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Her Low-Income Patients Were Labeled 'Noncompliant and Defiant.' So She Raised $500 Million to Build a Healthcare Company That Put Them First. Working as a doctor, Toyin Ajayi witnessed how the healthcare system fails traumatized patients in marginalized communities-down to the language it uses to describe them. She started Cityblock Health to change the equation.

By Jessica Thomas Edited by Frances Dodds

This story appears in the October 2021 issue of Entrepreneur. Subscribe »

Courtesy of Cityblock Health

When Toyin Ajayi, MD, began practicing family medicine in Boston, she cared for a patient for several years. "She had a number of chronic physical health diagnoses and a long history of mental health challenges, and she was often hospitalized because she hadn't taken her medicines," Ajayi says. "One time, when I was following up with her after yet another hospitalization, she told me, "I just want you to know, I am not noncompliant and defiant.' In healthcare we develop language that is not person-centered, and is sometimes even disparaging, and she had heard people label her that way. That was really profound for me, and it helped me formulate ideas about what it looks like to earn the trust of people we serve. It also started me down a path of trying to understand how chronic trauma shows up in people's health needs."

Related: 3 Strategies for Thinking and Acting Courageously

That path led Ajayi to cofound Cityblock Health in 2017 with Iyah Romm and Bay Gross. By March of this year, the company, which provides healthcare for historically marginalized communities, had raised $500 million, surpassed a $1 billion valuation, and grown to serve more than 75,000 members. Cityblock contracts with insurance companies to take on some of their most costly patients — typically low-income Medicaid and Medicare recipients — for a fixed cost per year. It provides members with comprehensive, often home-based healthcare services, particularly important for those dealing with mental health and addiction issues. Cityblock takes on the risk that those patients' care costs will surpass the annual fixed amount it receives from insurance companies. But if its model works correctly, it gives members a single resource for tackling health issues and helps them avoid costly hospital stays.

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