EP 53: Dr. Toyin Ajayi (Co-founder/CEO Cityblock Health) - Founding a $6.2B Business Focused on Providing Healthcare to the Impoverished

In the 53rd episode of the Logan Bartlett show, we’re joined by Dr. Toyin Ajayi, co-founder and CEO of Cityblock Health, and discuss the state of the U. S. healthcare system, out-of-control medical costs, transitioning to CEO, and diverse hiring in the workplace. (0:00) Intro (1:35) Welcome Dr. Toyin Ajayi (2:53) What is Cityblock? (10:48) Medicaid and the business model (15:32) Taking on the most expensive part of the population (22:05) Why for-profit (28:41) Working with a broken healthcare system (38:00) Arguments for democratizing healthcare (42:03) Dr. Toyin Ajayi’s background (47:04) Working on HIV/AIDS prevention (51:56) Building a non-profit (1:02:57) Having a co-founder step back (1:05:50) Diverse hiring Mixed and edited: Justin Hrabovsky Produced: Andrew Nadeau and Rashad Assir Executive Producer: Josh Machiz Music: Griff Lawson 🎙 Listen to the show Apple Podcasts: https://podcasts.apple.com/us/podcast/three-cartoon-avatars/id1606770839 Spotify: https://open.spotify.com/show/5WqBqDb4br3LlyVrdqOYYb?si=3076e6c1b5c94d63&nd=1 Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9zb0hJZkhWbg 🎥 Subscribe on YouTube: https://www.youtube.com/channel/UCugS0jD5IAdoqzjaNYzns7w?sub_confirmation=1 Follow on Socials 📸 Instagram - https://www.instagram.com/theloganbartlettshow 🐦 Twitter - https://twitter.com/loganbartshow 🎬 Clips on TikTok - https://www.tiktok.com/@theloganbartlettshow About the Show Logan Bartlett is a Software Investor at Redpoint Ventures - a Silicon Valley-based VC with $6B AUM and investments in Snowflake, DraftKings, Twilio, Netflix. In each episode, Logan goes behind the scenes with world-class entrepreneurs and investors. If you're interested in the real inside baseball of tech, entrepreneurship, and start-up investing, tune in every Friday for new episodes. Executive Producer: Rashad Assir Producer: Leah Clapper Mixing and editing: Justin Hrabovsky Check out Unsupervised Learning, Redpoint's AI Podcast: https://www.youtube.com/@UCUl-s_Vp-Kkk_XVyDylNwLA 🎥 Subscribe on YouTube: https://www.youtube.com/channel/UCugS0jD5IAdoqzjaNYzns7w?sub_confirmation=1 Follow on Socials 📸 Instagram - https://www.instagram.com/theloganbartlettshow 📱 X - https://twitter.com/loganbartshow 🎬 Clips on TikTok - https://www.tiktok.com/@theloganbartlettshow About the Show Logan Bartlett is a Software Investor at Redpoint Ventures - a Silicon Valley-based VC with $6B AUM and investments in Snowflake, DraftKings, Twilio, and Netflix. In each episode of The Logan Bartlett Show, we sit down with the people behind today’s most important startups and extract the tactics, lessons, and frameworks they’ve learned the hard way. Conversations span hiring to GTM, product, growth, fundraising and everything in between - collectively forming the ultimate playbook to make you a better CEO, investor or board member. Tap follow and enable notifications to stay ahead of the game.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:05Logan Bartlett?

  Welcome to the 53rd episode of Logan Bartlett Show. I'm your host Logan Bartlett, a partner at Redpoint Ventures. And what you're going to hear on this episode is a conversation that I have with Dr. Toyin Ajayi. She is the co-founder and CEO of City Block. City Block is a 1,300-person business that's focused on the Medicaid population and have invented a disruptive way of servicing people and actually doing good in the world. And so this was actually one of the more fun conversations I've had. We go into the healthcare system as it currently stands, why the costs are out of control in the United States, how they're looking at innovating and also doing good in the world, politics in the workplace,

• 0:48Logan Bartlett?

  hiring diverse people within your company, transitioning to CEO after initially starting as the president and co-founder of the company. Really, really fun conversation with Toyin. I appreciate her making the time and going through all the different stuff here. So trust you really enjoyed that. Before we get into that, though, just a quick reminder to like, subscribe, share, all of that stuff. We really appreciate it. We want to keep growing, keep sharing and doing well with the performance of the show. And so appreciate everyone continuing to get the word out, continuing to promote the podcast for us. We really enjoy doing it and want to keep growing and make this into as big a show

• 1:31Logan Bartlett?

  as it possibly can be. So thanks, everyone, for listening. And you'll hear now Dr. Toyin Ajayi. Dr. Toyin Ajayi, thank you for doing this today.

• 1:39Speaker 01

  Thanks for having me.

• 1:40Logan Bartlett?

  So you are the co-founder and now CEO of City Block Health. I wanted to do this for a while, for a bunch of reasons, I think, not the least of which, I guess, most recently valued at $6.2 billion. You've raised almost $900 million in venture capital from amazing investors like Redpoint and then other investors like Thrive, General Catalyst.

• 2:01Speaker 01

  All those other guys.

• 2:02Logan Bartlett?

  Tiger, Google, Wellington. You have good investors and then you have people like Thrive and Wellington, Tiger, all those other guys. But, and how many people are you guys today?

• 2:10Speaker 01

  We're about 1,300.

• 2:11Logan Bartlett?

  1,300, wow. So all that stuff is interesting and puts you in rarefied air. But then also your business is fascinating. And I remember when I was joining Redpoint, so I joined three years ago and the investment had already been made. And but I was talking to my partner Elliot, who led our investment in City Block about the investment when he was making it. And he described it to me and I was like, interesting, that doesn't seem like a venture-backed idea. There's obviously social good elements of this. I'm like, this seemed like a great thing to do in the world. And he broke it down and like started going through all the details of how the business actually works and all that. So I've always been fascinated and admire of what you guys are doing, just, you know, from the outside in. So maybe, can you give us just, what is City Block?

