Investing in Health Justice

What $160 million in Series C financing for Cityblock Health means for Medicaid and lower-income Medicare beneficiaries

Dr. Toyin Ajayi, Bay Gross, and Iyah Romm

Today, three years after we launched Cityblock from Alphabet’s Sidewalk Labs, we are excited to announce our Series C funding round, furthering our mission to radically transform the health of marginalized communities.

At the end of one of the most challenging years of all of our lives, we are taking a moment to reflect on what this moment represents and to redouble our focus and commitment to the path ahead.

As first-time founders of a venture-backed company, we have had to very quickly learn the norms and lingo of this world that we find ourselves in. No doubt, this $160 million investment, which values Cityblock at more than $1 billion, represents a significant milestone for our company. It signals real validation of the hard work, grit, and commitment of our teams who have worked diligently to build a business with solid foundations and a true mandate to create industry-wide change while delivering better care for our members.

It also enables us to welcome two fantastic new investors into our fold: General Catalyst and Wellington Management, who joined our existing investors in supporting Cityblock’s next phase of growth. Leading the investment, Hemant Taneja, from General Catalyst, is a technologist and deeply curious investor who has built several category-defining companies across a number of industries, including healthcare. His tenacity, patience, and conviction about the change needed in the world is deeply aligned with the values on which we’ve built Cityblock.

It is even more meaningful to have earned the resources and the mandate to scale our impact on behalf of marginalized and underserved communities during a year that has brought into stark relief some of the harshest consequences of our flawed and inequitable health and social systems.

Doing this work is a privilege and a responsibility that we do not take lightly. Doing our part in the fight for social justice and equity means continuing to demonstrate that it is possible — necessary, even — to align financial incentives around value and outcomes, and redesign the way we deliver healthcare with an orientation towards trust, accountability, and dignity, built with and for those who need it the most.

When we take a step back and reflect on the three-year arc that has led to this point, it has been continuously fueled by our deeply personal reasons for founding Cityblock: to eliminate health disparities and improve outcomes for those who need it the most.

Real People, Real Impact

We are building a big business that we aspire to scale to serve ten million people by 2030. To achieve this radical and audacious goal, we will need to tackle large, gnarly problems, build complex processes, and navigate nuanced financial arrangements. And yet, we can never lose sight of the fact that ultimately, this work is and always will be about people and the communities they live in. So we start with Sonia.

Sonia, whose name and photo we’ve changed here to protect her privacy, has been a Cityblock member since August 2018. Like so many of our members, lots of healthcare providers had counted Sonia out and considered her a “nuisance.” Alone, housing insecure, and vulnerable, Sonia’s situation presented to the healthcare system as an intractable challenge: she was visiting the emergency room several times a week for care and services with both bad outcomes for the health system (high costs) and for herself (terrible experience, poor health).

Sonia’s prior experiences with healthcare had led her to be wary and mistrustful of health systems. And her life circumstances made connectivity and engagement logistically difficult. After several months of persistent, respectful outreach using every modality we could (text messages, phone calls, scheduled meet-ups at a local McDonald’s), we were finally able to settle into a consistent, trust-based bi-directional communication routine with Sonia. Sonia’s first visit to our local Hub lasted for more than two hours. For the first time, she opened up about her life and experiences. She was welcomed with compassion, a lack of judgment, and consistency of positive intent by her care team. From there, we built trust and understanding.

And then COVID hit.

Sonia visited us in the Hub at the height of the first COVID wave with symptoms of COVID. We had identified her as high-risk based on our risk prediction algorithm. Her Community Health Partner had been in close contact, reminding Sonia that if ever she felt unwell, she should contact us immediately. Our on-call physician and nurse team evaluated Sonia and made the diagnosis of likely COVID. She was in distress and in-between housing, so the team immediately got her a new phone and enrolled Sonia in our high-risk short-term housing program, placing her into a hotel during the peak of the pandemic’s outbreak in her community. It was during this stay that Sonia began to acknowledge that she needed help finding a permanent housing solution.

Our team supported Sonia in applying for permanent housing. Soon afterward, Sonia moved into a fully furnished apartment — the first time in many years she had had a space to call her own!

The impact of Cityblock’s work in Sonia’s life has been profound. The past eight months represent the first time in years that Sonia spent more than a week outside a hospital. We continue to partner with Sonia to address her mental and physical health needs, building on the foundation of trust and the new belief she has in her own power and value.

“I’m getting much more rest, of course! It’s a blessing to not be at a friend’s house, or family’s houses, or hotels — back and forth. I got an apartment; it’s like 80 bricks off my shoulders. I can go to sleep when I want instead of staying at a friend’s house. Because until I found an apartment, I was homeless. So that’s no more, thank God. It’s a blessing. With Cityblock Health, there’s a support system…they’ve got my back. I just love the support. The support makes me trust more and more.” — Sonia

Sonia is one of a kind, and yet we know there are millions like her: people who need and deserve more from our healthcare system in order to live their best lives. And that’s why we’re here.

A quick primer on the problem

Our society has failed to build sustainable and scalable healthcare delivery models for low-income populations with complex health needs.

