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Healthcare at the Margins

“The Doctor’s Art” is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.

What should we do about the fact that a person’s health is affected in large part by social factors beyond the confines of the hospital? For a long time, traditional healthcare institutions have been inadequate in answering this question.

Joining us in this episode is Toyin Ajayi, MD, co-founder and chief executive officer of Cityblock Health, a tech-driven healthcare provider for communities with complex health and social needs. With a focus on Medicaid and lower-income Medicare beneficiaries, Cityblock Health has been widely recognized as an exemplar of a sustainable model of care delivery for marginalized populations.

Henry Bair and Tyler Johnson, MD, are joined by Ajayi to discuss Cityblock Health, as well as her clinical work, which centers on patients with chronic complex and end-of-life needs.

In this episode, you will hear about:

  • 1:57 Ajayi’s personal journey from growing up in Kenya to leading Cityblock Health
  • 4:11 Why Ajayi chose to focus her career on patients with complex and chronic health needs
  • 5:21 The social determinants of health and their impact on a patient’s ability to seek appropriate medical care
  • 10:35 Ajayi’s story of a chronically ill patient who appeared “difficult” but in truth was suffering from social inequities that limited his access to healthcare
  • 18:07 A discussion on Cityblock Health, the value-based healthcare provider that Ajayi co-founded to provide care to the Medicaid patient population
  • 22:02 The stigma around Medicaid patients and why Ajayi sees opportunities instead of barriers
  • 27:00 An in-depth exploration of the services Cityblock Health provides
  • 32:36 The challenges of the fee-for-service model of American healthcare, and how Cityblock seeks to address them
  • 37:50 Ajayi’s advice to medical practitioners on how to build trust and rapport with patients
  • 40:05 The future of Cityblock Health and the health equity movement

Following is a partial transcript (note errors are possible):

Bair: What should we do about the fact that a person’s health is affected in large part by social factors beyond the confines of the hospital? For a long time, traditional healthcare institutions have been inadequate in answering this question. Joining us in this episode is Dr. Toyin Ajayi, co-founder and chief executive officer of Cityblock Health, a tech-driven healthcare provider for communities with complex health and social needs. With a focus on Medicaid and lower-income Medicare beneficiaries, Cityblock Health has been widely recognized as an exemplar of a sustainable model of care delivery for marginalized populations.

Dr. Ajayi completed her medical training at King’s College London School of Medicine and her residency at Boston Medical Center. Her clinical practice centers on patients with chronic complex and end-of-life needs. Toyin, thank you very much for taking the time to join us and welcome to the show.

Ajayi: It’s my pleasure to be here. Thanks for inviting me.

Bair: I’d like to start by going back to the beginning of your career. I know that you are trained as a family medicine practitioner. So can you tell us what first drew you to that profession?

Ajayi: Yeah, absolutely. I’d always known I wanted to do something in and around healthcare. I grew up in a family, my dad was a public health physician, did a lot of global health work his whole career. My mom has always been, I think, a social justice warrior, if you will, and really focused on community building. And so I always knew that I would want to do something in this space.

I grew up in East Africa, in Kenya, Nairobi, and saw a lot of the early impacts of the global HIV/AIDS pandemic. And so really experienced pretty closely, close to firsthand, sort of the impacts of massive, massive infectious disease, public health crisis as it played out, particularly for lower-income people. And I saw very much and very closely the sort of impacts, the differential impacts, of some of the structural and societal biases and stigma that exists, particularly around women and women’s access to education and healthcare. And so I had a lot of kind of threads going through my head, thinking about public health, reproductive health.

But I decided to go specifically into medicine a little bit later than most. I’d hedged my bets. I was a pre-med in undergrad and sort of thought maybe I wanted to go there, but I wasn’t particularly convinced until a little bit later in my career when I was really trying to think about where I could have an impact the most. So I went to medical school, not necessarily thinking I would practice for a very long time initially, but really just thinking that it would be a really useful anchoring point for a career in health in some way, shape, or form.

And as luck would have it, I found out that I really, really love being a doctor. I love taking care of patients, I love clinical practice, and I love the experience that I get and just the exposure that I get through kind of talking to and sitting with and accompanying patients through their journey. And so I decided to do family medicine because it gave me the most breadth that I could get and the most access and an ability to to see the entire life cycle for families, which was really compelling for me.

Bair: Wow. I did not know that you had grown up in Africa. So that’s a fascinating perspective there. I’m curious because you have made your career, you have built your career around taking care of chronically ill patients and patients with complex health needs. What motivated you in particular to focus on this patient population?

Ajayi: I was just very compelled and really felt very passionately about caring for people who have the most complex needs, people who have the most to lose and the most to gain from the way that our healthcare system treats folks who are marginalized. And as I was training, I saw that folks with chronic conditions, physical health needs, behavioral health needs, people who struggled with addiction and substance use often had the most disproportionately poor outcomes of my patients. And that seemed to me like a reason to double down and to focus on trying to even the playing field at a minimum, trying to advance equity and health and health outcomes, with a particular focus on people who have the most challenges to overcome.

For the full transcript, visit The Doctor’s Art.

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Source: MedicalNewsToday.com