• 2:56Speaker 01

  Yeah.

• 2:56Logan Bartlett?

  And, yeah, and where you guys are today in your journey?

• 2:59Speaker 01

  Yeah, so we're a tech-enabled healthcare provider, which means we provide clinical services and social services focused on low-income marginalized people, mainly people who receive their health insurance through Medicaid, which is a sort of state-run federally subsidized program that creates insurance options for people who fall below the poverty threshold. We provide primary care, mental health, and social services. And the way our business works is we sell to health insurers that hold those contracts with the state and the federal government to take care of those individuals. And we take financial risk. So we essentially say, we're so confident in our ability to find people who've been, you know, marginalized from the healthcare system, folks who are struggling with homelessness and food insecurity as an example.

• 3:44Speaker 01

  We're going to find them, build relationships of trust with them in the healthcare system, and then deliver high-value, often community-based healthcare. So think primary care in their homes, think mental health and therapy services, think social services coordination. All is a way to help reduce the progression of their illnesses and reduce their need to go to the emergency room in the hospital, which is way more expensive as a use of healthcare dollars than the primary care and mental health and social services. And so we make a margin as a business when we do what we plan to do, which is to drive healthcare spending away from expensive reactive emergency room visits, hospitalizations, and towards Preventative proactive primary care and mental health.

• 4:29Speaker 01

  We save money because people are less sick. They're utilizing fewer healthcare resources and fewer expensive healthcare resources. And that's the margin that drives our business over time. So we currently operate in six markets. Northeast, further into the South, now in the Midwest. We serve about 100,000 people in these risk bearing relationships where we're actually accountable for the medical spend in addition to the clinical care we provide to them. And we've been scaling pretty quickly over the last five years.

• 4:58Logan Bartlett?

  That's great. I want to go into all of that. There's, I guess, three different components I want to hit. One is the care service. Then the other is the kind of the industry and Medicaid and all of that. And then the final one is kind of your business where you guys fit in there. But can you take me through like a journey of an individual person that you guys are servicing? And maybe it's a real example, maybe just an illustrative one of like someone that you provide care to and how you actually go about preventative care in that way?

• 5:26Speaker 01

  Yeah, absolutely. So we take care of a pretty significant number of people who struggle with mental health challenges. If you have a serious mental illness, so diagnoses, you may have heard schizophrenia, bipolar disorder, complex trauma, your likelihood of having to go to the hospital, your actually your risk of death, premature death, is orders of magnitude higher than someone who doesn't have those diagnoses because they have both physical health implications from the medications you tend to be on. People are at risk for diabetes, for heart disease. But there's also the risk that if you don't get your medicines, if you don't get the therapy that you need, that you're going to have an exacerbation and end up back in the hospital. So imagine a City Block member who has been struggling with a mental health challenge.

• 6:10Speaker 01

  Maybe they also have a substance use issue. These things often go together. So they're using drugs off of the street in addition to having challenges with their mental health. Their typical experience before City Block is that they've got a, maybe if they're lucky, they've got a therapist who they have a relationship with. They may have a psychiatrist who prescribes medications for their mental illness to help keep it at bay. They're likely utilizing drugs that they purchase off the streets. And they often have very significant challenges with social issues. Housing being a particular one, transportation to and from the doctors. They don't have a lot of money in their pocket. And what we hear and understand from the experiences of people living with mental illness is that they first of all experience like just the fragmentation of the healthcare system. It's almost impossible to get through.

• 6:54Speaker 01

  I once rode an elevator in a safety net hospital with a person who was sobbing. And I said, you know, what happened to you? And they said, well, I've been waiting for my psychiatry appointment to see my psychiatrist for six weeks because they were booked out for six weeks. I came in today. I had to take two buses to get here. And I got to the clinic and they told me that I hadn't reconfirmed. They left me a voicemail and they missed it. And they'd given away my slot. And this person was devastated. They waited six weeks for an appointment. The average doctor's visit for folks with serious mental illness is somewhere on the order of 40 minutes. You come in, like I said, if you're lucky, once a seven, six weeks and you get 40 minutes of a conversation, your drugs are prescribed and you're out the door. And that's it. And so you can imagine what that's like for people.

• 7:37Speaker 01

  At baseline, it's no surprise then that these folks often don't make it to the doctor's appointment. If you're having to take two buses, if you're having to figure out how to pay for childcare for your kid while you're gone, or it's a day off work, right? And that's cash out of your pocket. These folks tend to not access primary care effectively. And so what happens for a lot of these patients is that things get so bad that they have no choice but to go to the emergency room. And so if you imagine being a person who's struggling with mental health, who's hungry, who doesn't have a warm place to sleep at night, who feels stigmatized and unlistened to by the healthcare system and by the people around you, and it's Friday night and it's cold and you're alone. Actually, the only place you can go and feel sort of certain that someone will treat

• 8:21Speaker 01

  you like you matter, even for a minute, will actually have to ask you how you're doing and may feed you and give you a place to sleep, is the emergency room. And so we've created a system where the hospital is the default place to go for people who really need something completely different. Because what's the hospital going to do? They're going to stabilize you for a night, maybe give you some medicines and send you right back out into the world again. And so the city block experience is to say, we're going to stop this cycle because this cycle leads to premature death. It leads to a complete waste of healthcare resources. We're spending money on things that aren't high value. And most importantly, it's abrasive and traumatizing to people who deserve more and deserve better. And so what we do is we find people. We go to where they are. We don't wait for them to come to us. We reach out to them in shelters.

