Can Cityblock Health show us how it’s done?

01/03/21 • 9 min

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Episode 6 of Healthcare Beans podcast Cityblock Health is a unicorn startup serving high quality healthcare to low-income communities. Episode takeaways: (1) There are several high profile companies supporting the nation's transition to value-based healthcare. Cityblock Health is at the forefront. Here's a short list: Oak Street Health, Iora Health, Lumeris, and UniteUs. (2) Managing healthcare spending for complex, low-income patients is not an easy task - many smart, dedicated people have tried and failed. (3) Addressing the social determinants of health may be the determining factor for long-term success - not just for Cityblock Health, but for the entire sector. ~ James Transcript Hello and welcome to Healthcare Beans, I’m your host James Haven. In this episode, I’m going to focus on a rather interesting startup in value-based healthcare. On Healthcare Beans, I often talk and write about the many federal and state programs which address some really big challenges in healthcare (mostly around lowering healthcare spending or expanding access to good healthcare) and to be fair, the results of these government programs are kind of mixed. Many of these programs fall under some sort of accountable care model and these models try to connect physician (or hospital) payment to patient health outcomes; to put it simply, this means good doctors are rewarded for delivering good care, and bad doctors are financially penalized. But again, the results of these programs are mixed; many of them have not actually reduced the cost of healthcare (at least not in any significant way), and only a few programs show some promise in doing that in the near future. Outside of government programs, there are many interesting and valuable developments in the private sector, and in the end, it wouldn’t be surprising if healthcare companies make some real lasting changes in terms of lowering the cost of healthcare and improving our health outcomes. And the companies I’m currently thinking about use different types of data along with specialized care teams in order to manage (or drive down) healthcare spending. These companies (that I think are worth keeping an eye on) are Oak Street Health, Iora Health, Lumeris, Unite Us, and Cityblock Health. And I include these company names with links in the show notes, if you’re interested in learning more about them. So with that, I’d like to dive more deeply into Cityblock Health. Cityblock is headquartered in Brooklyn NY, and operates across NYC, Connecticut, Chicago and Washington DC. The company specializes in delivering quality healthcare to low-income patients. Now, when you hear “low-income” a few key points come to mind. Low-income patients often have more health problems than people with average incomes, and this is a well-known pattern coming out of numerous studies in Medicare and Medicaid. And because low-income patients have more health problems, they’re much more expensive to care for; they’re more likely to end up in the emergency room, and more likely to be hospitalized. And perhaps most importantly, low-income patients have social service needs that are often unmet. And that could be a lack of transportation, or unstable housing, not having enough nutritious food, being socially isolated... so not having nearby friends or family – and studies have shown these types of social problems play a huge role in poor health outcomes. Going back to Cityblock Health, the company just completed Series C fundraising and is currently valued at over $1 billion, so perhaps there’s an IPO in the near future. And early reporting suggests the company’s healthcare delivery model can reduce unnecessary health spending among complex patients. All in all, I’d love to invest in Cityblock Health if given the chance (it’s a very exciting company), but at the same time, it’s really important to understand just how difficult it is to truly reduce healthcare spending (emergenc...

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Carallel and caregiver burden in the US

Episode #5 of the Healthcare Beans podcast In the United States, caregiver burden is a really big problem. Episode takeaways: (1) Care-giving is very stressful work and roughly 48 million people in the US are spending about 28 hours per week caring for loved ones. (2) Patient health outcomes depend on your home environment. When you get sick, your future will depend on a caregiver. (3) A startup called Carallel (www.carallel.com) has demonstrated success in helping caregivers do their jobs well, and with less stress. Listen to the episode to learn more. Transcript Hello and welcome to Healthcare Beans, I’m your host James Haven. Today I want to talk about a major problem in healthcare (and really, across society) that has, historically, received very little attention. And to be fair, there’s really no shortage of problems facing health systems in the United States; some of the big ones are, of course, how we pay for healthcare (which is way too much), the quality of healthcare (our health outcomes are not awesome, especially considering the price tag), and access to healthcare (too many people don’t have insurance or they’re worried about losing their health insurance) – but the problem I want to highlight is the invisible healthcare workforce. As I’ve discussed in episode #3 of Healthcare Beans, there are a lot of people involved in delivering good care to you and your loved ones, and when we think about these folks, we’re usually thinking about doctors, nurses, care managers, social workers, data analysts, transporters, and several layers of administrators, and the list goes on and on. But the invisible healthcare workforce is you. It’s the unpaid caregivers at home; every patients’ family and friends who sacrifice their time and their energy to care for loved ones. And these caregivers are absolutely critical to ensuring good health outcomes for patients. And here’s why... Health outcomes are greatly affected by our home environments. Things like preparing healthy meals, making sure the oven is turned off, making sure there’s adequate heat in the home, moving safely from the bed to the bathroom and back again (recovering patients and chronically ill people have a high risk of falling in their homes), keeping track of their medications, getting fresh air and sunlight, touching base with the patient’s care team, and simply having healthy social interactions to ward off depression and anxiety. Altogether, this is a ton of work, and if you’ve ever dealt with sick friends or family members, you can understand the stress that comes with being a caregiver. In health policy circles, we call this “caregiver burden” and it’s no joke. Here are some stats that help paint a picture of how massive caregiver burden is in the United States – a new study from AARP & the National Alliance for Caregiving (this study came out in May of 2020) estimates that roughly 48 mil people are serving as unpaid caregivers in the United States, averaging about 24 hours per week performing caregiving activities. That is an enormous amount of unpaid, stressful work – and Gallup research estimates the direct economic cost of caregivers being absent from their paid jobs (to care for loved ones), is in the neighborhood of 28 billion dollars, annually. Suffice it to say, we need to start looking at solutions to the huge caregiving problem in the United States. And that’s why I’m pretty excited about this new company called Carallel – which is a digital platform designed to help caregivers reduce the stress that comes with caregiving, and actually help caregivers do a better job at managing the needs of their loved ones. So first, I’ll talk about how Carallel came to be. This company sprang out of the Guidewell innovation challenge which was called “Caring for Caregivers” – this challenge was launched in 2019. If you haven’t heard of Guidewell, it’s a rather interesting outfit - it’s essentially a holding company that owns...

