A new care model for those that need it most
A Sidewalk Talk Q&A with Cityblock Health’s Co-Founder and President, Dr. Toyin Ajayi
This Sidewalk Talk Q&A is part of a series of conversations with leaders at Sidewalk Labs incubated and portfolio companies.
Cityblock Health is a Sidewalk Labs spinout company that delivers personalized health and social care to low-income neighborhoods — and when the pandemic arrived in New York City, the Cityblock team knew their customers would be hardest hit.
“In the communities where we’re present, we serve some of the most high-risk and marginalized individuals,” says Dr. Toyin Ajayi, Cityblock’s Co-Founder and President. Ajayi spoke to Sidewalk Talk editors Eric Jaffe and Vanessa Quirk about all the ways the Cityblock team navigated the pandemic, including increasing touch points with members, delivering food to those that needed it, and scaling up their virtual care offerings.
Ajayi also gave us insight into the exciting innovations happening in health care more generally as well as her company’s latest challenge: bringing their care model to more cities in the U.S.
“We live and walk by the notion that to really understand what folks need and to meet their needs, you have to show up humbly in their communities,” she says. “You have to learn from what exists. You have to learn from the folks you’re serving. You have to hire teams from the communities you serve, who really understand the needs and the preferences and the ways of interacting with the folks that you serve.”
Watch a video of our conversation above or read an edited transcript below.
Eric: Can you tell us, for those who don’t know, what Cityblock Health does and describe your mission?
Toyin: Yeah, absolutely. So, Cityblock Health is a New York-based startup that has a mission to improve the quality and outcomes of care for marginalized communities. We are a primary care behavioral health and social care organization that delivers personalized health and social services, with a tech-enabled infrastructure, to individuals who receive health benefits through Medicaid or through Medicare, or both. Typically, folks with the most complex physical health, social health, and behavioral health needs in our communities.
Vanessa: One of the things that I find most compelling about Cityblock’s mission is this idea that your ZIP code can have an outsized impact on your long-term health outcomes. For people who may not be as familiar with this work as you are, why is there such a strong connection between your geography and your health?
Yeah, that’s a great question. So, there’s a lot embedded in that, right? Your ZIP code is reflective of so many more things than simply where you happen to live geographically. It’s reflective, of course, of your community. It’s reflective of the resources and access to social services, to community services, to transportation, housing quality, to food, to a clean and healthy environment. It’s also reflective, very often, and particularly in the segregation of a lot of the major cities in this country, of a likelihood of experiencing racial bias, that we know independently impacts people’s health and outcomes.
So, the reason why the ZIP code as an input or as a determinant of health is so compelling is because it encapsulates one’s social well-being, and your social circumstances, and access to social resources, in a way that really does drive health outcomes. The data are overwhelmingly compelling about this, for all of the reasons that I described, largely because of the proxy that it holds for access to high-quality social services.
Eric: How did Covid impact what you do, what Cityblock Health does, and the approach that you take?
In the communities where we’re present, we serve some of the most high-risk and marginalized individuals in that community. In New York as an example, which is our first and oldest and biggest market, we have a large population of folks that we care for in Central Brooklyn, which we now know is one of the areas hardest hit by Covid, both in terms of the rates of infection, as well as in terms of outcomes when people did become infected. It’s also a community that has a significant proportion of folks of color. And again, we’ve seen highlighted in the popular press, just how differentially the pandemic impacted folks of color. And again, this was no surprise. This is a reflection of all the various ways in which our health and social system continue to fail to meet the needs of marginalized, low income, and communities of color. We saw how it just played out on a large and horrifying scale during the Covid pandemic.
What it meant for us is that we needed to double down on our efforts to reach, engage, build trusted relationships, build a real sense of understanding and an almost omnipresent clinical model that made sure that our members knew: that we were there for them, that we were able to meet them in their homes, we were able to meet them digitally wherever they were through our virtual care models, that we were wrapping around and filling in the gaps where so many other parts of their social, and medical, and psychiatric ecosystem may have started to fall away. In very practical terms, it meant that we increased our touch points with our members by almost a factor of two in the pandemic. We were outreaching, and touching, and connecting to folks more frequently during the pandemic.
We did some really nice analytical work very early in the pandemic to identify our highest risk members, and make sure that we prioritize those folks for outreach. We expanded the suite of questions that we tend to ask people, just to help make sure that we have an understanding about where they are and what their social needs are, to include things that were relevant to this new dynamic. Do you have access to masks? To PPE? Are you considered an essential worker? What does that mean for your ability to self-isolate? Do you have enough medications to last you for 90 days? How are you thinking about food and other services that you may have relied on, and other systems to deliver for you?
That allowed us to really close gaps for people, particularly around food. That was one area where we found a real massive need in the pandemic, particularly early on. And we’re able to deliver meals to folks, connect with community-based organizations that were still operating and providing food, and help people stay home and stay safe, while also making sure that they had what they needed for their daily lives.
And then, most importantly, we were able to scale up our virtual care modalities pretty significantly. We had already been using virtual care as a core part of our ecosystem for our members, but we pivoted significantly away from in-person care in our hubs, which had also been a core part of our care modality, to doing a lot more work virtually. And that was really well-received and allowed us to make sure that we were keeping up, not just with Covid-related health needs, but also with preventive care and primary care, and all of the unmet needs that could start to show up afterwards.
Vanessa: As you’re looking around at health innovations, what looks promising or exciting to you? It could be a technology, a new kind of care model — what’s inspiring to you right now?