• 9:06Speaker 01

  We meet them on the street corners. We meet them in their homes. We build relationships of trust with them, brokered by people who are like them, have a similar lived experience, come from the same communities they come from, don't come with the bias and the stigma that is often associated with with people who access the healthcare system more traditionally. We figure out what they need and then we provide care to them. We'll come to your house. We'll get your therapist to you in your home. We'll make sure that the moment you say, hey, you know what? I'm ready to stop using heroin. I'd like to try something else. We'll get to your house as quickly as we possibly can and initiate you on a medication so you don't have to go through withdrawal, so we can help you stay away from the street drugs when you're ready. And if you're not ready, or you, you know, slip, as people do, we won't judge you.

• 9:50Speaker 01

  We'll come right back and continue to do that work. And over time, what that means is that a City Block member has a relationship of trust with a team member at City Block. They've been listened to and heard. They feel respected and dignified. And they're also receiving care, primary care, mental health, addiction services, that are high value and lower cost than if they were to go to the emergency room over time. And what that translates to is healthcare savings, improved quality, better engagement and better health outcomes across the population.

• 10:21Logan Bartlett?

  It's really, it's an amazing service and I'm sure the, I mean, the proof's in the pudding in terms of your ability to actually change outcomes and all of that. In terms of like the the industry and the way that you're able to do this, right? And I think maybe a little bit of a primer on Medicaid is probably helpful because you're going at risk and basically putting your money where your mouth is or putting your service where the money is, or whatever the analogy is. Can you talk a little bit about Medicaid and how your business fits into all of this? And maybe the experience, we talked about how fragmented all this stuff was for someone else, but. How do they actually go about getting Medicaid? And how does this shift in your business model?

• 11:06Speaker 01

  Yeah, absolutely. So every state administers a Medicaid program. And that's supported by federal dollars, but also by state taxpayer dollars. And the program is basically designed to provide insurance coverage for people who don't have an employer who can pay for that

• 11:22Logan Bartlett?

  Yep.

• 11:22Speaker 01

  and who are eligible on the basis of a number of criteria. But largely, it's somewhere along the sort of threshold for what that state considers the poverty line. And extric inclusion for people who are pregnant and for small kids, for young children. And so that program, state by state, is administered kind of differently. There's some kind of core rules, but it looks a little different. A person is eligible for Medicaid if they meet the criteria that their state has put forward. And if they do that, they can then go out and actually pick a Medicaid plan. That's what sort of the managed care program looks like. Instead of states individually paying healthcare providers, more often than not, states are subcontracting those contracts to private insurance companies.

• 12:07Speaker 01

  Big names you've heard of, United Healthcare, Aetna, as well as smaller regional health insurance plans. Take on, they bid for these contracts and then they become the sort of fiduciary agent of the state in managing that program. So they go out, they contract with healthcare providers. They've got to get a network of doctors and, you know, clinics and hospitals. And they go out and become the insurer of record for these members, which means they have to underwrite their medical spend. And the way our business works is we go to those insurers and we say, hey, you've got, you know, tens of thousands, sometimes up to a million people who you are accountable for providing health insurance to. What we know is that there's a subset of those, of that population,

• 12:51Speaker 01

  probably about 20, 30% that are your highest risk individuals. These are folks who have all of the challenges I described earlier. These are the folks who may not be using the healthcare services they have accessible to them in the ways that we would want them to because of stigma, because of all of the sort of challenges in the system, because it's so hard to access them, because they don't have transportation, because... Fill in the blank, a whole host of reasons that we can describe in more detail. How about we partner with you, health insurer, and we take on that risk with you? And we take accountability for going to find those members and providing care to them. And what that does is it changes our business, it changes our incentives and creates a business model for us to do the things we do differently. Because instead of being a typical provider in the network where we get paid, you know,

• 13:36Speaker 01

  60 bucks for a primary care visit when a patient comes in, we don't get paid any money. And it's sort of typical fee for service for finding people or for engaging them if they didn't show up in the clinic. We've created an incentive structure where we get paid only on the population outcomes. We get paid to do all of those extra things that I described. Coming to people's homes, helping them with transportation, engaging them, showing up for them when they're struggling. Because our overall pool of resources available is tied to the total medical spend and not just to the service we provide.

• 14:09Logan Bartlett?

  And that's why the example of the 40-minute therapy session, you guys will go an hour or an hour and a half.

• 14:15Speaker 01

  We can go as long as we need to.

• 14:15Logan Bartlett?

  Whatever they actually need, because you're actually trying to change the outcome. Because you're on, you're taking the risk of bending the cost curve, right?

• 14:24Speaker 01

  That's exactly right. So we've changed, we've changed the incentives to align around doing the right thing for the total population, doing the right thing long-term for the number. It's almost, I mean, the way I sort of describe it is like, you know, the typical healthcare system, the fee for service, you pay for what you get. It basically rewards units of healthcare services provided irrespective of the outcome. Right? If I'm a therapist in a traditional fee-for-service model, I do my 40-minute visit or my 50-minute visit, I bill for it, I get paid. Doesn't matter if the patient goes from my office to the emergency room. Doesn't matter if they never come back again. Doesn't matter if they don't feel any better at the end of the visit. Doesn't matter if they ultimately have a terrible outcome. Actually, I'm not getting paid for the outcome. I'm getting paid for the service I've rendered.

• 15:09Speaker 01

  We've changed that incentive structure, so we get paid for the outcome. It doesn't matter, frankly, if I spend 40 minutes or four hours or 10 hours over the course of six days. If the member gets better, if the patient we're serving gets better, that's what matters, right? And so we've created a different incentive, so we're getting paid for outcomes as opposed to for units of services provided.

• 15:32Logan Bartlett?

