1 00:00:04,720 --> 00:00:08,039 Speaker 1: In the United States, poor people tend to die younger. 2 00:00:08,960 --> 00:00:11,840 Speaker 1: The wealthiest one percent of Americans live more than a 3 00:00:12,000 --> 00:00:15,800 Speaker 1: decade longer than the poorest one percent, and that gap 4 00:00:15,840 --> 00:00:19,759 Speaker 1: has grown wider in recent years. There isn't just one 5 00:00:19,840 --> 00:00:23,080 Speaker 1: reason why this is the case. Where a person lives, 6 00:00:23,120 --> 00:00:25,960 Speaker 1: how much money they make, and how socially connected they 7 00:00:26,000 --> 00:00:30,040 Speaker 1: are all affect their well being. There's an argument in 8 00:00:30,040 --> 00:00:32,760 Speaker 1: the medical world that people would live longer if healthcare 9 00:00:32,840 --> 00:00:37,720 Speaker 1: providers could address patients social needs like food, housing, and transportation. 10 00:00:39,000 --> 00:00:42,800 Speaker 1: Welcome to Prognosis, Bloomberg's podcast about the future of health care. 11 00:00:43,360 --> 00:00:48,040 Speaker 1: I'm your host Michelle fe Cortes. Some healthcare companies are 12 00:00:48,080 --> 00:00:50,519 Speaker 1: trying to create new ways of caring for people with 13 00:00:50,640 --> 00:00:55,200 Speaker 1: complex social and medical needs. They're betting that improving care 14 00:00:55,240 --> 00:00:57,800 Speaker 1: for these patients will cut costs in the long run 15 00:00:58,280 --> 00:01:03,040 Speaker 1: by avoiding unnecessary hospital stays. They're also grappling with systemic 16 00:01:03,120 --> 00:01:08,480 Speaker 1: problems like inadequate housing, low wages, and even discrimination. On 17 00:01:08,520 --> 00:01:11,760 Speaker 1: this episode of Prognosis, bloom Brick News health reporter John 18 00:01:11,800 --> 00:01:14,560 Speaker 1: Tozzi takes us to Brooklyn, where a new company is 19 00:01:14,600 --> 00:01:22,600 Speaker 1: trying to overhaul the way medical care is delivered. Toyan, 20 00:01:22,680 --> 00:01:25,560 Speaker 1: a g E, was a young medical resident when she 21 00:01:25,600 --> 00:01:28,839 Speaker 1: saw up close how the health care system fails people. 22 00:01:29,840 --> 00:01:32,120 Speaker 1: She was training to be a family doctor in Boston, 23 00:01:32,400 --> 00:01:35,120 Speaker 1: working in a community clinic and a safety net hospital. 24 00:01:36,040 --> 00:01:38,399 Speaker 1: A lot of her patients were poor and they had 25 00:01:38,480 --> 00:01:42,080 Speaker 1: serious needs that doctors and hospitals weren't helping them with. 26 00:01:43,040 --> 00:01:45,520 Speaker 1: Toyan told me about it in a recent interview at 27 00:01:45,560 --> 00:01:50,720 Speaker 1: her office in Brooklyn. The people that I really was 28 00:01:50,720 --> 00:01:55,560 Speaker 1: passionate about caring for those are patients whom um, many 29 00:01:55,600 --> 00:01:59,320 Speaker 1: of my colleagues found kind of overwhelming or challenging or 30 00:01:59,320 --> 00:02:02,000 Speaker 1: more difficult to take care of. Those are people who 31 00:02:02,280 --> 00:02:05,600 Speaker 1: often had you know, ten or fifteen medications on their 32 00:02:05,600 --> 00:02:11,160 Speaker 1: medication list. They had physical illnesses, some had disabilities. Many 33 00:02:11,200 --> 00:02:14,520 Speaker 1: patients also had mental health problems or we're struggling with 34 00:02:14,600 --> 00:02:18,680 Speaker 1: substance abuse. They frequently wound up in the hospital and 35 00:02:18,720 --> 00:02:21,720 Speaker 1: their medical care cost a lot of money, but it 36 00:02:21,800 --> 00:02:24,239 Speaker 1: wasn't really helping them get better. What I observed was 37 00:02:24,280 --> 00:02:27,359 Speaker 1: that the healthcare system tended not to dig deep enough 38 00:02:27,440 --> 00:02:30,120 Speaker 1: to ask why, and that when you sat at the 39 00:02:30,160 --> 00:02:34,120 Speaker 1: bedside of someone like this and really started to ask why, um, like, 40 00:02:34,160 --> 00:02:37,160 Speaker 1: what's actually happening for you and what matters for you. UM, 41 00:02:37,200 --> 00:02:40,600 Speaker 1: the picture of their experience emerged that showed me just 42 00:02:40,639 --> 00:02:43,680 Speaker 1: how we were failing to address their needs. Toyan says, 43 00:02:43,760 --> 00:02:46,840 Speaker 1: the health care system just isn't built for the reality 44 00:02:46,919 --> 00:02:50,160 Speaker 1: of people's lives. Think about a single mom who's holding 45 00:02:50,160 --> 00:02:52,560 Speaker 1: down a job but struggling to make ends meet. I 46 00:02:52,639 --> 00:02:55,000 Speaker 1: think about what our healthcare system would ask her to 47 00:02:55,080 --> 00:02:57,440 Speaker 1: do in order to access really high quality health care. 48 00:02:57,440 --> 00:02:59,360 