Interview with Cityblock's co-founders Iyah Romm (CEO) and Dr. Toyin Ajayi (Chief Medical Officer), describing why they founded Cityblock and their vision for the company.
What problem does Cityblock solve?
With Cityblock, we address a massive need in the US, which is the challenge of individuals and communities with low access to effective primary care, behavioural care and social services. These individuals and communities combine poor outcomes with a disproportionate use of hospital care for issues that typically would be managed effectively by primary care providers in a more integrated model.
We partner with health insurers to take on financial risk for outcomes of this population, and we deliver value to payer partners, as well as to the company by improving outcomes over time and decreasing the use of hospital, emergency and other services that can be avoided through more effective preventive care.
What brought the two of you together to start Cityblock?
We have worked together for a decade and both of us are committed to doing work which provides the opportunity to improve social justice in a financially sustainable way. In many ways, the best businesses are born out of frustration and we are frustrated that the US health system is not focused on humans, but stuck in complicated structures.
I (Toyin) am a primary care doctor and I have always been deeply passionate about caring for the people that get left behind by our healthcare system, people who struggle with disabilities and mental health needs. Having seen first-hand the costs of healthcare and the generally poor outcomes, I know that we can intervene much more effectively by strengthening the way we provide care to people in the community in a sustainable and scalable structure. In addition, we are both very interested in building a truly diverse workplace: a multidisciplinary and multicultural workplace where people can bring their whole person to work.
Who is a typical Cityblock user?
We serve low income populations that qualify for state funded insurance, Medicaid, and people who are older and qualify for federally funded insurance, Medicare. We take care of some of the most vulnerable and high-need populations in the country that could have much better health through the type of care that we deliver. The size of this market is around 1.3 trillion dollars of taxpayers' spend on healthcare and there is ample room for improved efficiency.
How does being a patient of Cityblock change the healthcare experience?
Let us give you a real example of a patient, we can call her Sonia. She is a person in her mid-forties with a lot of trauma in her past, and now living in Brooklyn but without a steady address and with no permanent employment. When she lacks a place to sleep for the night, she goes to the emergency room where she will be admitted, get a bed for the night and something to eat. For years, she has been going to the emergency room up to 20 times a month, but she struggles to follow up with an ordinary doctor; instead she returns to the hospital.
When she gets assigned to Cityblock, someone from our team will reach out to her, and we have local teams from the neighbourhood that understand the community. The team will support her in moving her location of care away from the hospital and into a place that is more sustainable. Over time, the Cityblock team builds a relationship with her and will start to understand the full picture. She will be connected to a behavioural health specialist to get therapy if she needs it and we will get her a phone to ensure we can reach her and so that she can contact us. We will also connect her with social services to get relevant support with housing or food, if she needs it.
It is easy to see the human impact for a patient like Sonia. But in addition to that, we also see a 70 percent reduction in hospital use and a 45 percent reduction in healthcare spend over time.
Where do you want to take Cityblock in ten years?
In ten years’ time we want to serve ten million people across the country with a company that touches people in every community and every city in the US. We want to achieve this by creating a trusted brand where people can come for high quality, respectful care that makes them want to come back for more.
And what do you need to reach the goal?
We need people and resources for sure, to build the team, the company culture and strong processes. Of course, building technology is very important, in particular figuring out how we build technology that is accessible to people that have highly variable access to technology. To be efficient, we need to build strong community partnership to make sure that we can bring all the resources needed together. And finally, we need investors who understand and support our vision, and who realise that we are building a company for a generation rather than for two or three years.
"In ten years’ time we want to serve ten million people across the country with a company that touches people in every community and every city in the US. We want to achieve this by creating a trusted brand where people can come for high quality, respectful care that makes them want to come back for more."