  In taking on that part of the population, the highest risk, presumably the most expensive, is the value prop to United and Aetna and Humana, whoever it is, are they excited for you when you come in and say, "Hey, you can take our most expensive, presumably difficult to reach part of the population"?

• 15:50Speaker 01

  Yeah, that's right, because they're struggling with a number of challenges. One, of course, is the cost, but they're also struggling with, it's hard to achieve quality outcomes when you are struggling to engage this population of folks. You know, most plans are not set up to have boots on the ground, people in the community, a whole different incentive structure for caring for them. And so, yes, the value prop to them is, we've built a really kind of important skill set and a niche expertise in finding, engaging, building relationships with and providing care to your most complex, highest cost, most in need population. Let's take on that burden. And we're so confident in our ability to bend the needle that we'll take on the financial risk for that.

• 16:32Logan Bartlett?

  And so the business itself, 1,300 people, how do you bucket the, do you call them city blockers? I don't know.

• 16:39Speaker 01

  City folk.

• 16:40Logan Bartlett?

  City folk. How do you bucket the city folk in terms of like the responsibility? Because it's tech-enabled service, right? But you actually need to provide the service as well. So what are the big buckets?

• 16:50Speaker 01

  That's right. So the biggest set of component of our teams are folks in the community who are providing care. So ranging from our community health partners, those are individuals we hire from the communities we serve, people often with lived experience of some of the challenges our members go through. We hire them for empathy, for trust-building, for relationships, for tenacity, for organizational skills. But they're not clinically licensed, in fact deliberately not clinically licensed. These are folks who are really just... Feel like their, their job is to sort of understand the totality, what's going on for people. They form a large part of our workforce.

• 17:25Logan Bartlett?

  Why, why deliberately not clinically licensed?

• 17:27Speaker 01

  Because there's, you know, when you've spent your entire like life bumping up against the healthcare system, um, and people tell you what to do all the time.

• 17:34Logan Bartlett?

  Sure.

• 17:35Speaker 01

  And it feels a little judgy and often it feels kind of alienating, you know? And, um, there's something about the first interaction you have with a person being like, let's talk about your diabetes and why you're not taking your insulin. That feels very different from, hey, I just want to get to know who you are and what matters to you and what are the things that you're struggling with? You might be more inclined to say, you know, I don't have enough money to pay my utility bill and so my, I don't have a refrigerator to keep my insulin in, that's why I don't take it. Um, or my, like my fridge is empty because I'm hungry and I'm really focused on working 14 hours a day and I can't remember to take my meds because I'm exhausted when I get home in the evenings. Those are the types of things that we need to understand in order to build the relationships that we need to then deliver the care.

• 18:17Speaker 01

  Um, and there are people who are better at that. Um, they're also, it's also sort of a better use of our resources, um, because we're very focused, of course, on being efficient and effective to say, let's use our clinicians to focus on the things that they're uniquely capable of doing. Diagnosing, managing, engaging in treatment for, um, for the needs that our members have, of which there are many. And let's use other people in the, in the healthcare ecosystem to do the relationship building, to follow up the supports around social needs and the case, case management, care coordination. Um, the other bucket of our workforce though is clinicians and we range from primary care doctors, um, addiction treatment specialists, um, palliative care physicians, advanced practice

• 19:02Speaker 01

  clinicians, nurses, um, lots of behavioral health specialists, therapists, um, nutrition, pharmacists. It's a very interdisciplinary approach to care, um, that really leverages, um, the, the, the power that you can get when you get everybody in the same room. So we're not saying to the patient or the member, go over there for anything that's neck and above. So your feelings, your thoughts, what have you, and go over there for, um, you know, your body. Um, we're all, we're all integrated and we're all talking to each other, using the same systems and tools. And then, you know, we've got around that then, the technology to enable us to stratify our population, our understanding with data of who our people are, what they need, what the biggest challenges they may be facing are,

• 19:46Speaker 01

  is critical, like really understanding the population, being able to segment them, being able to anticipate needs, being able to prioritize who we see when for what, and then convert that into decision support for the team members. So folks aren't figuring it out all the time. We actually have set pathways and protocols and programs that we roll members into based on what they need and that allows our teams to really be in the right place, right time for our folks and to be measured and really the performance to be managed against our care model. And that's really the use of technology and our data. We've got big teams really focused on technology and data, really to power the model and ensure that we're learning over time

• 20:31Speaker 01

  and that we're instrumenting it effectively so that our teams can be as efficient as possible out in the field. We also provide a fair amount of care virtually too, right? And so we've done a number of really interesting things, recognizing that tech literacy, access to, it's not so much smartphone penetration is actually quite high in our population. There's a little bit of a misunderstanding of how prevalent smartphones are, even for folks on Medicaid. They often have phones, but they don't often have access to his data. And then the trust and the literacy to use those tools. And so we've done a lot of work in helping to onboard people to virtual care. And then we physically facilitate virtual visits with our providers, our physicians and advanced practice clinicians

• 21:14Speaker 01

  using EMTs and paramedics in the home. So the idea is like, if you have an urgent need, say, you know, you call us and in the evening, you're having palpitations and you're not sure if it's your anxiety or if you've got a heart problem, you're nervous, you would otherwise go to the emergency room. We really want to keep you at home. You want to be at home too. We'll send a clinician, EMT or a paramedic, to your home. They can check you out, get vitals. But they'll also facilitate a real-time video consultation with one of our advanced practice clinicians or a physician who can aid in the diagnosis and put in place a treatment plan. So it's different from saying, hey, you can do a telehealth visit. You can sort of access and get on board yourself. We often, people struggle with that kind of stuff. And so we facilitate with technology.

• 22:00Speaker 01

  But we also bring our clinicians into the picture so they have real human contact in that encounter.

• 22:05Logan Bartlett?