Speaker 1: We would ask her to take some time off work. 49 00:02:59,720 --> 00:03:01,800 Speaker 1: If a is an hourly wage worker, that's like cash 50 00:03:01,800 --> 00:03:03,800 Speaker 1: out of her pocket. Um. We'd ask her to pay 51 00:03:03,840 --> 00:03:06,160 Speaker 1: for transportation. We'd ask her to find child care. We'd 52 00:03:06,200 --> 00:03:08,200 Speaker 1: ask her to come to us to wait in a 53 00:03:08,240 --> 00:03:12,320 Speaker 1: waiting room. UM, sometimes a really long time. After all that, 54 00:03:12,480 --> 00:03:15,360 Speaker 1: she gets just a few minutes with a doctor. She 55 00:03:15,440 --> 00:03:18,000 Speaker 1: may get a prescription or advice to change her diet 56 00:03:18,200 --> 00:03:21,919 Speaker 1: or exercise more. But even feeling a prescription can be difficult. 57 00:03:22,360 --> 00:03:25,520 Speaker 1: Copas are high and significant, and the burden of getting 58 00:03:25,560 --> 00:03:27,240 Speaker 1: to the pharmacy and getting your meds is not an 59 00:03:27,240 --> 00:03:30,519 Speaker 1: insignificant thing for a lot of people in this country. UM, 60 00:03:30,520 --> 00:03:33,360 Speaker 1: and lifestyle modifications is so dependent on you know, do 61 00:03:33,400 --> 00:03:35,600 Speaker 1: you have a safe place to go take a walk 62 00:03:35,760 --> 00:03:38,120 Speaker 1: around your block? Can you even do that? Um? Can 63 00:03:38,160 --> 00:03:41,280 Speaker 1: you afford to buy organic, healthy, nutritious food or is 64 00:03:41,360 --> 00:03:44,560 Speaker 1: the you know, the four dollar burger meal from Wendy's 65 00:03:44,600 --> 00:03:46,560 Speaker 1: the best you can afford to do? And how in 66 00:03:46,600 --> 00:03:48,440 Speaker 1: the world can I think about my nutrition when I 67 00:03:48,440 --> 00:03:50,840 Speaker 1: don't have the resources to begin to even meet my 68 00:03:50,880 --> 00:03:53,840 Speaker 1: daily needs Toalian began to think about what it would 69 00:03:53,840 --> 00:03:57,560 Speaker 1: look like to deliver healthcare that accommodates the complex reality 70 00:03:57,640 --> 00:04:00,440 Speaker 1: of people's lives. There was sort of a fundamental overhaul 71 00:04:00,440 --> 00:04:02,840 Speaker 1: in the way that we think about ourselves as healthcare 72 00:04:02,840 --> 00:04:05,080 Speaker 1: providers relative to the patients that we're trying to serve. 73 00:04:05,080 --> 00:04:07,800 Speaker 1: That needed to occur in order for us to ever 74 00:04:08,000 --> 00:04:11,040 Speaker 1: have the hope of expecting better outcomes for them. Tony 75 00:04:11,120 --> 00:04:14,720 Speaker 1: and co founded a startup in to do that. It's 76 00:04:14,760 --> 00:04:17,599 Speaker 1: based in Brooklyn, New York, and it's called City Bloch Health. 77 00:04:18,400 --> 00:04:21,839 Speaker 1: The company aims to combine primary care, mental health care, 78 00:04:21,960 --> 00:04:24,400 Speaker 1: and assistance with a lot of the other non medical 79 00:04:24,480 --> 00:04:27,600 Speaker 1: things that can affect people's health. It matters if you're housed, 80 00:04:27,640 --> 00:04:30,159 Speaker 1: It matters if you have a warm place to sleep 81 00:04:30,200 --> 00:04:32,240 Speaker 1: at night. It matters if you have enough food to eat. 82 00:04:32,480 --> 00:04:34,680 Speaker 1: It matters if you have electricity to stay warm in 83 00:04:34,720 --> 00:04:37,440 Speaker 1: the winter and cool in the summer. This is an 84 00:04:37,480 --> 00:04:40,440 Speaker 1: idea that people in healthcare are talking about more and more. 85 00:04:41,160 --> 00:04:43,960 Speaker 1: Many aspects of people's lives outside the clinic and the 86 00:04:44,000 --> 00:04:47,600 Speaker 1: hospital have big consequences for their health. And there's an 87 00:04:47,680 --> 00:04:50,440 Speaker 1: argument that society could reduce what we spend on medical 88 00:04:50,480 --> 00:04:54,560 Speaker 1: care by spending more on social services. But that's a 89 00:04:54,600 --> 00:04:58,599 Speaker 1: contested notion. Here's Ashish Ja, a physician and Harvard Public 90 00:04:58,640 --> 00:05:02,720 Speaker 1: health professor. All of the evidence says that spending on 91 00:05:02,720 --> 00:05:06,600 Speaker 1: social services, if targeted well, can really have a profound 92 00:05:06,600 --> 00:05:09,800 Speaker 1: impact on people's lives in very positive ways. But it's 93 00:05:09,839 --> 00:05:11,360 Speaker 1: not going to pay for itself. It's not going to 94 00:05:11,440 --> 00:05:14,560 Speaker 1: save you enough money in the health care system to 95 00:05:14,720 --> 00:05:16,760 Speaker 1: justify doing it. You should do it because it's the 96 00:05:16,839 --> 00:05:19,600 Speaker 1: right thing to do. The same goes for increasing access 97 00:05:19,640 --> 00:05:24,200 Speaker 1: to primary