How the Georgia Department of Veterans Service Strengthened Statewide Care Coordination and Proactively Reached 1,200+ Veterans
The Georgia Department of Veterans Service (GDVS) serves more than 700,000 veterans and their families, helping them navigate benefits, healthcare, employment, and essential resources. By partnering with Unite Us, GDVS modernized its outreach and care coordination model through predictive analytics, proactive engagement, and a closed-loop referral network. This transformation enables Veterans to receive timely, high-quality support, preventing crises, reducing barriers, restoring trust, and improving whole-person outcomes across the state.
Key Takeaways
In this case study, you’ll learn how:
GDVS uses Unite Us’ Population Insights and Self Sufficiency Scores to power multi-tiered outreach campaigns, proactively identifying and engaging at-risk veterans before crises emerge.
Data-driven outreach has reached 5,000+ individuals and meaningfully engaged 750+ veterans and family members, improving access to housing, food, behavioral health, and financial resources.
A coordinated, closed-loop referral network, spanning state agencies and community partners, drives down referral acceptance times and increases resolution rates, rebuilding trust and reducing administrative burden for staff.
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Key Results
Veterans reached
Veterans and family members engaged through targeted campaigns
average referral acceptance time
referral resolution rate
Veterans connected through anti-loneliness initiatives
data-driven campaigns launched
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The Background: Building a Modern Support System for Georgia Veterans
The GDVS is dedicated to serving more than 700,000 veterans and their families across the state. Its mission is to deliver the highest quality of care, advocacy, and support as Veterans transition from military to civilian life. From benefits counseling and claims assistance to education and employment programs, GDVS has long been a trusted ally for Georgia’s Veteran community.
By partnering with Unite Us, GDVS has modernized its outreach and coordination strategies so that Veterans, their families, and caregivers can easily access critical health, housing, employment, and financial resources when they need them most.
The Challenge: Reaching Veterans Before Their Needs Escalate
Veterans and their support systems often face overlapping challenges: navigating benefits systems, securing employment, addressing mental health concerns, and accessing quality healthcare. Barriers like transportation, lack of internet access, and housing instability make these needs even harder to meet.
GDVS leaders recognized a persistent challenge: many Veterans simply didn’t know where to go or how to ask for help. GDVS needed a coordinated system that could both streamline interagency collaboration and proactively engage Veterans before challenges escalated into crises.
The Solution: Powering Proactive, Predictive Veteran Support
To address these challenges, GDVS partnered with Unite Us in 2022 to transform how care and support are delivered statewide. Through Unite Us’ platform, GDVS is:
- Leveraging predictive analytics to drive more effective outreach: Using Unite Us’ Population Insights, vulnerable Veterans are proactively connected to necessary services.
- Coordinating care seamlessly: Direct, trackable referrals are made to trusted partners, so that Veterans receive timely, high-quality support.
- Strengthening interagency collaboration: This partnership breaks down silos between agencies and community-based organizations so Veterans experience a true “no wrong door” when seeking support.
- Demonstrating mission-driven accountability: GDVS differentiates itself by prioritizing accountability, delivering comprehensive wraparound services, and fostering transparent partnerships that put veterans’ well-being first.
“Unite Us has significantly enhanced our ability to provide coordinated care.”
The Impact: Proactive, Data-Driven Outreach at Scale
Using Unite Us’ Population Insights and Self Sufficiency Scores, GDVS has launched 10 data-informed, multi-tiered outreach campaigns through the Unite Georgia Care Coordination initiative. An industry standard, Unite Us’ Self Sufficiency Score plays a critical role in identifying which Veterans are most in need of proactive outreach. By translating complex social, economic, and environmental factors into a single stability indicator, the score highlights individuals whose needs are likely to escalate—and those who may not otherwise seek help on their own.
Individuals identified as vulnerable are then contacted as part of the proactive campaigns, enabling GDVS to reach previously underserved Veteran populations across the state and quickly meet urgent needs such as housing, food insecurity, employment, and behavioral health.
To date, Unite Georgia Care Coordination has proactively served 769 veterans and family members through 10 targeted campaigns, with outreach efforts reaching more than 5,000 individuals statewide. Each campaign leverages predictive analytics to identify at-risk individuals and uses personalized messaging to deliver support proactively, ensuring no Veteran is left unseen or unsupported.
These campaigns consistently achieve strong engagement and meaningful connections with hard-to-reach populations, demonstrating that personalized, data-driven communication is key to rebuilding trust and driving real outcomes.
Impact
- Increased Awareness: 5,000 Veterans reached and made aware of GDVS services and the opportunity to request assistance.
- Proactive Engagement: 750+ Veterans and families connected through data-informed outreach campaigns.
- Greater Accessibility: Veterans of all backgrounds can access services without exclusionary criteria or eligibility barriers.
- Efficiency Gains: Average referral acceptance time has dropped to under 12 hours, while resolution rates remain above 95%, reducing delays and administrative burden.
- Increased Trust: Veterans who may have previously distrusted the system now engage confidently, knowing referrals connect them to vetted, accountable partners.
- Whole-Person Wellness: Veterans achieve greater self-sufficiency through access to benefits and essential supports, building long-term stability and independence.
Addressing Loneliness Through Timely, Targeted Outreach
Knowing that Veterans experience higher rates of loneliness than the general population, GDVS has prioritized proactive outreach efforts, especially during times when feelings of isolation can intensify, such as the holidays. Using Population Insights to identify veterans at the highest risk of social isolation, GDVS has launched targeted campaigns designed to foster connection and reduce barriers to support.
Each outreach effort aims to remind Veterans that they are not forgotten and that community resources, social support, and meaningful human interaction are within reach, even during the most challenging times of the year.
The first two campaigns alone connected with 1,000 veterans statewide, making this one of the department’s most successful data-driven strategies for supporting vulnerable communities. As GDVS prepares for a future third campaign, insights from earlier rounds will continue to elevate and refine how the team reaches and engages veterans who need connection most.
Looking Forward
The partnership between GDVS and Unite Us demonstrates the power of coordinated, data-driven care at scale. By combining predictive analytics with proactive engagement, GDVS is redefining what Veteran support looks like in the 21st century.
Looking ahead, GDVS plans to expand its proactive outreach efforts, strengthen employment pathways for transitioning service members, and deepen collaboration with local partners. With Unite Us as a long-term ally, GDVS aims to reduce unemployment, increase benefits utilization, and foster long-term self-sufficiency for Veterans across Georgia.
The future of Veteran care in Georgia is collaborative, data-driven, and accessible—empowering veterans to thrive—and GDVS is leading the way.
“Unite Us has significantly enhanced our ability to provide coordinated care. Through the platform, we can make direct, trackable referrals to trusted partner organizations, ensuring that veterans and their families receive timely support. It has transformed the way we manage complex cases by allowing us to see real-time progress and outcomes, ultimately improving both our efficiency and the veteran’s experience.”
Dr. Patricia Ross, Commissioner of the Georgia Department of Veterans Service
About Unite Us
Unite Us is the nation’s leading software company bringing sectors together to improve the health and well-being of communities. We drive the collaboration to identify, deliver, and pay for services that impact whole-person health. Through Unite Us’ national network and software, community-based organizations, government agencies, and healthcare organizations are all connected to better collaborate to meet the needs of the individuals in their communities.
