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Cityblock Health is focused on providing affordable, person-centered healthcare services in low-income and marginalized communities while also building sustainable business models. Founder and CEO Toyin Ajayi spoke on Disruption Today about the health care system’s challenges in addressing inequities, personalized medical care, behavioral health care and social services for patients.
“Do I believe that health care is a right, that it should be available to all people, regardless of their ability to pay, and that it should be distributed fairly? yes. 100% and there are many ways to achieve that,” Ajayi said.
“It’s unacceptable in 2022 that we’re looking at exactly the same data about health care disparities, health care outcomes, all exacerbated by Covid 15 years ago,” she added of the current health care system. “Everybody’s like, ‘Oh my God, black and brown people are dying more from Covid. Oh my god the poor are dying more from covid. Oh my god, essential workers who don’t have health insurance.’ We know this. Peace be with you. So, yes, I would have framed it differently and I wasn’t content to moan and groan about it. We have to do something.
Based in Brooklyn, New York and now in seven markets, including Indiana and Ohio, Cityblock works with many people who lack basic things like food, a safe place to sleep, and social support, which puts them at greater risk of worsening chronic conditions. As a result, many end up relying on emergency rooms for crises like insulin deficiency or psychiatric emergencies because they don’t get the kind of care they would at home.
“I came into this work as a physician. I really love caring for underserved communities. I come into this work from a place of true heart. This is my life’s work and my mission,” said Ajayi. I realize that there are real economic forces driving the for-profit space, but the more we learn and read about it, the more we learn about it, even in the not-for-profit space.
Addressing systemic issues like health disparities is ethically important, but there is an opportunity for payers to learn how to create a more effective business by caring for people differently.
When launching in a new market like Indiana or Ohio, Citiblock looks for areas with socioeconomic disparities, and partners, payers and health insurers to launch into those markets.
“We spend our pre-launch time figuring out where we need to be in the environment,” Ajayi said. “Being near public transportation, near grocery stores, making sure we’re doing the ecosystem right and being in places that are accessible to our members, and we can also set ourselves up to go home and see people from there. “
Part of this includes working with community organizations, including shelters, housing agencies and food pantries. “We think of ourselves as the glue in an ecosystem that connects existing providers, specialty providers, hospitals, communities, organizations and creates a seamless experience for the people we serve,” said Ajayi.
She explained that many of these organizations operate with difficult and vulnerable business models. For example, during a pandemic, many community organizations can’t find enough staff to keep going. Many of them run on slim margins and are supported by grants. This means that Cityblock must be ready to support community organizations in the ecosystem, including providing packaging and goods.
Tech and data science can also support more personalized care. For example, data science helps Cityblock figure out who to engage with first in a patient population that is often very diverse in terms of age and needs.
“I have to involve everyone. Who do I go after first? Who do I call first? Who’s going to the emergency room tomorrow unless they call from us? Who’s not home today, maybe not working, or who might be involved on the weekend,” Ajayi said. To help us investigate better.”
Better data science means people need to retell their stories when they seek care. “When we interview our members who don’t like the traditional health care system, it’s, ‘I have to tell my whole story over and over again.’ And then they add to the discrimination and stigma many people face. More than half of our members are people of color, because that’s the best representation of Medicaid and bi-eligible populations.
“It sounds good to tell your story over and over again, but the health care system forces people to tell their story over and over again, leading to conflict, depression and sometimes trauma, which is completely counterproductive to the therapeutic relationship. Better health outcomes. Even easing that makes sense to us.” It’s a lift.
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