Cityblock Health CEO Toyin Ajayi on scaling human-centric models of care • TechCrunch
Cityblock Health is focused on delivering affordable, people-centric healthcare in low-income and marginalized communities while building sustainable business models. Founder and CEO Toyin Ajayi spoke at Disrupt today about the challenges of addressing healthcare inequalities while serving patients with personalized medical care, behavioral healthcare and social services.
“Do I believe that health care is a right that should be available to all people regardless of their ability to pay and should be shared fairly? Yes. 100%. And there are many ways to achieve that,” Ajayi said.
“It is unacceptable that in 2022 we are looking at the exact same data that we were looking at 15 years ago on health inequalities and health outcomes, all of which have been exacerbated by COVID,” she added of the current health system. “Everyone’s like, ‘Oh my God, black people 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 not content to bitch and bitch about it either. We have to do something.”
Based in Brooklyn, New York, Cityblock now lives in seven markets, including Indiana and Ohio, and works with many people who lack access to basic essentials like food, safe places to sleep and social support, adding further risk factors for deterioration creates chronic diseases. As a result, for crises such as insulin deficiency or acute psychiatric care, many rely on emergency departments because they did not receive the type of care that could have kept them at home.
“I come to this work as a physician, I am passionate about serving underserved communities. I come to this work from the bottom of my heart. This is my life’s work and my mission,” said Ajayi. “I’m also a deeply pragmatist and I recognize that there are real economic forces driving most decisions in our healthcare system, certainly in the for-profit realm, but even as we learn and read more about it, even in the not-for-profit realm.”
Addressing systemic issues like health inequalities is important on a moral level, but there is also an opportunity for payers to explore how they can build a more profitable business by caring for people differently.
When launching in a new market like Indiana or Ohio, Cityblock looks for places where there are socioeconomic differences and then looks for partners, payers and health insurers to enter markets with.
“Before launch, we spend the time figuring out where exactly we should be in the neighborhood,” Ajayi said. “Can we be close to public transport, close to grocery stores, make sure we really map the ecosystem and show up in places that are accessible to our members, and also position ourselves to go home and people can see from there? ”
Part of that means working with community-based organizations, including emergency shelters, housing agencies and food supplies. “We see ourselves as part of the glue within an ecosystem that brings together the existing providers, the specialty providers, the hospitals, the communities and organizations, creating a seamless experience for the people we serve,” said Ajayi.
She noted that many of these organizations operate under weak and vulnerable business models. For example, during the pandemic, many community-based organizations couldn’t find enough workers to keep coming in. Many run on tiny profit margins and are funded by grants. That means Cityblock must be prepared to support community organizations in its ecosystem, including tasks like packing and delivering groceries.
Tech and data science can also support more personalized care. For example, Data Science Cityblock can help identify who to reach out to first in patient populations that often vary greatly in terms of age and needs.
“I have to include them all. Who do I go after first? Who do I call first? Who’s going to the ER tomorrow unless they get a call from us? Who aren’t home today because they probably won’t be working, or who are likely to be available at the weekend,” Ajayi said. “These are things we can use to better refine our data and our data products.”
Better data science also means people don’t have to repeat their story as often when they seek help. “When we ask our members what they don’t like about the traditional healthcare system, it’s like, ‘I have to tell my whole story over and over again.’ And then you add layers of discrimination and stigma that many people face. More than half of our members are black because that is the best representation of Medicaid and dual eligible populations.”
“Telling your story over and over again seems benign, but the healthcare system pushes people into telling their story over and over, it subjects them to friction, attrition, and sometimes even trauma, what a therapeutic relationship that will result, Totally counterproductive is better health outcomes. Even alleviating that is such a significant lever for us.”