Cityblock Health names Toyin Ajayi CEO as startup eyes expansion into new markets

Cityblock Health, a healthcare provider focused on marginalized populations with complex needs, has tapped Toyin Ajayi, M.D. as its new chief executive officer.

Ajayi, a co-founder of the company who previously served as president, will focus on scaling the rapidly growing company as it focuses on providing healthcare services to Medicaid, dually-eligible and lower-income Medicare beneficiaries.

Prior to Cityblock, Ajayi, a practicing family medicine doctor, served as chief medical officer of Commonwealth Care Alliance, an integrated health plan and care delivery system for individuals eligible for both Medicare and Medicaid.

Co-founder Iyah Romm has stepped down as CEO and will remain a member of Cityblock's board. In November, Romm announced he was taking a leave of absence to focus on his mental health. Former federal policymaker and healthcare investor Andy Slavitt took the reins as interim head of the office of the CEO.

Launched in 2017 out of Alphabet’s Sidewalk Labs and anchored in a first partnership with EmblemHealth, Cityblock was founded as a groundbreaking care model designed to meet the complex health and social needs of underserved communities. The company combines primary care, behavioral health and chronic disease management services that address social determinants like transportation, housing and access to healthy food.

The company currently operates in New York, Connecticut, Massachusetts, Washington DC, and North Carolina. It recently expanded into Ohio and will start operating there later this year.

"We've had this really incredible trajectory over the last four and a half years and we've really been able to codify our model, our value proposition, and the impact that we have on, particularly, the hardest-to-reach patients and to care for populations of folks on Medicaid and who are dually eligible," Ajayi told Fierce Healthcare. "We're in this great position where we get to just continue to scale and expand our impact and our scope. My focus is on expansion and continuing to push the envelope and innovate in ways that we can meet the needs of our members and delight our customers. I want to continue to demonstrate it's possible to do this work and do it well."

From 2020 to 2021, Cityblock doubled its membership and grew its annual run-rate revenue five-fold over the past two years, the company reported.

The company has a reported valuation of $5.7 billion and recently banked $400 million in a late-stage funding round. Cityblock investors include heavyweights in the industry such as Softbank, Tiger Global, General Catalyst, Maverick Ventures, 8VC and Town Hall Ventures.

The startup has raised $891 million to date, according to Crunchbase.

Cityblock serves a heterogeneous population with complex needs—74% of its members qualify for financial assistance and 77% are members of a racial or ethnic minority. The company developed a technology-enabled, high-touch approach to building trust with and engaging these communities, which has demonstrated positive outcomes for Cityblock members as well as their payers and state governments, according to executives.

"In many ways, Cityblock's work is just getting started. This is an important time for a visionary leader like Toyin to take the company to the next level and deliver sustainable and scalable outcomes," said Slavitt, who serves as chair of Cityblock's board of directors. "After a thorough process, it became even more apparent that Toyin is the right person for this role—she's a brilliant and respected executive who has a vision for the healthcare system we need to build and the leadership skills to do it."

Cityblock Health's strategy is to meet the complex health and social needs of this population by taking care back to the neighborhood level. It does this by partnering with local community-based organizations to help its members get access to primary care, behavioral health care and social services. 

As the company looks to expand into new markets, there are scalable components of its business, Ajayi said, such as hiring local talent and using data to identify patients with the highest risk and using those insights to personalize care.

"Our engagement, our ability to meet people where they are and build relationships of trust and to help pull people back into the healthcare system in ways that feel respectable and dignifying of them that is critical and scalable," she said.

But she also acknowledged challenges with scaling a care model that serves marginalized populations with a focus on meeting them at the neighborhood level.

"Particularly in the Medicaid population, that is a lot that is just so different market by market, state by state. There are elements of this that will always be bespoke because we have to be responsive to local contexts and local requirements," she said. "We've worked on trying to figure out how to understand and optimize for the core capabilities that are scalable and then how to make sure that we have flexibility in the model that enables us to be hyper-local and hyper-bespoke where necessary."

Cityblock's model reflects an underlying philosophy that improving health outcomes and minimizing systemic healthcare inequities requires fundamentals that address the root effects of poverty, like having access to nutritious food, according to the company.

And the devastating impact of COVID-19 has been a painful reminder of the vulnerability of lower-income communities and communities of color.

"The pandemic highlighted that people, like the members we serve, people who struggle with physical health, behavioral health and social health challenges were the most vulnerable to the worst outcomes. We need to both champion and innovate around care models and operational models designed to make sure that we can deliver care for these populations," she said.

Cityblock grew "significantly" during the pandemic, Ajayi said. While many fast-growing healthcare startups have gone public in the past two years, she would not comment on any potential plans for an IPO.

"We're so focused on continuing to execute for members. This has never been for us about valuations," she said. "This work is about proving that there is a sustainable and scalable business case for the work that we do, and that the populations that we serve are worthy of very high quality and excellent care."

Rather than focusing on patients who are both financially and physically healthy, Cityblock is taking on financial risk to serve people most in need and its continued growth is proving that the model can work. Big investors also are banking on the company's business model to serve Medicaid patients.

But it's not an area that health tech startups have historically focused on and it's an area that's still ripe for innovation.

"Historically health tech and healthcare innovation, particularly in the venture-backed space, have focused on point solutions or on technology-only solutions. Those just won't work for this population," she said.

"You need to be able to engage, understand and intervene across multiple dimensions, with human touch and care, like actual hands-on care, in addition to technology and analytics and data. But that is a more complex and certainly a more long-term endeavor.
That, I think, is tough," she said.

Ajayi also points to the lack of diversity overall in the venture capital ecosystem as a barrier for startups that want to focus on marginalized populations.

"It creates biases towards what problems people are exposed to and what problems they think are worthy of solving. VC has really operated largely as an echo chamber where you see more companies and more founders who are building things for people like them so that that is another component that has to shift," Ajayi said. "The more voices we have at the table, the more problems we get exposed to, the more solutions we can bring to bear."

She added, "We're starting to see that unfold as well and that's a really exciting shift on the horizon."