  The overall mission in what you're doing is so inspiring and impactful. And the healthcare system is so broken in so many different ways that we can talk more about. I guess the key point is going at risk in all of this, right? And so we touched on this earlier, but you're actually saying, hey, we're going to do all this preventative care. And we think the total cost of service of the people within our population is ultimately going to be lower because we're going to help ensure that they're getting the right level of care so that they're not going to the emergency room, you know, just whatever. Because they're having their heart palpitations, to use the example earlier. The question I had was, when you were starting this,

• 22:49Logan Bartlett?

  why do this as a for-profit entity? Because you worked at Commonwealth Care Alliance, right? Which was a nonprofit.

• 22:57Speaker 01

  Yeah, that's right.

• 22:58Logan Bartlett?

  But kind of a similar-ish mission.

• 23:00Speaker 01

  Yeah.

• 23:00Logan Bartlett?

  Right, servicing similar populations. So when you were originally getting going, what was the inspiration to do this as a business rather than a social good? And then ultimately, making this work was actually the belief that you could bend the cost curve and actually change the outcome. And I assume you had some data or some intuition that that would actually be the case. I mean, it makes sense to me. But you probably didn't have tons of data that said you actually would be able to do that. So I'm just curious, what was that decision tree when you were getting going to do it this way versus that way?

• 23:35Speaker 01

  Yeah, yeah. So take the first piece, which is, why is this a for-profit company? And I think that the fundamental reason is that these models have to scale. This model has to scale. We want to meaningfully codify that there's a different way to provide care, particularly for people who are falling through the cracks. And scale requires capital. And it requires a business case that is sustainable. I actually have seen through my career, as you said, nonprofits all the way through. I've seen so many good programs die for lack of ongoing funding.

• 24:16Speaker 01

  I've seen such like haphazard application of, you know, of programs for populations that are based on, well, if I can get funding, I'll give you a great example, and this happens all the time in in community-based hospitals and clinics. You'll find that they have this wonderful program for, I don't know, breast cancer screening. So if you test, if you test positive, you have breast cancer. There'll be a case manager assigned to you. People will have this incredible experience of navigation. If you were the same patient and you had a different kind of cancer, there's no program. Why? Because this team was more successful at raising funding for philanthropic dollars to go do that one thing. That's not a solution that scales. That's not a solution that actually bends the curve at all for anybody.

• 25:01Speaker 01

  I firmly believe that in order for innovation to disseminate, you've got to find a recurring, sustaining approach to funding the work. And in this case, it's obvious, like there's economic value to be had from the work that we do. Why not codify it in a business case that makes sense? That allows it to scale? That frankly dignifies the people we're serving with a set of services that we know will persist. Right? Because that's if we make money, when we make money, as we continue to show that it works. Like, we create ongoing incentives and recurring revenue streams to provide, to not just continue the care, but also to fund innovation and R and D as we continue to iterate on the model. It's really important to do that.

• 25:46Speaker 01

  Because I believe so firmly that we've got to be shifting things on a macro level pretty profoundly. And these isolated proofs of concept, these cool projects here and there, just won't cut it at scale. I think the other thing is that I believe in what we're demonstrating is that it is possible to marry many of the things that we love about nonprofits. The values, the mission orientation, the commitment to community with.

• 26:16Speaker 01

  A really sound business case and really sound economic theory of the case. And to do that, I think is actually, potentially creates a blueprint for business building in the future in general, outside of healthcare even. How do we think about building socially responsible companies with a culture and a focus on actually improving social, social good and addressing social good while also staying true to really solid economic fundamentals around ensuring that businesses are sustainable and that they make sense. And so that's, that was the reason. And, and it's, it's, and then to your sort of earlier, your other question about like, well, okay, so how do you take the data, the proof points and translate that? You know, I think that the reality is, for all the reasons I described, there's, there's

• 27:01Speaker 01

  a lot of evidence around all of the interventions we're putting in place. First of all, it's not rocket science. Like I just described it to you. All makes sense, right? Yeah, totally. You know, you've got somebody who's like hungry, on the streets, struggling, and there's no place for them to go and no one's trying to find them and provide care to them. You push them into a necessarily more expensive place in the healthcare system and you don't actually change outcomes. And so there's, there's, it's, it's, it's not, again, rocket science. There's evidence around all of these interventions. There's evidence around food and its impact on improving healthcare outcomes, particularly for people with diabetes and kidney disease and other chronic physical health issues. There's strong evidence for housing as a, as an intervention that meaningfully improves

• 27:44Speaker 01

  health outcomes and life outcomes for people, particularly people with serious mental illness who are street homeless. There's excellent evidence for care coordination and collaboration across all of the different healthcare providers, providing care to a person with complex needs. There's excellent evidence for primary care and for the importance of preventative care and addressing care quality and improving healthcare spend and utilization. And, you know, had the benefit of having operated in many of these models and innovated in many of these models prior to founding City Block. But, but putting that all together with a, as I said, this sort of aligned and the, the business model that creates incentives to do the right thing by our members, created,

• 28:25Speaker 01

  I think, the, the foundation for a, a powerful scale business that will in itself continue to create the incentives and the resources to push the envelope. Year on year and year and year to deliver better outcomes to these populations.

• 28:41Logan Bartlett?

  That's great. Now, now, this is all within the, you're innovating within the system that we have.

• 28:48Speaker 01

  Yeah.

• 28:48Logan Bartlett?

  Right. And I've heard you say, hey, if I could wave my magic wand and start over, we wouldn't necessarily end up in this exact incentive structure. I guess maybe even zooming out because Medicaid, Medicare, employer-based health insurance, all of that stuff is, it is a byproduct of decisions that were made, you know, 100 years ago at this point, right? In some ways, less so with some of the newer programs. But are there, are there other areas that you see that, that you would, you would change immediately within the overall system that, that are just low-hanging fruit for either the government

• 29:29Logan Bartlett?

  or how we administer care? Because we are operating within the confines of the structure we've set up. And what you're doing is just absolutely incredible. But we set up this system and it's obviously not the best system.

