The health care status quo for Medicaid and other underserved patients often leaves them on the sidelines, said Cityblock Health CEO and co-founder Dr Toyin Ajayi.
They may have infrequent access to the medical system, hampered by transportation problems or the need for to be absent from work. Doctors’ offices can be busy and they can not enough time to address concerns. In the meantime, racial and ethnic minorities And LGBT patients more often report discrimination or disrespect, driving them away from providers. Thus, patients end up in the emergency room when their health problem worsens.
Ajayi said Cityblock’s value-based model of care – which includes primary care, mental health care and assistance meeting social needs – encourages them to find patients who need support and how to meet all their health needs.
She sat down with MobiHealthNews to discuss why it can be difficult to provide care to the Medicaid population and how Cityblock is approaching expansion into new markets.
MobiHealthNews: There seems to be a clear opportunity in healthcare when patients first go to the emergency room for care. It’s very expensive and not effective. I know Cityblock is fairly well fundedbut do you think digital health in general has really taken advantage of the opportunities in this space, especially with the Medicaid population?
Dr. Toyin Ajayi: No, I think you’ve seen it, haven’t you? Historically, we founded the company about five and a half years ago. And at the time, there were very, very few venture capital-backed, digital-focused, Medicaid-focused people-focused companies. When we started the company, there was so much resource, attention and talent focused on improving access to care and experiences for people who already had resources, who are privately insured, who were digitally savvy, who were at the top of the life expectancy curve based on their demographics and income.
We saw a real opportunity to say, “Well, let’s focus on bringing all these tools to the table and focusing them on the people who need them most and the people who are so often left behind.” It was a pretty radical and new idea when we started the company, and we’ve remained one of the biggest companies in this space truly focused on marginalized and underserved communities. It’s not that there’s a lack of funding. And it’s certainly not a shortage of talented people to do this job. It’s just difficult.
MNH: What are some of the things you find that were the most challenging in building your business?
Ajayi: Everything about starting a business is difficult. So I don’t want to reject that. It’s hard to get it right. We take care of a population with very heterogeneous needs. We talk about Medicaid, but there are a lot of different reasons people are on Medicaid, and people have different needs. It is by no means a homogeneous population. And so, to be successful in delivering results for our people that we serve, we have to be really good at a number of things.
We have to be really good at engagement, relationship building and trust building. We have to be really good at providing excellent chronic disease management and primary home care, preventive home care. We have to be really good at involving and caring for people struggling with mental health and addiction issues.
We must excel in managing care transitions inside and outside the hospital. We must be excellent in taking care of pregnant mothers and in the perinatal and postpartum phase. And the list continues.
It’s a business model complexity and a clinical complexity that few companies really have, because they manage a much more circumscribed population. But we think it’s so important to recognize that people can’t be disaggregated.
This mental health business is for your brain and your emotions. And then there’s the diabetes society and the cardiovascular disease society. In fact, we are humans, we are all integrated, everything speaks to each other.
And asking people to navigate these complex, siled solutions for their health needs is asking too much, especially for people who are really struggling with complex physical, behavioral and social health issues.
MNH: Cityblock recently extended to Indiana with a partnership with MDwise. You noted how different the Medicaid population is and that there are a lot of different needs out there. How do you think in which states to expand?
Ajayi: First of all, we are really excited about the partnership with MDwise. They were an incredible partner there. We are totally mission aligned and very committed to serving the state and serving it very well.
We are excited to grow the business because we see so many opportunities to bring better care to communities that really need it and to people who have often been left behind. It is therefore a strategic priority for us, and we will continue to do so.
We seek communities where we know there is a real need, where there are physical health, behavioral health and social issues facing a population, where there is significant managed care penetration – and specifically managed Medicaid and dual eligibility programs, and where there is a policy landscape that supports the integration of physical and behavioral care and social care services into a compelling and cohesive benefit design for people. These are for us the kind of fundamental criteria that can really guide our desire and our decisions to enter a market.
MNH: How often do you consider partnerships like this when considering expansion?
Ajayi: We always enter a new market with partners. So we partner with managed care organizations that pose a financial risk to populations because they are the insurer of populations, whether it’s Medicaid or people with dual eligibility. We help them identify who their most-at-risk populations are, and then take responsibility for providing care. This is still our market entry strategy.
Once there, we also partner with community organizations, primary care practices and other supports within the community to ensure that we truly understand the needs of the community and support the satisfaction of these needs.
Health is local; it’s one of our favorite slogans. And that means we need to adapt the model to make sure we specifically address the needs of the communities we serve since, what is the right language to use to describe what we do and who we are? Which teams do we hire?
We hire people from the communities we serve. What social priorities should we focus on to ensure we meet the needs of the population? All of these things are customized and tailored to the specific markets in which we operate.