The impact of COVID has magnified health disparities across the country, reinforcing the need to support communities that have been systematically excluded.

We see three fundamental problems:

First, the inequity of America’s social infrastructure, including the legacy of systemic racism, has created unacceptably disparate health outcomes across our society. COVID-19 laid bare the longstanding deep fractures of our society and the inequity of our social and health safety net, and has reinforced for all of us the need for a radical transformation of community health.

Second, the industry’s fee-for-service payment system is contributing to poor outcomes, particularly for marginalized communities. Under the fee-for-service care model, providers get paid per patient they see and per treatment or test they prescribe. They are financially incentivized to see a high volume of patients (and disproportionately perform tests and interventions), leaving little room to invest the dedicated time and resources to address the plurality of individuals’ needs across medical, behavioral health, and social domains. We need a shift in how our healthcare is funded and prioritized to create real value — measured in health outcomes and cost savings, all fundamentally driving equitable outcomes.

Finally, the models that have to-date addressed key components of these challenges have not successfully scaled. Innovative, venture-backed models to deliver integrated care in a value-based way have, to date, touched fewer than one million members in total. This sits against a backdrop of 12 million Dual Eligibles, 75 million Medicaid members, and about 25 million Medicare members with complex needs. We must lead the charge to take the learnings from our care model and democratize access for millions.

Our approach

Cityblock is a transformative, value-based healthcare provider focused on improving outcomes for Medicaid and lower-income Medicare beneficiaries. We provide medical care (both primary care and complex specialty services), behavioral health, and social services to our members virtually, in their homes, in the community, and in our neighborhood hubs.

We leverage a value-based model, meaning we are not paid on a fee-for-service basis, like most health care providers. Cityblock splits the cost savings that come from better outcomes with the healthcare payer. Our financial structure squarely aligns the health needs of our members with our reimbursement — so that when our members need us the most, we’re able to show up.

Our custom technology stack, which includes Commons, our advanced care facilitation and delivery platform, has been developed in-house by our clinical and technology teams to unlock personalized care at scale for every member. It allows social workers, pharmacists, doctors, paramedics, and our virtual care teams to all come together on the same page in real time. With each new market we enter, our technology reinforces our care model, allowing us to serve more members while ensuring consistently high quality, empathetic, and effective care.

And we’re doing it while contributing deeply to local workforce development, hiring locally, building progressively, showing that doing the hard work of building an anti-racist company in a venture-backed environment is not only possible but preferable. Our internal culture is reflected in the ways our members experience their care at Cityblock. So we build intentionally with and for our Cityfolx, investing in our people and leaning deliberately into the discomfort of actively challenging our norms and ways of being.

It’s past time a healthcare company was designed this way: when our communities are healthy, everyone wins.

What it means for members

Our members receive trust-based longitudinal care delivered by an integrated team that includes doctors, nurses, physician assistants, behavioral health specialists, licensed clinical social workers, paramedics, and community health partners, all working in our members’ homes, in our neighborhood hubs, and virtually.

We seek to listen to our members and to constantly build new services to better meet their needs. For example, when COVID first hit Brooklyn, and we were doing everything we could to keep our members safe in their homes, we launched our Community Rapid Response (CRR) program.

With CRR, we send experienced paramedics into the homes of Cityblock members experiencing acute medical needs, like pain or shortness of breath, who then collaboratively evaluate and care for the member with a real-time video consultation with a physician. These physician-paramedic teams offer the same assessment and care as an urgent care center or emergency department.

We are also building specialty care models, including maternity, serious mental illness, and care for other chronic conditions.

Our focus on engagement is anchored around the importance of building and sustaining longitudinal trusted relationships between our members and their Cityblock care team.

What’s next

This year has been marked by the highest highs and the lowest lows of our personal and professional lives. Along with millions of others across the United States, our teams have been bereaved as we have mourned lost loved ones due to COVID. We’ve endured almost a year of holidays and birthdays spent apart from our closest friends and family. We’ve watched with horror as the disparities we’re dedicated to breaking down emerged center stage in the death tolls of this pandemic.

But it has also been a year of deep gratitude and awe working alongside the incredible Cityblock community as we’ve thrown our shoulder into fixing a broken healthcare system in the face of truly unprecedented times.

At this unique moment in time, our mission remains unchanged. We are aggressively building towards a full-stack health platform to enable a healthcare system that advances health justice — driving better health outcomes for all, not just the few.

In the upcoming year, while also continuing to support our members and teams during these especially challenging times, we will use this new capital to broaden our reach. We will bring our services to several new geographies, launch a maternity care program, expand our virtual care capabilities, and invest deeply in codifying the standards of care we are developing into technology and data infrastructure. In ten years’ time, we will be serving ten million members across the country.

So if you’re a clinician who aspires to practice a new type of care, a technologist who wants to build digital products in service of one of the most important problems of our time, a community organizer passionate about leveraging your work for broader impact, or someone deep in traditional healthcare who knows there is a better way, we’d love to hear from you. We are just getting started. Onward.

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