care. Primary care and preventive services are good 98 00:05:24,240 --> 00:05:27,599 Speaker 1: things to do to improve people's health, but the reason 99 00:05:27,640 --> 00:05:30,240 Speaker 1: to do them is for the health reasons. Uh. The 100 00:05:30,320 --> 00:05:33,320 Speaker 1: reasons to do them is not because it will somehow 101 00:05:33,360 --> 00:05:36,680 Speaker 1: again magically pay for itself with all the savings you'll 102 00:05:36,720 --> 00:05:38,719 Speaker 1: get down the road. There's almost no evidence that it 103 00:05:38,760 --> 00:05:42,520 Speaker 1: ever does. A recent study in the New England Journal 104 00:05:42,520 --> 00:05:46,560 Speaker 1: of Medicine showed some of the challenges. Researchers looked at 105 00:05:46,560 --> 00:05:50,839 Speaker 1: a high profile experiment in Camden, New Jersey. A randomly 106 00:05:50,839 --> 00:05:54,760 Speaker 1: selected group of patients who were frequently hospitalized got assistance 107 00:05:54,839 --> 00:05:58,880 Speaker 1: and home visits from nurses, social workers, and community health workers. 108 00:05:59,680 --> 00:06:02,599 Speaker 1: The goal was to prevent them from being hospitalized again, 109 00:06:03,440 --> 00:06:06,240 Speaker 1: but after six months, the patients who got this extra 110 00:06:06,279 --> 00:06:08,279 Speaker 1: help were just as likely to wind up in the 111 00:06:08,320 --> 00:06:11,800 Speaker 1: hospital again as similar patients who didn't get the intervention. 112 00:06:14,600 --> 00:06:18,440 Speaker 1: But Tollan argues that improving care and social support can 113 00:06:18,560 --> 00:06:21,359 Speaker 1: reduce costs in the long run, at least for the 114 00:06:21,400 --> 00:06:24,679 Speaker 1: patients who cost the most and who the existing system 115 00:06:24,800 --> 00:06:28,760 Speaker 1: often fails. Those are the people. City Box is focused 116 00:06:28,760 --> 00:06:33,640 Speaker 1: on patients with complex medical and social needs. They often 117 00:06:33,640 --> 00:06:36,640 Speaker 1: don't get help with the things they really need, even 118 00:06:36,640 --> 00:06:38,800 Speaker 1: though they cost the health care system a lot of 119 00:06:38,839 --> 00:06:43,080 Speaker 1: money through frequent hospital trips and emergency visits. A core 120 00:06:43,160 --> 00:06:46,239 Speaker 1: piece of City Box approach is also caring for people's 121 00:06:46,279 --> 00:06:51,120 Speaker 1: mental health and addressing substance use. These problems are staggeringly 122 00:06:51,240 --> 00:06:54,200 Speaker 1: common but the medical system often doesn't treat them well, 123 00:06:54,640 --> 00:06:58,680 Speaker 1: so trauma, anxiety, and depression being the main ones UM 124 00:06:58,720 --> 00:07:02,880 Speaker 1: that make physical health worse. It's really hard to motivate 125 00:07:02,880 --> 00:07:05,320 Speaker 1: to take your medications for your diabetes, your blood pressure 126 00:07:05,360 --> 00:07:07,240 Speaker 1: when you are feeling so low you can't get out 127 00:07:07,240 --> 00:07:10,520 Speaker 1: of bed. City Blok is trying to stitch all these 128 00:07:10,560 --> 00:07:14,920 Speaker 1: things together, physical health, mental health, and social assistance in 129 00:07:14,920 --> 00:07:19,040 Speaker 1: a seamless way. The company is focused on people who 130 00:07:19,040 --> 00:07:23,840 Speaker 1: are on public insurrence programs including Medicaid and Medicare. Those 131 00:07:23,880 --> 00:07:27,680 Speaker 1: cover people who are lower income, elderly, or disabled, and 132 00:07:27,720 --> 00:07:31,360 Speaker 1: City Bok takes on the most expensive patients. They're struggling 133 00:07:31,400 --> 00:07:34,920 Speaker 1: with multiple chronic physical health needs UM, they have mobility 134 00:07:35,000 --> 00:07:39,240 Speaker 1: needs or disabilities, people with serious mental illness and or 135 00:07:39,360 --> 00:07:42,680 Speaker 1: substance use, and many of them have deep social needs. 136 00:07:42,760 --> 00:07:45,200 Speaker 1: On top of that, the people are struggling with housing 137 00:07:45,200 --> 00:07:48,880 Speaker 1: and security, or food and security, or UM social isolation 138 00:07:49,280 --> 00:07:53,360 Speaker 1: challenges with transportation UM all of those things um coalesced 139 00:07:53,360 --> 00:07:56,640 Speaker 1: to increase the likelihood of poor outcomes for populations with 140 00:07:56,680 --> 00:08:01,200 Speaker 1: complex needs. The company uses technology to or stand those challenges. 