Health tech startup Cityblock Health, with its mission of delivering stepped-up primary care to Medicaid patients, is finding its footing in the very cracks that the Covid-19 pandemic has exposed. It’s leveraging its signature technology to help this highly marginalized population.
“It’s very telling here that up until before the pandemic, there was a real unspoken belief that you couldn’t [digitally] engage low-income folks, folks who don’t have smartphones readily available, folks who don’t have money for big unlimited data packages,” Cityblock’s co-founder and chief health officer Toyin Ajayi said during a Wednesday panel at STAT’s Health Tech Summit. “Very, very few folks are really engaging in the hard work of designing tools that bridge the digital divide … and from the outset, we saw a lot of potential here.”
The basic idea behind Brooklyn, N.Y.-based Cityblock, which was launched more than three years ago and carries a billion-dollar valuation, is not new: To keep patients healthy and out of the hospital — and cut costs — care is delivered by a coordinated team of providers that includes not only health professionals such as physicians and nurses, but also social workers who can help identify other factors that play a role in a person’s health, such as housing, education, and income.
Updating this idea is Cityblock’s new technology platform, which it calls Commons. It brings together these different professionals so that they can make notes, troubleshoot problems, and share takeaways in real time to help patients.
“It allows us to facilitate interdisciplinary team care in a way that [electronic health records] just haven’t done,” Ajayi said.
Beyond that, Cityblock thinks of technology as “an enabler of a model of care as opposed to the solution in and of itself,” Ajayi said. It’s also using technology to meet people where they are.
“If folks are texting and using SMS, that’s when we’ll meet you,” Ajayi said. “If folks are much more interested in using telephone care and video care but with coaching and support, then we’ll meet you there, too.”
Iyah Romm, Cityblock’s CEO and other co-founder, said that this “meeting” often means thinking differently about the questions and processes that drive the design of their technology platform.
“Health care for our population is not about just your diabetes medications or whether your doctor shows up on time,” he said, adding that it’s about feeling safe at home or having transportation to and from the pharmacy, child care, and jobs. “Part of our design thinking is building a health system that meets all of those health needs, which is a fundamentally different way of approaching software development.”
Ajayi recalled the story of one Cityblock user, a 60-year-old grandmother who has been struggling to manage her diabetes. “She said to me at some point, ‘Look, doctor, if you, if you just Snapchatted me when I need to take my insulin I’d remember it,’” Ajayi said. The takeaway: This grandmother was using Snapchat with her grandkids and meeting them where they were, so for Cityblock, it underscored the message, “If that’s the tool you need, so be it,” Ajayi said.
In another example, one man who became more tech-savvy through receiving care from Cityblock was also able to use those skills to cope with the isolation of the pandemic.
A couple of years ago, this patient couldn’t text. “Now, you can’t stop him,” Ajayi said. “He’s texting, he’s sending videos and photographs, and he’s connecting with his family and his community. It kept him sane and healthy during the pandemic, and so it becomes a tool that you can use to deploy so much more than just reminders and in your traditional health care.”
For Cityblock, the pandemic’s outsized impact on vulnerable communities has helped to crystallize the company’s mission.
“If there’s one lesson, it’s that care [that is] constrained by place, your ability to come to a clinic of all random and arbitrary things, by time of day, your ability to pay, [and] by your insurer is not going to meet the needs of the population as a whole,” Ajayi said. “Models that allow us to innovate, to flex to meet people where they are, to show up for them 24/7, to intervene and to invest in a holistic experience of care — that is the way that our health care system ought to be designed for the future.”