• 29:41Speaker 01

  Yeah, it's crazy broken. I mean, it doesn't matter who you are, right? Like if you're a consumer of healthcare, you know how awful it is.

• 29:47Logan Bartlett?

  Oh, totally. I don't shop for MRIs, right? Or whatever. If I have to go get an X-ray, I'm not price shopping. Like I would anything else. For a flight, I would go figure out what the cheapest flight is. But for an X-ray, I'm like, oh yeah, sure, I'll go there. And I have no idea what the price of it is, right? There's so many different incentives and problems that exist in the whole thing.

• 30:03Speaker 01

  It's so broken.

• 30:04Logan Bartlett?

  So if I gave you a magic wand, or if I, if there was a request for innovation from an entrepreneur, like, are there any things that just feel like very intuitive that we could actually change now that we've ended up with this system?

• 30:17Speaker 01

  Yeah, I mean, there are, I mean, these are all sort of changes on the margins, but like meaningful changes, right? Like so, expansion Medicaid. So first of all, people within, like, we need health insurance to access healthcare services, right? Like, people who are uninsured incur significant barriers to healthcare services and significant barriers to well-being. It's just.

• 30:40Speaker 01

  Not ideal. And we've created this sort of gap between employer-based insurance and Medicaid. In many states, it hasn't been closed. That's a problem. So Medicaid expansion, no-brainer. Get people coverage. Let's start there. Second thing is, how do you address access issues? Some of it's a reimbursement issue, and we're making progress around reimbursing, particularly behavioral health, in a way that's commensurate with the effort required, so that it starts to create an incentive for therapists and psychiatrists to actually come out of cash-paid private practice and take insurance. That's a problem. We have a real problem when we, you know, the majority in most communities, the majority of private practice therapists

• 31:22Speaker 01

  and psychiatrists can make the decision to just not take insurance. It makes no sense to them. The economics never, never work in favor of taking insurance, and that leaves out so many people from being able to access the services they need. We saw that the pandemic really accelerated again a bunch of kind of no-brainer, somewhat low-hanging fruit opportunities, particularly in advancing the ability to access telehealth services. Some of those are going to get rolled back as we roll back the public health emergency. Why? Why? We've proven that it's possible to provide a lot of services actually really well and really accessibly for people virtually. Why would we roll that back? Like, that seems like an obvious opportunity from a policy perspective to improve.

• 32:04Speaker 01

  Have been really excited to see recently that Medicaid programs are now allowed to fund more social services than in the past. There's a whole long road of opportunities we could take on there. There's been a historical, very significant prohibition for Medicaid funding housing. But we know that the relationship between housing and healthcare spend, healthcare needs, healthcare utilization is like, it's so intertwined. It's relaxing some of those rules to enable us to think about all of the factors that drive health and to fund interventions in those factors that drive health. Food, transportation, housing would be really, really important. But I've said it and I'll stand by it, right?

• 32:47Speaker 01

  Like, if I was designing this system from scratch, like, this would not be it.

• 32:51Logan Bartlett?

  Yeah.

• 32:51Speaker 01

  Like, it's just not.

• 32:53Logan Bartlett?

  I don't think any, no one can look at the cost and outcomes and say that, like, this is the best structure, right?

• 32:59Speaker 01

  Not at all.

• 33:00Logan Bartlett?

  Are there countries, and I haven't gone detailed into looking, I know there's many countries that have much better cost and outcome than the United States does.

• 33:08Speaker 01

  Almost basically every.

• 33:09Logan Bartlett?

  Every single.

• 33:10Speaker 01

  Every developed country.

• 33:11Logan Bartlett?

  Developed country is better, yeah.

• 33:12Speaker 01

  Yeah.

• 33:12Logan Bartlett?

  Is there anyone you really admire, like, how they've been ministered from a country's standpoint, how they've gone about doing this?

• 33:18Speaker 01

  Yeah, I mean, I think so. Fundamentally, I think the countries that do well, first of all, start with a notion that every single human in that country should be entitled to healthcare coverage in some way, shape, or form, irrespective of their ability to pay.

• 33:32Logan Bartlett?

  Which, which sounds like such a politic, like, it becomes so politicized in some way, like, everyone deserves healthcare. But like, even from a capitalist perspective, right? Like, let's take the humanity out of it. Like, starting from that premise bends the cost curve of the totality of what we pay, right? It's like, it's, it's, it's good business, quote unquote.

• 33:54Speaker 01

  It's good business, it's good business. These countries have said, it is, it behooves us to use taxpayer dollars to ensure, in addition to employers, and they've all figured out different ways of doing this, to ensure that every single person has access to healthcare, like, period. So, like, starting there, and that is a sort of a universal truism of all of the countries that perform better than we do in terms of value for dollars spent in the healthcare system. And just, just even looking at mortality, right? Like, look at the mortality, average life expectancy in all of these countries relative to the amount of money they spend in healthcare. And we are a complete outlier in the United States. So, starting with coverage, critical. The second piece is that, you know, we in the United States have been really slow.

• 34:38Speaker 01

  This is such a tension between the way we think about capitalism and the way we think about government, government and, and regulation. We've been really slow to regulate parts of healthcare that are very much subject to, to market failures. So, exactly what you said, right? Like, you have no incentive as a consumer to price shop for MRIs. And, and we haven't created. Any way of addressing that, information for you as an example. So there's an information asymmetry. Pricing is completely opaque to most consumers in the healthcare system.

• 35:10Logan Bartlett?

  And why is that? Just because of the incentive structure that comes with it?