141 00:08:02,000 --> 00:08:05,280 Speaker 1: They built a custom electronic medical record system that tracks 142 00:08:05,280 --> 00:08:08,280 Speaker 1: members social needs as well as their physical and mental health, 143 00:08:09,360 --> 00:08:12,640 Speaker 1: and it allows clinicians and other workers to communicate smoothly 144 00:08:12,960 --> 00:08:15,640 Speaker 1: to keep members from falling through the cracks. We have 145 00:08:15,720 --> 00:08:18,080 Speaker 1: visibility across all of those things and then have tools 146 00:08:18,080 --> 00:08:21,000 Speaker 1: with which to help deliver better care on the social 147 00:08:21,040 --> 00:08:22,840 Speaker 1: side as well as on the physical health side. We 148 00:08:22,840 --> 00:08:25,400 Speaker 1: should disclose at this point that one of city Box 149 00:08:25,440 --> 00:08:29,600 Speaker 1: investors is Sidewalk Labs. That's a subsidiary of Alphabet, the 150 00:08:29,640 --> 00:08:32,560 Speaker 1: parent company of Google, and it's run by Dan Dotorff. 151 00:08:33,000 --> 00:08:36,120 Speaker 1: Doctor Off was CEO of Bloomberg News parents Bloomberg LP 152 00:08:36,440 --> 00:08:44,440 Speaker 1: until he's on the board of City Block. But let's 153 00:08:44,440 --> 00:08:47,760 Speaker 1: get back to toy In. A handful of healthcare organizations 154 00:08:47,840 --> 00:08:51,920 Speaker 1: across the country have built reputations for improving healthcare for 155 00:08:51,960 --> 00:08:54,880 Speaker 1: the type of complex patients that City Block works with. 156 00:08:55,840 --> 00:08:58,600 Speaker 1: Toyan worked at one of them, a nonprofit health plan 157 00:08:58,679 --> 00:09:02,640 Speaker 1: in Massachusetts called the Commonwealth Care Alliance. The inspiration for 158 00:09:02,720 --> 00:09:05,000 Speaker 1: me and for the rest of our founding team was 159 00:09:05,040 --> 00:09:08,320 Speaker 1: really about the opportunity to take clinical models that we 160 00:09:08,360 --> 00:09:11,920 Speaker 1: had seen and tested um and bring them to scale 161 00:09:11,960 --> 00:09:14,760 Speaker 1: to populations that wouldn't otherwise have access to these types 162 00:09:14,800 --> 00:09:18,720 Speaker 1: of interventions. City Block is betting that it can deliver 163 00:09:18,800 --> 00:09:21,960 Speaker 1: better care to people who the medical system often fails. 164 00:09:22,520 --> 00:09:25,679 Speaker 1: But it's more than that. Toyan believes that doing so 165 00:09:25,800 --> 00:09:30,400 Speaker 1: will also reduce overall spending on medical care. Fundamentally, for us, 166 00:09:30,960 --> 00:09:34,359 Speaker 1: our business is about proving that there is a sustainable 167 00:09:34,400 --> 00:09:39,520 Speaker 1: business case for improved care and for an improved experience 168 00:09:39,559 --> 00:09:42,480 Speaker 1: of care for communities who very frequently have not received 169 00:09:42,520 --> 00:09:45,640 Speaker 1: those things. And so it matters a lot um that 170 00:09:45,679 --> 00:09:49,200 Speaker 1: we are not just adding services to the system UM 171 00:09:49,200 --> 00:09:53,120 Speaker 1: with the promise of um them being sort of globally 172 00:09:53,160 --> 00:09:55,200 Speaker 1: felt to be beneficial, but that we're actually held to 173 00:09:55,800 --> 00:10:00,160 Speaker 1: real world economics. This is definitely not a charity. The 174 00:10:00,200 --> 00:10:04,200 Speaker 1: company has raised more than eight million inventor capital. City 175 00:10:04,200 --> 00:10:06,439 Speaker 1: Block agrees to take care of some of the sickest 176 00:10:06,480 --> 00:10:10,160 Speaker 1: and most vulnerable patients. It has contracts with inferrors like 177 00:10:10,240 --> 00:10:13,079 Speaker 1: Emblem Health in New York and Blue Cross blue Field 178 00:10:13,080 --> 00:10:16,520 Speaker 1: of North Carolina, and City Block makes money if it 179 00:10:16,559 --> 00:10:20,080 Speaker 1: can reduce the costs for the expensive complex patients it 180 00:10:20,160 --> 00:10:23,400 Speaker 1: takes on by keeping them out of the hospital. Let's 181 00:10:23,640 --> 00:10:26,160 Speaker 1: invest the vast amount of money that we spend in 182 00:10:26,200 --> 00:10:29,200 Speaker 1: healthcare today. Let's invest some of it on things that 183 00:10:29,240 --> 00:10:30,840 Speaker 1: we know are going to move the needle for people 184 00:10:30,880 --> 00:10:33,720 Speaker 1: that really matter, and let's do so with an intent 185 00:10:33,920 --> 00:10:37,000 Speaker 1: to reduce waste um and to reduce suffering, and to 186 00:10:37,080 --> 00:10:40,680 Speaker 1: improve time spent at home with people's families and their communities. 