Open City Labs

01/09/2026

States are about to receive up to $200M/year for rural health. The question is:

Will they buy more of the same tools?

The Rural Health Transformation (RHT) program is a once-in-a-generation inflection point.

We have the capital to modernize infrastructure. But if we use it to build more siloed "snapshot" tools, we fail. We need to invest in infrastructure that supports Thriving—connecting healthcare, social care, and government agencies into a unified, longitudinal view of the person.

This isn't just philosophy. Technology innovation is central to solving the workforce retention and population health crisis.

In this article, I map out:

1. Why a Thriving Agenda could orient and align government agencies around metrics of success.
2. How we need more holistic, aspirational, longitudinal and data driven measurements to align policy success.
3. Open City Labs' vision for a cross sector infrastructure where prevention is like time travel.
4. How defining and advancing a Thriving Agenda could be essential for aligning AI with human values.
👇 Read the full edition here and share: What thriving means to you?

https://champ.ly/2LAXDBWU

Health Policy is drowning in changing language and AI has an alignment problem. What if a Thriving Agenda was the missing architecture for both? In 1967, Dr.

01/05/2026

Closed-Loop Referrals were the engine for Medicaid waivers. But they aren't enough for Medicare's new innovation models.

For the last decade, 1115 Waivers and DSRIP programs focused on one metric: The Connection. Did we get the patient to the food pantry?

But in 2026, Medicare’s new models for social drivers and chronic conditions don’t just ask "Did we connect them?"

They ask: "Did we manage the whole person?"

Here is the shift most organizations miss:

Referrals (Waiver Era) = Essential for access.

Care Plans (Medicare Era) = Essential for Whole Person Health & Payment.

Medicare’s new G-Codes (CHI/PIN) and the CMS ACCESS model explicitly require standardized care plans.

Why? Because a referral is a transaction. A Care Plan is a commitment to outcomes. It bridges the gap between clinical care and social support, ensuring the work you do actually drives health improvements—while unlocking the revenue to sustain it.

If your infrastructure was built for waivers, it might not be ready for Whole Person Care.

On Tuesday, Jan 27, we are breaking down the specific technical requirements to turn social care into a sustainable, outcomes-driven revenue engine.

Don't leave impact on your patients' health (or millions) on the table:

https://champ.ly/JUlnAS2C

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Whole Person Health is Finally Funded. But Referrals Won't Get You Paid. In 2026, a historic wave of federal funding is hitting the market to address the…

01/05/2026

The era of "one-off" social care contracts is ending. The era of the Revenue Ecosystem has begun.

Sophisticated CBOs and AAAs have been contracting with healthcare for years. You know the value of your work. You don't need to be convinced that "Social Determinants matter."

But the game has changed.

With the $50 Billion Rural Health Transformation awards and the new CMS ACCESS Model, we aren't just seeing more funding. We are seeing complex, overlapping funding streams that require a new level of infrastructure.

The challenge for 2026 isn't "getting a contract." It is Program Alignment.

* How does your organization align strategy and beneficiary navigation to Medicare Community Health Integration, Personal Illness Navigation and new CMS Innovation models ACCESS, and MAHA ELEVATE?
* Can you "stack" investment in BOLD Alzheimer's infrastructure with payment models that focus on chronic disease management?
* Can you generate the compliant Care Plans required to unlock these payments, or are you just sending referrals?

If you are trying to manage $50B in new opportunity with spreadsheets and siloed referral tools, you are leaving millions on the table.

It’s time to align your infrastructure with the opportunity.

On Tuesday, Jan 27, Open City Labs' CEO Matt Bishop will host a technical briefing on the Infrastructure for Whole Person Health. We will decode exactly how to stack these funding streams into a single, sustainable revenue engine and model health and human thriving..

Reserve your spot here:

https://champ.ly/JUlnAS2C

Whole Person Health is Finally Funded. But Referrals Won't Get You Paid. In 2026, a historic wave of federal funding is hitting the market to address the…

07/11/2024

Our CEO Matt Bishop was a recent co-author of this HIMSS white paper, "Measuring Digital Health Equity for Impact: A Proposed Framework for Using Digital Determinants of Health (DDOH) To Measure the Impact of Digital Health Services."

A Proposed Framework for Using Digital Determinants of Health (DDOH) to Measure the Impact of Digital Health Services

03/30/2024

Our CEO Matt Bishop was honored to speak at HIMSS on a panel titled, "Modernizing Health & Human Services Data Infrastructure through Policies and Standards that Support SDOH and Health Equity."

02/16/2024

HIMSS and Open City Labs are thrilled to announce our upcoming free webinar on how New York State is tackling health equity and the social determinants of health (SDOH). With a $500M investment in SDOH infrastructure and the processing of claims for $3.1B in social services, Social Care Networks will play a crucial role in this effort. Join us to learn more about leveraging the NYS Medicaid waiver for Social Care Network success!

Register now:

This link will take you to a page that’s not on LinkedIn

09/08/2023

Several states (CA, OR, MA, NC, AR) are leveraging Medicaid 1115 Waivers to address the social (drivers) determinants of health (SDOH).

Here are 4 Trends and 4 Untapped Opportunities for states seeking to leverage 1115 Medicaid Waivers to address health equity and

If you want to discuss how you might implement some of these ideas, we are offering a free two hour consult. Feel free to reach out.

06/07/2023

Matt Bishop will be presenting later today at the 211 San Diego
Community Information Exchange Summit with 211 San Diego's Director of Interoperability and Social Impact Alana Kalinowski. Their session is titled, "Better Care At Lower Costs: ​Open Data Standards that Drive Scalable Interoperability."

05/11/2023

Our CEO Matt Bishop headlined the technology speakers today at the US Health and Human Services Office of Inspector General (OIG) "Modernizing Data for Oversight at HHS-OIG."

I spoke about the need for bidirectional APIs for collecting data necessary for OIG's, automating reporting, and how the same concept could be extended to enable exchange of eligibility and data that is part of application forms like government benefits like SNAP and WIC.

This Social Health Information Exchange approach could improve access to government benefits, forgoing the need to enter the same data in multiple forms, and enable real time privacy preserving monitoring, which is critical for public health and AI safety/trust.

11/02/2022

Open City Labs and our partner company MayJuun (Team "FHIR-FLI") are excited to be winners of the Administration for Community Living Social Care Referrals Challenge Grand Prize and Bonus Prize!

True access to life changing services can only be accessible when systems can seamlessly exchange data. As we continue to work towards that end in New Jersey by using tech to identify people who are at risk due to lack of access to adequate, or nutritious food, or who are at risk of becoming homeless with MayJuun's Cuestonario and connecting them with services with Open City Labs Navigator360 we can improve health & prevent health problems from developing. Thanks to the hard work from both teams that made this award possible!

October 27, 2022 ACL is proud to announce the final winners of the Social Care Referrals Challenge. Launched in March 2020, the competition sought IT solutions to support health care systems and community-based organizations in partnering to provide holistic health and social care for older adults a...