• 35:13Speaker 01

  Because of the incentive structure that comes with insurance system. We've allowed it to become so opaque, so rife with opportunities for arbitrage, and so invisible to consumers that it's impossible for consumers to make rational choices about how they use their healthcare dollars, even when you're at risk for them through your copays, through your deductibles, through your premium overtime. So like we, and we're just starting to see people chip at that. But even things like saying, well, should we put price caps on healthcare services? Should we actually just cap how much anyone, anywhere can charge for an MRI? And this country's been unwilling to do that, right?

• 35:57Speaker 01

  Other countries say, yes, absolutely, we should. We know how much it costs to do an MRI. And we're going to say, there shouldn't be, you know, we, well, we're going to cap the spread between the lowest cost provider and the highest cost provider. And we're going to cap their ability to make profit on that spread because we believe that access, transparency, visibility to an understanding of how much things cost is more important in ensuring that we're, again, efficient fiduciary, we have a responsibility to the way that we spend our taxpayer dollars.

• 36:27Logan Bartlett?

  And there's some things that are binary in nature that sort of, before I get yelled at from all my libertarian friends on this, there's some things that are binary in nature in x-ray and MRI. There's some services that like, we roughly know what they call. We're not talking about like, the totality of doctors being able to charge what they view as appropriate, but there are certain services that are mostly binary in nature, right? You go in, you get them, and it should fall within a certain cost curve, and it just doesn't. Like, it's 10, 20x, 30x, the cost from, if you go to X versus Y, right?

• 37:02Speaker 01

  That's right. That's right. And, you know, I think, I think there are ways to do this that are still in keeping with. The American libertarian ideal in some ways, right? Like, every person should have a purchasing power. Like, we should give people the ability to use the market to create incentives for them to do well. Like, these are all things that are, I believe, important. We believe in choice here very much. And, you know, a lot of countries that have chosen to administer their healthcare system differently don't give as much space for choice, even as an example. And so, we can figure out ways to do it that are in keeping with the sort of values of this country, but that start to move towards saying, we have an obligation to be better,

• 37:47Speaker 01

  more responsible arbiters of how we spend our dollars. And we have an obligation to address the fact that we're just not getting value for the healthcare system as it's currently constructed at scale.

• 38:00Logan Bartlett?

  As we sort of talk about some of these more democratizing access and care and, you know, government-supported plans and all that, one of the arguments I've heard is like, hey, well, why do people from Canada come over to the United States to get certain service? And why does it take six months to get an MRI? I don't know what the number is, I'm making this up. But people will tell that to me, and I don't know if that's actually factually true. But, hey, certain types of service in Canada takes so much longer than it does in the United States. And why do all the best doctors in the world, why do they gravitate to the United States? And are we going to lose that?

• 38:34Speaker 01

  Yeah.

• 38:34Logan Bartlett?

  In going down this other idealistic path that we just sort of touched on a little bit here? What do you think about that?

• 38:40Speaker 01

  Yeah, no, it's such a great question. I mean, I think, and this is what I was sort of trying to land on, where I think there's so much that's good about the way that we, this country stimulates innovation, attracts, like, brilliant talent, and has been, for a really long time, at the forefront of medical technology development, of new therapeutics. It's partly, like, all the things that are challenging, also that sort of fuel this, right? Like, which is, there's an ability to make a lot of money pushing the envelope in healthcare in the United States, right? There's an ability to fund innovation because the return potential is dramatically higher here than anywhere else. Like, that's why people want to, you know, develop new drugs and sell them in the United States market

• 39:25Speaker 01

  because the ability to kind of really, really benefit from that is huge. I think there's such a big gap between Being Canada or being the United Kingdom and where we are today, that there's still opportunity to say, okay, let's, let's align our policy in a way that raises folks who are at the bottom to what we, what we as humans and as a society can say is a sort of a minimum acceptable access and quality of care. Let's get them there while, while not curtailing the ability for others with more resources to pay to buy on the private market what they wish. Like I'm, you know, I, I have my own sort of personal feelings about that.

• 40:07Speaker 01

  I think we can, I think we can do more to kind of get in the middle here. I think it's, it's obscene that, that, that some folks have, you know, ready access to skip the line for, we saw this during the, you know, the COVID vaccine rush. People were skipping the line to get access to drugs. They could get someone to come to their home and provide them a scarce vaccine because they could afford to pay for it. Well, you know, the patients I was serving in, in Brooklyn were suffering and waiting and, you know, and, and had their resources. That feels obscene to me, but I'll allow it if that, if that, if people care so much about it, I'll personally allow it. I think it's possible to, to preserve that ability and also say that we can and must

• 40:51Speaker 01

  do better for people who today are totally falling through the cracks. Like it is, it's an indictment on us as a generation of leaders, as a generation of people, I'm sort of making some assumptions about your listener base, but by and large, this is, these are, these are among the one percenters or approaching.

• 41:07Logan Bartlett?

  Sure.

• 41:07Speaker 01

  It's an indictment on all of us that there are people today who don't know where their next meal is coming from in this country, you know, the, the most, the sort of wealthiest country on the planet, they don't know where their next meal is coming from and they don't know how to access basic healthcare services, preventive care, primary care and mental health. Like we gotta do something.

• 41:26Logan Bartlett?

  Yeah. It's interesting. Like you can hold both thoughts in your head that you don't want Canada, but also we can do better. Like those, those two dots are actually.

• 41:33Speaker 01

  It's possible.

• 41:33Logan Bartlett?

  It's possible. You gotta, I can hold. And it's amazing, I mean, not to, like all this stuff gets so politicized and so it's hard to even, you have to be one way or the other and all. All these things, but like we can raise the floor and keep what makes it great. And so I, I, I appreciate that you guys are innovating within the, the system of all this stuff to help raise the floor and, and have socially good benefits, but also in a commercial application, right? I, I think that's a, you know, it's a great thing and hopefully we can see more businesses like that.

