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VITALS: Toyin Ajayi on Value-Based Care

When Toyin Ajayi, M.D., speaks about health care, it’s with a joyfulness that infuses everything from an anecdote about a patient to her explanation of how “value-based care” means investing in each person for the long run.

In her recent appearance on Northeast Ohio Medical University’s VITALS series, Dr. Ajayi led off the webinar with a story about how she once established rapport with a patient on an unusually nice spring day by taking a walk around the Boston neighborhood of the hospital where she was then working.   

This patient had been marginalized in the health care system. After getting to know the doctor a bit, she confided that she was aware of how physicians had labeled her as “non-compliant.” 

“I’m not non-compliant; I’m defiant,” she told the physician, who after her initial astonishment absorbed that statement as a teachable moment about treating patients with respect.

The Feb. 4 event, introduced by President John T. Langell, M.D., Ph.D., MBA, MPH, was the latest in the VITALS: Visionary Health Leadership in Action series, which presents thought leaders in health care. 

A model of respect

Of course, taking a walk with a patient is a rarity, not a regular occurrence, for Dr. Ajayi. But when she co-founded Cityblock Health four years ago, it was with a goal of treating each person with dignity, intentionally setting out to earn their respect, she said.  As just one example: Cityblock’s culture is to ask each patient at the beginning of their appointment what they would like to be called – Mr., Mrs., Ms., their first name, or something else.

“Language matters,” Dr. Ajayi told the webinar audience. Her Cityblock team doesn’t call patients by their disease states. Actually, it doesn’t call them patients, either. It calls them members, because they consider the work being done to be a partnership. They ask members about their health goals and engage them in figuring out together how to work toward them.

If this is all beginning to sound pie-in-the-sky, Dr. Ajayi is firmly grounded in reality. What are the challenges of running Cityblock, asked moderator Cheryl Powell, managing editor of the Akron Beacon Journal, in the Q&A session following Dr. Ajayi’s presentation?

Dr. Ajayi laughed, a big open grin lighting up the Zoom screen. “I don’t know where to start! Everything is hard,” she confessed, with obvious enthusiasm for meeting the challenge. 

Founded in New York City, Cityblock Health has served its members for three years, with Dr. Ajayi as chief health officer. It delivers primary care and behavioral health care, along with social services to help its patients –most of whom are eligible for Medicaid – obtain the medical care they need. When COVID-19 started spreading, the team built an algorithm to reach those at highest risk. They called each person to provide tests, counseling and treatment so they didn’t feel abandoned. 

One listener wondered if the Cityblock model could be applied to specialized care, too. 

Yes, Dr. Ajayi answered, explaining that as a value-based model, they are incentivized to focus on what gets the best results for a patient. Cityblock takes a risk up front for the total amount that will be spent on a patient, then provides the care that will drive the best outcomes. (This contrasts with a fee-based model, in which care providers are incentivized to do tests that may not be needed, she noted.)

Setting goals together

Having compassion for what everyday life is like for those seeking medical care makes you a better physician, said Dr. Ajayi, a Stanford graduate who earned a medical degree from King’s College London School of Medicine. Put yourself in their place: Imagine you live in an unsafe neighborhood and even when you can get to the store, you don’t know which foods are healthy choices. When you visit your doctor because your knees hurt, they say, “That’s because you’re overweight. Lose some weight,” and send you home. 

But what if that doctor asked what your goals were, and you said they were to walk up the stairs to watch your grandchildren, to do the grocery shopping without pain, or spend less money on insulin for your diabetes each month? Then, what if the doctor asked, “What are your challenges to meeting those goals?” and you were able to confide that at night, when you get sad and lonely, you lose your willpower and can’t resist the French fries? And after that, you made a plan, together?

Dr. Ajayi would like to abolish the feeling so many patients have of being dismissed because they’re not good enough. “Look for success” with patients, she advised. Are they getting more steps in than they did on their last visit? Good!

It has been exciting to see this model of care succeed in New York, said Dr. Ajayi, where Cityblock has been able to “meet our members wherever they are and earn the right to keep them out of the hospital.” In 2022, Cityblock plans to expand into Cincinnati, Cleveland and Columbus.  

VITALS webinars are free and open to the public, with Continuing Education credit available. Each speaker has the opportunity to speak and invite discussion on any of the VITALS topics: value-based, innovation, technology, advocacy, leadership and service. 

The next VITALS speaker is Cliff Megerian, the new CEO of University Hospitals Health System (UH), at 5 p.m. Thursday, March 4. 

Watch Dr. Ajayi’s VITALS presentation.