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Virtual reality is now a healthcare thing

Episode 7 of the Healthcare Beans podcast Virtual reality (VR) therapy can be very effective for treating pain. The key issues are the types of pain that can be treated with VR, and how we can pay for it. In early 2020, Medicare approved payments for acupuncture to help treat pain without prescribing opioids, which clearly signals the demand for different ways to treat pain. Episode takeaways: (1) Due to the opioid crisis, it's very difficult to (legally) get your hands on prescription pain medication. Clinicians are reluctant to prescribe opioids for anything except severe pain. For people with substance use disorder, this is a good thing. But that also means we need other, non-addictive ways to treat or eliminate pain. (2) Virtual reality companies like AppliedVR and XR Health are providing VR therapy to better manage acute pain, chronic pain and anxiety. VR therapy can be self-administered in your home, after receiving minimal instruction. (3) The next step for VR therapy is getting health insurance companies to pay for it. Certain Medicare Advantage plans and commercial insurers have started covering VR therapy, but it still has a long way to go. The benefits of virtual reality for patients are becoming clear, but what's not clear is whether the technology will be widely adopted, or will it actually help lower the rates of opioid addiction in the United States. I'm betting it will do both. ~ James Transcript Hello and thanks for tuning into episode #7 of Healthcare Beans, I’m your host James Haven. This episode is inspired by a recent experience I had with my dentist (and please bear with me – this will certainly connect with the broader theme of healthcare in the United States).. So I showed up for an emergency visit on a Saturday; and I was in a lot of pain and it turned out that I needed my wisdom tooth pulled... I’m one of those types that wait till the last minute for dental care because I just hate going to the dentist. Now, I’ve had this sort of dental work before, where after a tooth extraction, I start to experience a lot of pain, maybe around 4 hours after the surgery, when the pain medication wears off. As a matter of fact, I once ended up in the ER after dental surgery, the pain was so bad. So I describe my past experience with the dentist and I ask her for prescription pain medication (real pain medication); not high dose tylenol/ibuproferin. And she said to me (these are her exact words) – it’s not in my philosophy to prescribe opioids for a tooth extraction. I got to say, I wasn’t expecting that, and I was a little upset. Nobody wants to hear about someone’s clinical philosophy when you’re having pain. So I left the dentist office with a useless prescription of high-dose Tylenol and crossed my fingers for good luck. About 6 hours later, I was in serious pain. The Tylenol didn’t work, the dental office was closed, and I was pacing back-n-forth in my living room because that’s what I do when I’m not feeling well. And then it hit me – the last time this happened (and I ended up in the ER), the emergency room physician gave me a prescription codeine; and I filled that prescription. So the codeine was somewhere in my home, I just had to find it. And that’s what I did; I frantically searched for the codeine, found it, and popped one pill. And about 20 min later, the pain was much reduced and after another 10 min, the pain was pretty much gone. Presto! Now, the moral of the story is not that codeine is the best thing since sliced bread; I mean, it worked well, but that’s not the point. The point is that pain management is a very real problem in healthcare. Dentists and doctors are very reluctant to prescribe opioids, and there’s a very good reason for that; the opioid epidemic is killing thousands every year, and the best way to save lives, at least in the near term, is to stop prescribing opioids for anything less than 3rd degree burns (unfortunately).