Marshfield Clinic Health System is the latest organization to take a tech-driven approach to connect patients with the social services they need, such as housing or employment.

The Wisconsin-based provider, which describes itself as one of the largest rural integrated systems in the country, will have its community resources groups screen patients for social needs ranging from food and shelter to transportation and childcare using NowPow’s social determinants of health (SDOH) technology platform.

In addition to identifying potential needs at the individual and community levels, the technology also helps coordinators link patients to nearby social services that can address their needs, the organizations said.

“This tool is not targeted just at the highest risk population. If we do this correctly, we’ll be able to screen all of our patients,” Jay Shrader, Marshfield’s vice president of community health, wellness and health equity, told Fierce Healthcare. “The goal here is to help us prioritize and figure out which ones are the most relevant and important to address initially, and then work with our community partners to make that happen.”

The system—which comprises nine hospitals, one children’s hospital, a research institute, a health plan and dozens of clinics—knows it’s serving a patient population with limited access to support, Shrader said. Many of its communities have a limited number of physicians and mental health providers, short-staffed public health departments and social service organizations reliant on philanthropy, he said.

Marshfield has backed a number of programs to support these community partners over the years, he continued. The system hosts the largest Americorp program in the state of Wisconsin, he said, and partnered with nearby universities and technical colleges to grow the local clinical workforce and build teams that can connect in-need individuals to community resources.

However, Shrader said the system has been looking at ways to ensure its social determinants and health equity programs aren’t just standalone efforts.

“We know that we have to embed it in everything that we do and the fabric of our organizations, so working with NowPow elevates that,” he said. “It allows us to have a platform that is well defined, that is a well-oiled machine to take this to the next level and start baking this into different and more clinical practice areas—but then also really strengthen the partnerships with our community-based organizations.”

After first dipping its toe into the pool of SDOH tech vendors about a year and a half ago, the health system and the Chicago-based software company began working together in earnest around December, Shrader and a representative of the system said. So far, NowPow CEO Rachel Kohler said, the Marshfield team has “a big appetite” and is already encouraging her product team to add new capabilities to the SDOH platform.

“Marshfield is really making a significant commitment to technology and to workflows,” she said. “Integrating NowPow directly into the EHR to be able to do this work at scale not only helps the breadth of their patient population but also really creates a rich data set around understanding the needs and the prevalence of the resources across the geography that match the needs of the patient population.”

NowPow has notched dozens of health system, payer and non-healthcare customers since its was founded in 2014—NYC Health + Hospitals (the largest public healthcare system in the U.S.), Humana and the Chicago Department of Public Health, just to name a few recent additions.

But while the biggest names in its rolodex have focused on urban populations, Shrader said NowPow has some rural experience under its belt as well. Efforts scaling across Arizona and Minnesota and a research program in North Carolina have helped the tech company understand how it needs to iterate its approach to better address the needs of these communities, she said.

“For example, in rural communities, patient privacy and confidentiality [are] hugely important because the populations are so small,” she said. “We’ve really gone the miles to be able to treat them in a very sensitive way [and] to ensure they have the control that they want.”

The partnership with NowPow is expected to help the health system and its health plan in its efforts to reduce costs as it embraces an accountable care model. Shrader added that the system’s new tools will help it lend more support to the Wisconsin community organizations that “are very good at what they do” but can only stretch their limited resources so far.

“There’s a trickle-down effect when it comes to social needs and helping our communities know, with rich data, where there might be gaps,” he said. “Our community partners have been extremely excited and looking forward to this because they realize that it’s another tool in their tool belt.”