Repairing the American social contract with technology

The social contract is a simple promise. When people contribute to society, the systems around them should help provide a path to health, security, and opportunity. Typically, parts of this promise are delivered through social goods. Things like healthcare, food, housing, childcare, education, and financial support. These are the basic services that allow people to take part in society and live with dignity. For many, this promise no longer feels real.

Since 2000, the price of hospital services has risen 308%, childcare 164% and rent 148%, while average hourly pay rose 137%.¹

Technological progress has deflated the cost of goods and services across much of the economy, restructuring whole industries. In hospitals, output per hour of work grew just 2% in thirty years, against 82% across the rest of the economy.² The deflationary transformation of healthcare never arrived. Instead, a combination of regulation and labor-intensive work meant that technological change had limited productivity gains. Health care now accounts for 11.7% of US payroll jobs, up from 7.3% in 1990.³

Because of this, the organizations responsible for delivering social goods are under pressure. Costs and operational overheads continue to rise. Each new program brings new vendors and more administrative work, and help for low-income families is already split across more than 80 federal programs.⁴ Our system is not failing due to a lack of care. It is failing because the underlying economics simply don’t add up.

Organizations are forced to ration their attention. They use cheap, generic outreach for most members and reserve expensive, staff-led support for the small group who are already high-risk or high-cost. In health care, 5% of people account for about half of all spending.⁵

What if we could reach people before they become high risk? Early intervention is simply too expensive to provide at scale. A health plan may know that a member needs help. They may already have a benefit that could help them. But identifying the need, reaching that member, choosing the right response and tracking the result often happen between fragmented systems and vendors. Leaving staff to spend their time getting data from system A to system B so that member Y can get the care they need. It’s all pretty archaic and painfully inefficient.

Agentic systems will fundamentally alter the unit economics of delivering high quality, personalized care at scale. Multiplying the capabilities of teams that, today, are stretched thin providing care for a fraction of their population.

Applying AI to the delivery of social goods can lower the cost of finding a need across a population. It can make communication more bespoke. It can help decide what action to take. It can verify whether that support reached the right person and produced the intended result.

But better economics are only half of the opportunity.

The other half is trust. It is created when a person asks for help and receives a clear, useful response. It is created when a referral is handled in minutes instead of weeks. It is created when a benefit arrives while it can still make a difference. Every reliable action tells a person: someone has your back.

An agentic system for healthcare & human services follows four principles:

1. It builds trust through action. It can screen populations, help members navigate their care, and assist in enrollments.
2. It is auditable. It keeps a record of each message, decision and dollar, so programs can prove how resources are being allocated.
3. It is designed for human collaboration. It can handle the routine and programmatic work, and brings in a person when a member needs judgement, empathy, or trust.
4. It is compliant. It follows each program’s rules for privacy, eligibility and payment.

At BPS we’ve been building towards this future since 2017. With each solution we’ve brought to market, we’ve always been focused on making the delivery of social goods that bit easier.

Beginning with Bridgemart, a digital safety eyewear program developed in partnership with Walmart. We then generalized that same payment infrastructure to other programs. Which became iQpay, letting a program restrict money to a specific purpose, deliver it to members and record how members use it. Nearly a decade since starting the company we are on the cusp of our next evolution.

Now, we’re building Meadow, the first agentic community health worker. It is the culmination of nearly a decade of technical and market expertise with one goal: to completely transform how social goods are delivered across the US.

We know the social contract can’t be repaired through words alone.