187 00:10:41,160 --> 00:10:43,560 Speaker 1: There's no question that a lot of people get poor 188 00:10:43,600 --> 00:10:47,280 Speaker 1: medical care in the United States and that difficult social 189 00:10:47,320 --> 00:10:51,800 Speaker 1: circumstances make their health outcomes worse. The question is whether 190 00:10:51,880 --> 00:10:55,959 Speaker 1: fixing those problems can also bring down medical costs. Many 191 00:10:56,000 --> 00:10:58,199 Speaker 1: of these services we we as a system haven't yet 192 00:10:58,200 --> 00:11:00,640 Speaker 1: figured out how to quantify the value of You know, how, 193 00:11:00,679 --> 00:11:04,200 Speaker 1: how how valuable is it in dollars? Is it a 194 00:11:04,200 --> 00:11:05,880 Speaker 1: five dollar thing or a ten dollar thing or a 195 00:11:05,880 --> 00:11:08,959 Speaker 1: twenty dollar thing to help support somebody who UM was 196 00:11:08,960 --> 00:11:11,720 Speaker 1: going to get evicted, UM to go to housing court 197 00:11:11,840 --> 00:11:14,679 Speaker 1: and fill out paperwork and keep their home. It's not 198 00:11:14,720 --> 00:11:16,840 Speaker 1: that City Blox thinks there should be a price tag 199 00:11:16,880 --> 00:11:19,320 Speaker 1: on these things. We don't have a rule book. We 200 00:11:19,360 --> 00:11:21,880 Speaker 1: don't have a pricing book for these types of services yet, 201 00:11:22,280 --> 00:11:24,520 Speaker 1: nor do I think we should in a fee for 202 00:11:24,559 --> 00:11:27,800 Speaker 1: service way, because these are actually interventions that have longitudinal value. 203 00:11:28,760 --> 00:11:31,720 Speaker 1: That means city block hopes to improve members health over 204 00:11:31,760 --> 00:11:35,079 Speaker 1: the long term. Even if helping someone keep their home 205 00:11:35,240 --> 00:11:38,200 Speaker 1: doesn't affect their health this week, it might mean they're 206 00:11:38,200 --> 00:11:41,199 Speaker 1: healthier a year from now than if they had been evicted. 207 00:11:41,600 --> 00:11:44,840 Speaker 1: If the company's approach makes patients healthier over time, it 208 00:11:44,840 --> 00:11:47,520 Speaker 1: will lower costs, and City Block will get to keep 209 00:11:47,679 --> 00:11:51,480 Speaker 1: some of the savings. Today, City Block is caring for 210 00:11:51,520 --> 00:11:54,760 Speaker 1: thousands of people in New York, Connecticut, and North Carolina, 211 00:11:55,040 --> 00:11:59,160 Speaker 1: and it's expanding to Massachusetts soon. I visited a couple 212 00:11:59,160 --> 00:12:02,640 Speaker 1: of the company's clin Actually, CityWalk doesn't call them clinics. 213 00:12:02,920 --> 00:12:05,880 Speaker 1: It calls them health hubs because they're intended to be 214 00:12:05,960 --> 00:12:10,080 Speaker 1: more than just a medical office. At a new space 215 00:12:10,120 --> 00:12:12,880 Speaker 1: in a strip mall in Greensboro, North Carolina, there are 216 00:12:12,880 --> 00:12:17,199 Speaker 1: paintings from local artists. Inspirational slogans are printed on the walls. 217 00:12:17,800 --> 00:12:20,800 Speaker 1: Ron Carter, the hub manager, showed me around one day. 218 00:12:21,240 --> 00:12:22,760 Speaker 1: This one here on the wall says what matters to 219 00:12:22,840 --> 00:12:25,160 Speaker 1: you manage to us, and we really believe in that, 220 00:12:25,440 --> 00:12:27,880 Speaker 1: and obviously we want to remembers to feel that. There 221 00:12:27,880 --> 00:12:30,680 Speaker 1: are exam rooms and meeting rooms for counseling. There are 222 00:12:30,720 --> 00:12:34,000 Speaker 1: also respite spaces where members can make private phone calls 223 00:12:34,080 --> 00:12:38,360 Speaker 1: or just sit quietly if they want. Eventually, the staff 224 00:12:38,400 --> 00:12:42,000 Speaker 1: plans to host events like nutrition classes or yoga. The 225 00:12:42,040 --> 00:12:44,640 Speaker 1: idea is to be a little more like a community center. 226 00:12:45,400 --> 00:12:49,200 Speaker 1: Laura Mused, the site's manager for community partnerships, told me 227 00:12:49,280 --> 00:12:52,280 Speaker 1: that was already happening in Greensboro. The members we have, 228 00:12:52,440 --> 00:12:55,480 Speaker 1: we see every every week. Some come in and just 229 00:12:55,520 --> 00:12:57,480 Speaker 1: have a glass of water and say hello. We've gone 230 00:12:57,520 --> 00:13:01,360 Speaker 1: to that level. Since I've visit City Block in November 231 00:13:01,440 --> 00:13:05,720 Speaker 1: in North Carolina, the situation has changed. The company paused 232 00:13:05,800 --> 00:13:09,520 Speaker 1: most of its operations there in mid January. City Block 233 00:13:09,600 --> 00:13:12,079 Speaker 1: has a contract with the state's Blue Cross Blue Field 234 00:13:12,080 --> 00:13:15,080 Speaker 1: plant to take care of Medicaid patients, but an unrelated 235 00:13:15,120 --> 00:13:19,280 Speaker 1: state budget standoff delayed funding for the new North Carolina 236 00:13:19,360 --> 00:13:22,959 Speaker 1: Medicaid program. The company said it hopes to resume when 237 00:13:22,960 --> 00:13:26,400 Speaker 1: the budget impass is resolved. City Block has a doctor's 238 00:13:26,440 --> 00:13:29,520 Speaker 1: like toy In and nurse practitioners