identify where she needs the most support.
Connect to Community-Based Care
Based on her responses, KokuaNet's smart matching engine identifies local community-based organizations near Cora that are equipped to assist with her specific needs. These organizations are already vetted and ready to provide housing assistance, food access programs, and transportation services.
Matching and Scheduling Services
Once matched, the selected organizations confirm availability and reach out to Cora with specific dates and times they can provide support — no endless calls, no waitlists. Cora is empowered to choose what works best for her schedule, knowing the services are truly available and within reach.
Follow-up and Outcome Validation
After the services are delivered, KokuaNet follows up with Cora through a text message or phone call to ask: "Did you receive the service as expected?" Cora confirms that she received food support and received help scheduling medical transportation. She's grateful, and we mark her case as a closed social care gap.
Screening built around you
How We Quantify Need, Score Acuity, and Take Action
Our Solution ensures that the referrals don't end in silence
Quantified Risk is a numeric score we assign based on a person’s SDOH profile housing, food, safety, transportation, and more. Each factor is weighted by its evidence-based link to outcomes like ER visits, chronic illness, or avoidable costs.
How We Score It: We ask questions across key social domains like housing, food, transportation, and safety. Each response is weighted based on how strongly it’s linked to health risks like ER visits or chronic illness. The total score places each person into a Low, Moderate, or High risk tier which guides how urgently we act and which services we prioritize.
What We Do to Fix It: We match each person to local, verified organizations based on their SDOH risk score and location. If a referral isn’t accepted or confirmed, we automatically retry until a service is delivered and verified. Our system ensures no one falls through the cracks and you only pay when a gap is truly closed. Screening Built Around You A solution ensures that referrals don’t end in silence. Patients feel supported beyond the platform, and health outcomes improve with each confirmed gap closure.
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