A Net That Actually Holds

Earlier this year, KQED reported on a farmworker in Contra Costa County named Marisol. She picks fruit in hundred-degree heat. She is undocumented, uninsured, and recently lost her path to coverage. When she felt lumps in her breast, she had to choose between paying rent and seeing a doctor. A free clinic caught the tumor in time, and it turned out to be benign. She was lucky. A system shouldn't run on luck.

Marisol is one person carrying three crises at once: a strain on her body, no coverage, and the constant calculus of which basic need to skip this month. Our health system, when it sees her at all, tends to treat each crisis in isolation: a screening here, a referral there, a form to fill out, a box to check. But a body doesn't work in boxes. A body is an ecosystem. The hunger, the missed appointment, the untreated condition, and the fear all compound. Treat one and ignore the rest, and you haven't really helped.

This is the problem CareMessage exists to solve. And right now, it is getting harder and more urgent at the same time.

Why Now

Three forces are converging on the people we serve.

The first is AI. Powerful new technology is arriving fast, and almost all of it is being designed for the healthy and the wealthy. Left unchecked, AI will widen the digital divide, not close it.

The second is misinformation. Trust in basic preventive care is eroding, and not only because of fringe voices. Some of it now comes from the institutions and authorities people used to rely on. A parent hesitates over a routine childhood vaccine. Confusion has become a public health threat of its own.

The third is the unraveling of the safety-net itself. More than three million people have lost federal food assistance since last summer, driven by new rules rather than any drop in need. Free and charitable clinics are bracing for a surge of uninsured patients as Medicaid coverage rules tighten. The people losing food, losing coverage, and losing continuity are the same people. Again, the crises compound.

Many organizations are meeting this moment by retrenching. We are doing the opposite. Last year, I wrote that we would double down rather than pull back, and we have. We are building.

The Audacious Idea

Let me be plain about the problem. Primary care in this country is failing the people who need it most. But the math of fixing it is more hopeful than it looks.

Ninety million people in the United States live at or below twice the federal poverty line. The healthcare safety-net (community health centers, free and charitable clinics, and tribal health organizations) can reach about a third of them, roughly 32 million, at its absolute best. We already reach millions of those people every year. So the question was never whether the problem is too big to dent. The question is where to push.

Here is the bet. Take the millions of people we already reach, and prove we can measurably improve their health: more cancers caught early, more chronic conditions controlled, more healthy pregnancies, more families who keep both their coverage and their groceries, at a fraction of what the broken status quo spends to get worse results. Then extend that model past the four walls of the clinic, into the food programs and community organizations where people actually live, to reach the 60 million the healthcare system alone will never touch. That is the shift we are making: from the largest patient engagement platform for low-income populations in the country into something bigger, a connected system that powers the conversations that lead to healthier lives.

The Ingredients Only Matter Together

People sometimes look at everything we're working on and see a list. Maternal health. Early childhood. Diabetes and mental health. Medicaid. Food. Rural and tribal communities. Interoperability. AI and data. It can feel like a lot of separate things. It isn't. It's one system, because a person is one whole life.

The foundation is our investment in responsible AI, data, and interoperability, the connective tissue that lets a single text about a missed appointment also surface a food need, flag a coverage lapse, and route the right help, all while staying private, consented, and grounded in clinical oversight. We build it for the people usually left out: in their languages, at their literacy levels, with safety first.

On that foundation, we meet whole people where life is hardest. We aim to support families from pregnancy through a child's earliest years, when a little timely guidance bends the whole arc of a life. We aspire to help people keep chronic conditions like diabetes in check, providing a steady stream of encouragement and education in the daily life between clinic appointments (including via our newly released Wellness Copilot solutions). We are accelerating efforts to help people hold onto their Medicaid coverage through turbulent redetermination cycles, with reminders and a human hand when the paperwork becomes overwhelming. We are focused on closing the loop on food and other social drivers of health, so a need that surfaces in a clinic doesn't disappear into a referral nobody follows. And we are extending all of it into new markets and new partners, so this care reaches people the traditional system was never built to serve, including tribal and rural communities.

Each ingredient is good on its own. Together, they stop being a list and start being a system.

The Momentum is Real

This isn't a someday idea. It's already accelerating.

In all of 2025, CareMessage reached about 6 million people. In Q1 2026 alone, we reached more than 3 million unique patients. Our existing customers are deepening their work with us, and the broader safety-net is moving toward exactly the kind of outcomes-focused care we were built for.

And the patients tell us what it means: "The texting program helped me a lot. I would never eat breakfast before. Now I eat breakfast everyday, I take my pills at the same time every morning and I am consistent. I feel smarter so that I don't get diabetes!"

That is food, medication, and behavior change, all moving together in one person's life through a few well-timed messages. Now imagine it for millions more.

Why I'm Writing This

I'm not here to ask you for anything today; rather, I want to show you what's possible, and to encourage you to continue believing that it’s worth building.

We are living through a domestic health crisis that falls hardest on the people with the least. We can keep treating their lives as checklists, or we can build them a system of care that treats them as whole. CareMessage has the reach, the trust, the technology, and the evidence to build that system.

If you build for a living, come build with us. If you lead a clinic, a community organization, or a network, let's connect care across the gaps your patients keep falling through. And if you simply believe that where you were born and what you earn shouldn't cost you ten or fifteen years of your life, then you already understand the whole idea.

The safety-net was never one thing. It is millions of small catches: a reminder that lands, a benefit that gets kept, a question that finally finds an answer, a person who feels known. Woven together, and woven well, those catches become what the people we serve have rarely had. A net that actually holds.

A person is not a problem to be closed out. A person is a whole life worth holding onto. Let's hold the net together, and reclaim the years.

With Care,
Vineet Singal
CEO