and labs. But what 239 00:13:29,640 --> 00:13:33,400 Speaker 1: makes it different from most medical practices is people like Quacy, 240 00:13:33,440 --> 00:13:36,280 Speaker 1: who works for City Block in Brooklyn. When my name 241 00:13:36,360 --> 00:13:41,720 Speaker 1: is quasy Um Quis Peterson m ah Um community health partner, 242 00:13:43,000 --> 00:13:45,840 Speaker 1: every patient that City Box takes care of is assigned 243 00:13:45,880 --> 00:13:49,520 Speaker 1: to a community health partner like Quacy. She has about 244 00:13:49,520 --> 00:13:52,320 Speaker 1: forty patients on her roster, and she might visit six 245 00:13:52,400 --> 00:13:55,480 Speaker 1: or seven of them in any given day, or they 246 00:13:55,480 --> 00:13:59,319 Speaker 1: come here, or I've met people in the community of 247 00:13:59,480 --> 00:14:03,760 Speaker 1: med members at the shelters, UM I I go where 248 00:14:03,760 --> 00:14:07,840 Speaker 1: they act. Quacy worked closely with City Box medical staff, 249 00:14:08,160 --> 00:14:11,360 Speaker 1: but she isn't a condition. She's there to help patients 250 00:14:11,480 --> 00:14:13,680 Speaker 1: with all the other stuff that can affect their health, 251 00:14:14,040 --> 00:14:19,360 Speaker 1: like transportation. I have UM picked them up from the appointments. 252 00:14:19,680 --> 00:14:23,160 Speaker 1: I accompanied them to the appointments. One day, she was 253 00:14:23,200 --> 00:14:25,480 Speaker 1: making a house calm when her client took a long 254 00:14:25,560 --> 00:14:28,120 Speaker 1: time to answer the door. He usually comes to the 255 00:14:28,160 --> 00:14:31,200 Speaker 1: door very quickly, and this one time a president of president, 256 00:14:31,320 --> 00:14:34,160 Speaker 1: but he doesn't come quickly and do I'm like, okay. 257 00:14:34,280 --> 00:14:37,800 Speaker 1: He did come and he can barely walk. He's a 258 00:14:37,880 --> 00:14:41,240 Speaker 1: diabetic and he fell. The man had injured his knee 259 00:14:41,280 --> 00:14:44,480 Speaker 1: a few days earlier, but he hadn't gotten any treatment. 260 00:14:44,920 --> 00:14:47,840 Speaker 1: So Quasi called toy in. She said, okay, bring him. 261 00:14:47,880 --> 00:14:49,840 Speaker 1: Don't let him go to the e R. He's gonna 262 00:14:49,880 --> 00:14:52,640 Speaker 1: wait there too long. Toyan examined him at the connect. 263 00:14:52,800 --> 00:14:55,160 Speaker 1: So she came here. I brought him here in my car, 264 00:14:55,880 --> 00:14:59,200 Speaker 1: you know, and um, she took him in right away, 265 00:15:00,040 --> 00:15:04,000 Speaker 1: did the xt ray, she gave them crutches, the ice 266 00:15:04,080 --> 00:15:05,840 Speaker 1: BacT all these sort of things. He left her with 267 00:15:05,880 --> 00:15:08,680 Speaker 1: a little bag. It's impossible to say what might have 268 00:15:08,760 --> 00:15:12,080 Speaker 1: happened if Quacy hadn't visited the man and discovered that 269 00:15:12,120 --> 00:15:15,760 Speaker 1: he was hurt. Even minor injuries can become serious for 270 00:15:15,840 --> 00:15:18,680 Speaker 1: people with diabetes because their wounds are slow to heal. 271 00:15:19,480 --> 00:15:23,600 Speaker 1: An infected wound could even lead to an amputation. Clinicians 272 00:15:23,720 --> 00:15:26,960 Speaker 1: often see situations where a serious illness could have been 273 00:15:27,000 --> 00:15:31,240 Speaker 1: avoided if they had reached the patient earlier. So my 274 00:15:31,360 --> 00:15:35,520 Speaker 1: name is Joanna Humanis Mahiah, and I'm an e respectitioner. 275 00:15:35,840 --> 00:15:38,920 Speaker 1: Joanna worked in hospitals and home care before coming to 276 00:15:39,000 --> 00:15:42,760 Speaker 1: City Bark. I felt that it was with some patients, 277 00:15:42,920 --> 00:15:45,480 Speaker 1: very very challenging to keep them out of the hospital, 278 00:15:45,960 --> 00:15:48,200 Speaker 1: And in my opinion, it was because we were coming 279 00:15:48,240 --> 00:15:50,760 Speaker 1: to these patients when they were already very sick, and 280 00:15:50,800 --> 00:15:55,520 Speaker 1: they were already acute, and we were we were just 281 00:15:55,600 --> 00:15:58,560 Speaker 1: a little too late for what they actually needed. City 282 00:15:58,560 --> 00:16:01,080 Speaker 1: Box is trying to build a system that reaches patients 283 00:16:01,120 --> 00:16:04,560 Speaker 1: before it's too late, when there's still an opportunity to 284 00:16:04,640 --> 00:16:07,240 Speaker 1: keep them healthy and out of a hospital or nursing home. 285 00:16:07,960 --> 00:16:11,000 Speaker 1: It relies on people like Quacy. It also relies on 286 00:16:11,040 --> 00:16:14,720 Speaker 1: communications software to keep pack of patients needs and coordinate 287 00:16:14,720 --> 00:16:18,200 Speaker 1: their care. If members give permission, City Box care teams 288 00:16:18,240 --> 00:16:20,640 Speaker 1: will get real time alerts when somebody goes to the 289 00:16:20,680 --> 00:16:24,000 Speaker 1: emergency room. The alert pops up in the chat software 290 00:16:24,000 --> 00:16:27,680 Speaker 1: Slack that all the City Box staff use. Here's Quazy. 