Cityblock: Technology Meets Community Health
Who is Cityblock?
In October 2017, Bay Gross, Iyah Romm, Mat Balez, and Toyin Ajayi launched Cityblock, a technology/community driven company founded on the premise that health is local and that we are in desperate need of a new care model that improves local health. Their mission: to radically improve the health of urban communities, one block at a time
Bay Gross and Mat Balez both come from tech backgrounds (both are former Google employees), Iyah Romm has worked over a decade in leading, developing and deploying care interventions across the US, and Dr. Toyin Ajayi served as Chief Medical Officer of the Commonwealth Alliance and has a background in development economics and International Development. Together, this team holds vast expertise in complex healthcare issues, consumer technology, and digital product design.
Crown Heights, Brooklyn
Cityblock is present in several cities, but first piloted in it’s sole NY site, Crown Heights, Brooklyn. Crown Heights is quite a diverse community, with a majority West Indian and African American population. There is also a significant Hasidic Jewish population. Cityblock has partnered with community-based organizations, health plans, and provider organizations to redesign the delivery of health and social services.
In terms of existing health care and health outcomes, Crown Heights residents face many barriers to leading healthy lives. According to a recent 2018 NYC Community Health Profiles Report, 12% of adults in Crown Heights (and neighboring Prospect Heights) are uninsured and 14% report going without needed medical care in the past 12 months, similar to the rest of NYC. Crown Heights and Prospect Heights’ adult obesity rate is 26%, which is similar to the rest of NYC. Thirteen percent of Crown Heights and Prospect Heights adults have been diagnosed with diabetes and 33% of adults have been told they have hypertension.
How it Works
Cityblock is focused on serving underserved Medicaid populations. Seeing how technological advances in healthcare have largely left out investing in new innovations for this high need and high cost population behind, Cityblock founders sought to change that. What makes this health tech company different beyond their focus on reaching more vulnerable populations, is their recognition of the complexity of health. Health is more than just an absence of sickness and increased access to doctors visits, but rather complex layers of social determinants and other environmental factors shaping opportunities and outcomes. Based on partnerships with local Community Based Organizations (CBO’s) and social service providers, Cityblock worked to address the social, economic, environmental, and educational needs of their members. Cityblock is made up of care teams that include doctors, nurses, social workers, and most importantly Community Health Partners (CHP), that together are able to deliver a home-based intensive primary care model with integrated behavioral health, substance abuse counseling, and social benefits coordination to address social determinants of health that impact members health outcomes.
The CHPs are at the frontlines of this care model. Functioning as community health workers, CHPs work directly with community members to help address the economic, social, physical and mental challenges they may be facing. These CHPs are often local community members themselves and are eager to better their communities health and wellbeing. Additionally, the company creating a new workforce of local community members working as CHPs.
If a member were to be struggling with access to food, the CHP might help connect the member to food stamp services, and help the member apply for these services. If a they had difficulties getting to their appointments due to transportation barriers, the CHP would arrange a care ride.
The role of technology in facilitating better health outcomes
Cityblock provides a 360-degree view of each member’s medical and social needs, enabling care planning, Telehealth visits, community referrals, alerts, and seamless care team workflows. CHPs work with community members to access existing social determinants of health, and what barriers that are exacerbating negative health outcomes, or have the potential to create negative health outcomes. This is made possible primarily through the trust and relationship building done by the care team and with members, but aided with a digital platform referred to as The Commons.
The Commons is able to map Income and entitlements, housing, medical and preventative care, mental health, food access, employment, transportation, engagement, safety, social support, legal support, and education. Based on a members existing , the CHP and patient work together to develop a plan that addresses their most pressing concerns and needs. The commons also allows for greater continuity of care and more seamless communication, with care teams capable of communicating with members via SMS and other digital modalities.
The use of digital technology in the case of Cityblock is an example of digital technologies bridging physical experiences. It’s more than a product. This technology is facilitating community trust building that will hopefully translate to better overall health outcomes.