Yeah, a couple of things. I think one is I’m really inspired by the creativity and the proliferation of organizations of companies that are seeking to focus digital care on lower-income and marginalized communities. I think folks have really understood just the potential for virtual health to impact and improve access, to, in some ways, be a tool for equity to make sure that marginalized and lower-income communities have access to tools and technology that so many others can take for granted.
And I’m hopeful that at least some of these companies will be focusing in on the segment of the population that maybe doesn’t have unlimited data packages on their phones, doesn’t have smartphones, doesn’t always have reliable, safe, and private places to have clinical conversations. But we need to figure out a way to make technology work for those individuals as well. And I’m excited to see more and more folks kind of dipping their toe in this. We have to say, “This is a hard problem to solve, but a really interesting and worthwhile one.”
I think the other place where I’m interested and excited to see models evolve is, frankly, through companies that take a view as we do: that point solutions are not going to be the answer to this. We’ve got to be thinking about an end-to-end journey for members, for individuals, that says: “You may be a person who is living with an addiction. And also, you’re a person who has primary care needs. And you’re a person who has other mental health needs. And you’re a person who may at some point need to see a specialist for their care.” We have to think about the end-to-end experience as opposed to just point solutions. And we’re starting to see more and more folks, thinking the way that we do about that holistic experience that fully encapsulates a person’s lived reality and their needs along a continuum.
Eric: Can you talk about some of the ways that your care model has had a direct impact on people’s lives, or the way you’ve seen members respond to this end-to-end model in a way that the traditional model just wasn’t able to?
Yeah, absolutely. So, we are rigorously looking through our data to see that we’re having the effect that we want. And we start from a theory of change, which is the idea that in order for us to be successful, we have to find people. We have to build trusted relationships with them. We have to engage them in an experience of care that they feel is enjoyable, that meets their needs, that they would come back for.
And then we have to identify what their needs are, and meet them. And in so doing, avoid the exacerbations of health needs that lead people to go to the emergency room, lead people to hospital admissions, lead people to escalations in their ill health, because they weren’t addressed upfront. And so, what we see in the data, and what we see through the experiences of our members, is that we’re meeting all of those objectives.
We are engaging our members at a rate that is much, much, much higher than typical health care providers and payers are able to reach. These are folks who have lots of reasons to be mistrustful of the healthcare system. These are folks who have lots of things going on in their lives. These are folks for whom the traditional healthcare system’s approach, of picking up a phone and trying to call you, isn’t going to work to form a meaningful engagement.
So, we see in our rates of engagement, that our tenacity and our creativity around our outreach has really paid off. We then see that the members are responding to the experience of being a Cityblock member with positivity. Our Net Promoter Score is consistently in the high eighties and low nineties, which is unheard of in healthcare, truly, particularly in this population. And that’s been consistent across segments of our population, irrespective of your types of need level or complexity. Whether you have mental health challenges or physical health challenges, this has been consistent across our markets. So, that’s an incredibly compelling and positive sign for us.
Then we see that we’re closing gaps clinically. We’re providing primary care and mental health and social services in a way that’s proactive, and really geared towards helping people stay home and healthy and in the community, as opposed to being in the hospital. And what we see in our data and what we see in the experiences of our members is that, because they receive care from Cityblock, they’re less likely to go to the hospital, on the order of about 20 percent, over a one-year timeframe. And so, that’s also compelling, right? And that’s when we know that the secret sauce is working. And when folks really feel cared for, they feel seen, they feel respected, they feel heard. And we’re delivering services that make a difference for their health and for their wellbeing.
Vanessa: Would you talk briefly about the other cities that you’ve expanded to, and how different or similar the approach has been in these new cities?
Yeah, absolutely. So, our tagline is: Health is local. And we really believe it. We live and walk by the notion that to really understand what folks need and to meet their needs, you have to show up humbly in their communities. You have to learn from what exists. You have to learn from the folks you’re serving. You have to hire teams from the communities you serve, who really understand the needs and the preferences and the ways of interacting with the folks that you serve. And we’ve been doing that, and it’s been successful for us so far.
We’ve grown beyond New York to serve members in Connecticut, in Massachusetts, in North Carolina, and Washington, D.C. We’ve announced that we will also be launching in Ohio later this year, across a couple of geographies there. And it continues to be a proof point, I think, of the model and the need for this model in the world, that we continue to have partners actively engaged in conversations about how we can grow with them, grow to serve more of the members that they’re accountable for, and to bring our model of care to other parts of the country.
Eric: Toyin, last question and we’ll let you go. As you think about that expansion and, hopefully, expanding even further and delivering your care model to more and more people, delivering even better care, what are the biggest challenges you think you face?
We’ve been very fortunate so far. We’ve been able to attract investment and support from really wonderful venture firms, who believe in our mission and believe that there’s a scalable business case for doing this work in this way, in these communities. And so, that’s been wonderful. We’ve been incredibly fortunate to be able to attract top talent across a really, really diverse and heterogeneous set of skills and backgrounds, from our frontline care team members, to our clinicians, to our operational leaders, to our technology, data analytics teams, and that’s been fantastic.
I think the question for us continues to be: Can we find partners that see what we see, see the opportunity? Can we grow our teams fast enough and with enough quality to meet the needs? And can we start to tell the story more broadly that there’s a sustainable and scalable business case for doing the right thing for communities that have been left behind? If we can continue to do all those three things, we really believe that there’s a massive, massive opportunity to make a real impact in the world and in the lives of folks who need it the most.
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