In March 2022, newly appointed CEO Toyin Ajayi faced a strategic crossroads for Cityblock, the healthcare organization she had helped found five years earlier. In its short history, Cityblock had proven successful at serving minoritized populations with complex health and social care needs. Now, Ajayi needed to determine near-term populations of focus to continue to rapidly scale that success.
Toyin Ajayi, Iyah Romm, and Bay Gross founded Cityblock in 2017 “to radically transform the health of the most marginalized communities across [the US]." Physician entrepreneurs Iyah (Cityblock’s first CEO) and Toyin had frontline experience serving the healthcare needs of these populations, which are disproportionately people of color with worse health outcomes than their White counterparts. The founding team believed that the fragmented existing model was unable to provide integrated preventative, clinical, behavioral health, and social care to this population. In contrast, Cityblock developed a whole-person model, emphasizing tech-enabled care-coordination and grassroots engagement of low-income communities.
The founding team took their idea to the Sidewalk Labs incubator, a subsidiary of Alphabet, and secured $2.4 million in seed funding. They managed to bring in a New York City-based insurance company as their first client. As an early-stage venture, the organization developed its model serving people living with complex health and social care needs in Crown Heights, Brooklyn. In Brooklyn, Cityblock established Neighborhood Health Hubs – community health centers offering comprehensive services under one roof and prioritized hiring locally to build community engagement and trust. They had success improving outcomes, reducing costs, and facilitating a positive member experience. The success of their approach and existing business development pipeline led to a $20.8 million Series A round in 2018.
Like other healthcare organizations serving minoritized communities, COVID-19 posed significant challenges for Cityblock’s members and staff. The organization’s members, who suffered co-morbidities that increased risk of COVID-19 infection and mortality, were disproportionately impacted by the virus. Cityblock’s model proved resilient as its telehealth services and other offerings delivered comprehensive, tech-enabled coordination of clinical and social care services during the pandemic. Cityblock continued to grow exponentially, reaching Unicorn status (a valuation of approximately $1 billion) by 2020.
In 2022, Ajayi and her team had to determine a near-term focus for growth. To this point, the organization had concentrated on improving health outcomes and reducing costs for Medicaid patients, individuals eligible for both Medicaid and Medicare, known as dual eligibles, and low-income Medicare patients. Also relevant to the populations of focus for Cityblock, the United States was grappling with distressing pregnancy related outcomes, particularly prevalent among Black birthing people. Cityblock had started initial work with partners in maternity care through a partnership serving Medicaid beneficiaries. Going forward, one strategy was to pursue faster growth in its existing population of dual eligibles and Medicaid members. Alternatively, the organization could focus its growth strategy on developing its maternity services.
Like many strategic decisions of this nature, Cityblock found itself unable to simultaneously pursue both opportunities on a large scale and had to select an anchor approach. As a mission-oriented healthcare company, the team wanted to assess which of these two strategies allowed Cityblock to have the most impact. While both the prospect of focusing on mothers and children and dual eligibles resonated strongly with the organization's mission, Cityblock needed to pick one primary population of focus for its near-term strategy.
Citation: Kaakpema Yelpaala, Blake Robertson, and Matthew Kaspy, “Cityblock: Populations of Focus to Scale a Whole-Person Care Model,” Yale School of Public Health Case Study PH-24-101, August 9, 2024.