291 00:16:27,920 --> 00:16:30,240 Speaker 1: So then I would meet them at the hospital if 292 00:16:30,280 --> 00:16:33,200 Speaker 1: they happen to go into the emergency room and they admitted, 293 00:16:34,080 --> 00:16:36,920 Speaker 1: and um, even if they're not ante, I'll go to 294 00:16:36,960 --> 00:16:39,320 Speaker 1: the era. Finally, what's going to And you should see 295 00:16:39,320 --> 00:16:42,560 Speaker 1: the face they'd be so surprised. Quazy shows up at 296 00:16:42,560 --> 00:16:45,400 Speaker 1: her patients houses and at the hospital, but she also 297 00:16:45,440 --> 00:16:48,120 Speaker 1: shows up to support them in ways that healthcare workers 298 00:16:48,200 --> 00:16:51,160 Speaker 1: don't normally do. Even going to court, I have members 299 00:16:51,200 --> 00:16:54,280 Speaker 1: I go to housing court for I have members that 300 00:16:54,400 --> 00:16:57,360 Speaker 1: I tell them what's the process, what's because I have 301 00:16:57,480 --> 00:17:00,480 Speaker 1: been the tenant going to court for not paying right 302 00:17:00,520 --> 00:17:04,000 Speaker 1: because I also lost my job. This is an important 303 00:17:04,040 --> 00:17:07,720 Speaker 1: piece of City Box model. The people working as community 304 00:17:07,720 --> 00:17:11,959 Speaker 1: health partners are from the places they serve. Quzy understands 305 00:17:12,040 --> 00:17:15,960 Speaker 1: the challenges that her client's face because she's faced them herself. 306 00:17:16,600 --> 00:17:20,040 Speaker 1: My position got phased out at Brooklyn Hospital when my 307 00:17:20,119 --> 00:17:24,959 Speaker 1: son was born, so I had no job, new baby, 308 00:17:25,560 --> 00:17:30,240 Speaker 1: rent to pay, and you have savings. But when you 309 00:17:30,280 --> 00:17:32,960 Speaker 1: have a newborn, you're looking for a job that's saving 310 00:17:33,119 --> 00:17:37,119 Speaker 1: and you're paying rent, and you're paying this and it 311 00:17:37,200 --> 00:17:41,399 Speaker 1: depletes quickly. That kind of experience helps Crazy relate to 312 00:17:41,440 --> 00:17:45,639 Speaker 1: members who don't always trust doctors or medical institutions. I 313 00:17:45,720 --> 00:17:49,080 Speaker 1: have people who don't trust. I'm dealing with the distrust 314 00:17:49,160 --> 00:17:53,840 Speaker 1: of the medical field. So with me, now UM for 315 00:17:53,880 --> 00:17:55,560 Speaker 1: me to build a trust like I will meet them 316 00:17:55,560 --> 00:17:57,359 Speaker 1: where they're at and talk normal. I'm not trying to 317 00:17:57,400 --> 00:18:00,640 Speaker 1: talk any nine letter words. You know. I would tell 318 00:18:00,720 --> 00:18:02,960 Speaker 1: them to like I would if you understand, I have 319 00:18:03,040 --> 00:18:05,840 Speaker 1: to get to their level and they will see that 320 00:18:05,920 --> 00:18:09,439 Speaker 1: I'm not be asking them. Toyan says building trust with 321 00:18:09,480 --> 00:18:13,159 Speaker 1: patients is essential to improving care over the long term, 322 00:18:13,200 --> 00:18:15,880 Speaker 1: and it's one of the ways the medical system has failed. 323 00:18:16,920 --> 00:18:19,040 Speaker 1: You think about what, um, what it feels like for 324 00:18:19,080 --> 00:18:22,840 Speaker 1: somebody to walk into a hospital or a clinic. Um, 325 00:18:22,840 --> 00:18:26,280 Speaker 1: it's an unfamiliar space. UM. You are kind of at 326 00:18:26,280 --> 00:18:30,080 Speaker 1: their mercy. UM. You're in a thin paper gown. You 327 00:18:30,119 --> 00:18:32,399 Speaker 1: sit where you're told to sit. UM. And the person 328 00:18:32,440 --> 00:18:33,879 Speaker 1: comes in and they've got a white coat on it, 329 00:18:33,880 --> 00:18:35,439 Speaker 1: and they've got all these letters on their name, and 330 00:18:35,480 --> 00:18:38,120 Speaker 1: they are you know, they're typing a computer. You can't 331 00:18:38,119 --> 00:18:39,800 Speaker 1: see the screen. You don't know what they're saying about you. 332 00:18:39,840 --> 00:18:42,399 Speaker 1: There's so many ways in which we reinforce this notion 333 00:18:42,440 --> 00:18:46,520 Speaker 1: of power UM. That is UM that is so antithetical 334 00:18:46,600 --> 00:18:50,600 Speaker 1: to trust building. The problem is particularly acute for people 335 00:18:50,640 --> 00:18:53,960 Speaker 1: who have historically been marginalized by the medical system or 336 00:18:54,000 --> 00:18:56,920 Speaker 1: society more broadly. You