Cityblock Health is focused on providing affordable, human-centered healthcare in lower-income and marginalized communities, while also building sustainable business models. Founder and CEO Toyin Ajayi talked at Disrupt today about the challenges of tackling the healthcare system’s inequalities, while serving patients with personalized medical care, behavioral health care and social services.
“Do I believe that healthcare is a right, that should be available to all people, irrespective of their ability to pay and then it should be distributed equitably? Yes. 100%. And there are a lot of ways of achieving that,” Ajayi said.
“It’s unacceptable in 2022 that we’re looking at exactly the same data that we were looking at 15 years ago about healthcare disparities, healthcare outcomes, all exacerbated by COVID,” she added about the current healthcare system. “Everyone’s like, ‘oh my god, Black and brown people are dying more from COVID. Oh my god, poor people are dying more from COVID. Oh my god, essential workers who don’t have health insurance.’ We knew this stuff. Give me a break. So, yes, I would have designed it differently and I’m also not content to bitch and moan about it. We’ve got to do something.”
Based in Brooklyn, New York and now live in seven markets, including Indiana and Ohio, Cityblock works with many people who lack access to basics like food, safe places to sleep and social support, which creates more risk factors for worsening chronic conditions. As a result, many rely on emergency rooms for crises, like running out of insulin or acute psychiatric care, because they didn’t received the kind of care that would have kept them at home.
“I come to this work as a physician, I’m deeply passionate about caring for underserved communities. I come to this work from a place of real heart. This is my life’s work and my mission,” Ajayi said. “I’m also a deep pragmatist and I recognize that there are real economic forces that drive most of the decisions that people make in our healthcare system, certainly in the for-profit space, but even as we learn and read more about it, even in the not-for-profit space.”
Addressing systemic issues like health disparities is important on a moral level, but for payers there is also an opportunity to figure out how to create a more viable business by caring for people differently.
When launching in a new market, like Indiana or Ohio, Cityblock looks for places where there are socioeconomic disparities, and then looks for partners, payers and health insurers with whom they launch into markets.
“Pre-launch we spend the time figuring out where exactly in the neighborhood should we be,” Ajayi said. “Can we be near public transportation, near grocery stores, making sure that we’re really mapping the ecosystem and showing up in places that are accessible to our members and also positioning ourselves so we can go to the home and see people from there.”
Part of this means working with community-based organizations, include shelters, housing agencies and food pantries. “We think of ourselves as part of the glue within an ecosystem that knits together existing providers, the specialty providers, the hospitals, the communities, organizations and creates a seamless experience for the people we serve,” Ajayi said.
She noted that many of these organizations run on tenuous and vulnerable business models. For example, during the pandemic, many community-based organizations couldn’t get enough workers to continue coming in. Many run on tiny margins and are grant-funded. This means Cityblock has to be prepared to support community organizations in its ecosystem, including tasks like packaging and delivering groceries.
Tech and data science can also support more individualized care. For example, data science can help Cityblock figure out who it needs to engage with first in patient populations that are often very diverse in terms of age and needs.
“I have to engage all of them. Who do I go after first. Who do I call first? Who’s going to go to the emergency room tomorrow unless they get a phone call from us? Who’s not home today because they’re likely not working, or who’s likely to be engageable on the weekend,” Ajayi said. “Those are types of things we can use our data and our data products to help us better refine.”
Better data science means people also have to repeat their story less as they seek care. “When we interview our members about what they dislike about the traditional healthcare system, it’s ‘I gotta tell my whole story over and over again.’ And then you add on layers of discrimination and stigma that many people face. More than half of our members are people of color, because that’s the best representation of Medicaid and dually-eligible populations.”
“Telling your story over and over again seems benign, but the healthcare system makes people tell their story over and over again, it subjects them to friction, abrasion and sometimes even trauma, that is entirely counterproductive to a therapeutic relationship that’s going to result in better health outcomes. Even alleviating that is such a meaningful lever for us.”