Sharing Social Needs Data Across Sectors: Lessons From the Centers for Medicare and Medicaid Services Innovation Center's Accountable Health Communities Model.

This article examines the experiences of Accountable Health Communities (AHC) awardees in sharing health-related social needs (HRSN) data—such as housing instability and food insecurity—with clinical partners and community-based organizations (CBOs) to inform care and advance health equity. Findings from focus groups and interviews with 19 awardees and their partners reveal that while some clinicians used HRSN data to tailor care, many were uncertain how to apply this information, and technological challenges hindered data sharing. CBOs primarily received aggregate data for program planning but faced barriers including limited technological capacity, increased workload, and misaligned data systems, with few incentives to participate fully in data-sharing initiatives. The study highlights the need for better clinician guidance on using HRSN data, meaningful engagement and funding for CBOs, and co-designed data-sharing platforms that prioritize patient privacy and equity to enhance the effectiveness of addressing social determinants of health.