know, when I talked to my 337 00:18:56,920 --> 00:19:00,920 Speaker 1: my African American patients, I not and frequently will people 338 00:19:00,960 --> 00:19:02,159 Speaker 1: say to me like, I'm scared to go to the the 339 00:19:02,200 --> 00:19:03,919 Speaker 1: hospital because I don't feel like they treat people like 340 00:19:04,040 --> 00:19:08,040 Speaker 1: us well. And none of us can in today's day 341 00:19:08,040 --> 00:19:10,080 Speaker 1: and age, with all the reporting around this faint shock 342 00:19:10,480 --> 00:19:12,560 Speaker 1: about that, we can't say, oh, no, it's just you're 343 00:19:12,560 --> 00:19:15,840 Speaker 1: making that up. It's true, it's true. They feel it 344 00:19:15,880 --> 00:19:17,880 Speaker 1: because they know it to be true. And the way 345 00:19:17,920 --> 00:19:21,520 Speaker 1: we pay for healthcare only makes this gap and trust wider. 346 00:19:22,320 --> 00:19:25,199 Speaker 1: Doctors are reimbursed for the volume of care they deliver, 347 00:19:25,760 --> 00:19:29,040 Speaker 1: and the cost of that care is often hidden from patients. 348 00:19:29,160 --> 00:19:33,160 Speaker 1: It creates incentives to do things to people, um, even 349 00:19:33,160 --> 00:19:37,280 Speaker 1: when they may not actually deliver value to them. And 350 00:19:37,280 --> 00:19:40,560 Speaker 1: and and we're we're basically not at all transparent around prices. 351 00:19:40,800 --> 00:19:43,640 Speaker 1: The pressure on doctors to see more patients in less 352 00:19:43,680 --> 00:19:47,320 Speaker 1: time has further eroded trust with patients. The worst thing 353 00:19:47,440 --> 00:19:49,479 Speaker 1: that we've done is we've created such pressure on our 354 00:19:49,480 --> 00:19:53,639 Speaker 1: clinicians in particular that we have um made it almost 355 00:19:53,640 --> 00:19:56,840 Speaker 1: impossible for them to just be humans and be human 356 00:19:56,880 --> 00:19:59,960 Speaker 1: with their patients in ways that for a long time, 357 00:20:00,040 --> 00:20:03,199 Speaker 1: I think it's surmounted all the other barriers, right Like, 358 00:20:03,280 --> 00:20:06,000 Speaker 1: if I can just sit with you, look in your eyes, 359 00:20:06,720 --> 00:20:08,400 Speaker 1: you know, put my hand on your hand, and tell 360 00:20:08,440 --> 00:20:10,919 Speaker 1: you that I'm like, I'm here because I want to 361 00:20:10,960 --> 00:20:13,240 Speaker 1: do best by you, That I will tell you the 362 00:20:13,240 --> 00:20:15,520 Speaker 1: truth as best as I know it, that I will 363 00:20:15,560 --> 00:20:18,760 Speaker 1: do my very best to help you live your best life. 364 00:20:18,800 --> 00:20:21,199 Speaker 1: If I could, if I had ten minutes to just 365 00:20:21,359 --> 00:20:24,359 Speaker 1: do that with you, perhaps all the other stuff wouldn't matter. 366 00:20:24,720 --> 00:20:27,680 Speaker 1: But we've stripped even that away. UM, so that now 367 00:20:27,720 --> 00:20:29,920 Speaker 1: our clinicians don't even have the ten minutes to do that. 368 00:20:30,320 --> 00:20:32,680 Speaker 1: City Box is up against some of the biggest challenges 369 00:20:32,760 --> 00:20:35,840 Speaker 1: that face our health care system and our society. It 370 00:20:35,920 --> 00:20:39,520 Speaker 1: treats the most expensive, complex patients. It's trying to re 371 00:20:39,640 --> 00:20:42,640 Speaker 1: engineer a health care system that often doesn't work well 372 00:20:42,680 --> 00:20:45,399 Speaker 1: for them. And if it does all that, toy and 373 00:20:45,480 --> 00:20:48,480 Speaker 1: believes that City Bok can save the system money while 374 00:20:48,520 --> 00:20:51,520 Speaker 1: improving the lives of the people it's so often fails. 375 00:20:56,400 --> 00:21:00,359 Speaker 1: And that's it for this week's prognosis. Thanks for listening, yeh. 376 00:21:06,720 --> 00:21:08,720 Speaker 1: Do you have a story about healthcare in the US 377 00:21:09,040 --> 00:21:11,280 Speaker 1: or around the world We want to hear from you. 378 00:21:11,800 --> 00:21:14,960 Speaker 1: Find us on Twitter at Fay Cortes or at Jaytaws. 379 00:21:16,359 --> 00:21:18,720 Speaker 1: If you're a fan of this episode, please take a 380 00:21:18,720 --> 00:21:21,400 Speaker 1: minute to rate and review us. It really helps new 381 00:21:21,440 --> 00:21:25,720 Speaker 1: listeners find the show and don't forget to subscribe. This 382 00:21:25,760 --> 00:21:28,760 Speaker 1: episode was produced by Toe for Foreheads. Our story editor 383 00:21:28,800 --> 00:21:32,680 Speaker 1: was Rick Shine. Special thanks to Healthcare team leader Drew Armstrong. 384 00:21:33,480 --> 00:21:36,639 Speaker 1: Francesca Levie is head of Bloomberg Podcasts and We'll be 385 00:21:36,680 --> 00:21:39,200 Speaker 1: back next week with the new episode. See you then.