• 42:03Speaker 01

  Yeah.

• 42:04Logan Bartlett?

  So shifting gears a little bit, um, your personal journey. So you were born in the United States, but grew up in Kenya.

• 42:11Speaker 01

  That's great.

• 42:11Logan Bartlett?

  Can you, can you take us through like how you ended up, uh, here to, I, I, I get the feeling you're maybe an accidental entrepreneur, maybe?

• 42:18Speaker 01

  Oh, a hundred percent.

• 42:21Logan Bartlett?

  I didn't know if that was gonna be if you were to disagree with that.

• 42:23Speaker 01

  No, no, no, no, no.

• 42:23Logan Bartlett?

  I assume you don't, you don't become a doctor and then go work at a nonprofit. This isn't the, uh, the blueprint.

• 42:29Speaker 01

  I'm gonna be a CEO of a venture backed company.

• 42:30Logan Bartlett?

  Yeah, exactly.

• 42:31Speaker 01

  I don't even know what those words meant.

• 42:32Logan Bartlett?

  This is, this is not the blueprint people follow generally, but, but can we talk a little bit about how, yeah, the, the journey along the way?

• 42:39Speaker 01

  Yeah, I mean, briefly, you know, my parents came to the United States from, from Nigeria, so I'm a first generation American, um, uh, for, for grad school. Um, and in Boston, um, had me and my sisters and then moved to Kenya, um, to do for their careers. My dad is a physician, a public health doctor and, um, and, and was working in global health. We ended up there, um, went to school there, um, finished high school there and then I came to the US for college. At seventeen, sort of started to figure out what it, what this is like.

• 43:11Speaker 01

  And it was, it was an interesting transition and then, um, continued my education, did a master's degree in England, went to medical school. Um, and then moved to West Africa because I was really interested in, in global health and in sort of really, my, my career has always been about improving the quality of care, improving health outcomes and access to care for people who are marginalized. Um, that's just, that's just always been my thing and will forever continue to be my thing.

• 43:37Logan Bartlett?

  Was that, was your father in a similar like line of service? Obviously he was a physician, but was that something that like you grew up around?

• 43:44Speaker 01

  Yeah, so I grew up in Kenya at the height of the AIDS epidemic. So I grew up in the, you know, eighties and nineties, um, uh, seeing people on the streets begging for food. Um, who were visibly suffering from AIDS. I grew up, at that time, the life expectancy, average life expectancy was about forty years. And, and so, this, and, and I went to private school. You know, my parents had resources. And so I would drive to school, looking at kids who looked just like me, who weren't going to school, who had no clothes, were hungry, and, and had lost their parents in this horrible, horrible epidemic. And I also remember watching on TV the debates in the global public health space

• 44:28Speaker 01

  about whether they should make antiretroviral drugs available to Africans when they first became available. And it was a public discussion. Well, their lives are, I mean, that went on the, that's sort of the, the, on the lines of, their lives are pretty bad anyway. Why bother? There's a prominent economist who basically made that argument. Economically speaking, saving one of these lives does not make sense globally. There were arguments about, well, they don't really understand how to tell time. How could they possibly take a drug three times a day? There were arguments about, well, it's just too expensive to even begin to think about how making those drugs available made sense. And so, that was my upbringing. And, and my parents were very transparent. They themselves had not, had not grown up with a lot of resources.

• 45:12Speaker 01

  That, you know, I, my sisters and I had done nothing to deserve a private school, you know, three meals a day, a safe and warm home. We just happened to have lucked into it by virtue of, you know, who we got born to and what the circumstances were that we lived in. And so, this idea that like, that it could be one of us, any one of us, truly, lack of, like, chance, circumstance, whatever, we could just as easily be with the patients I serve, is very like, very sort of true to me. Like, I really feel that, and I know it. And the notion of service was something that I was raised with and has always been at the forefront for us.

• 45:53Speaker 01

  You know, it's just, it's, it's impossible, I think, to, to see what I saw as a young person and not realize that we all have an obligation to care for others around us and that we're interconnected in much more powerful ways than we know how. It took, for many people, and I think in the US, it took the pandemic of, of, of COVID to realize that like, my health is, is connected to your health. If we're taking the subway with hundreds of thousands of people who didn't have access to a vaccine or chose not to take it, my risk is increased. If I am, you know, living in a system in which we're breathing the same air, we are interacting with each other, like, we have to recognize that we are all intertwined.

• 46:36Speaker 01

  That was very, very obvious to me growing up and has always been something that's guided me in terms of the work that I do and the places I gravitate to.

• 46:43Logan Bartlett?

  So you grew up around that, and I'm sure that was a very impactful experience. And then you went to school at Stanford in California. And then, what, did you, were you pre-med?

• 46:53Speaker 01

  I was pre-med, yeah.

• 46:54Logan Bartlett?

  Pre-med. And so, you knew you were going to be a doctor, or at least hope you were going to be a doctor, I guess. And so then you, then did you go study medicine in the UK? Was that what you were over there?

• 47:05Speaker 01

  Yeah, no, actually, no. So I first, I finished at Stanford, and I actually worked for a year in San Francisco on a program that was basically providing small grants, federal grants, to HIV/AIDS prevention and treatment programs. I was so, in retrospect, I don't know why, I was so lucky to get this job. I was, you know, young, super unconnected at the age, and my job was to basically administer a grant program that was giving, like, micro grants, like, truly like $5,000 grants to community-based organizations, supporting people with AIDS, and to provide technical assistance. And I was the technical assistance, like, and I was like, I don't have any skills. What puts these people, really? But I was helping these little nonprofits, like, figure out, like, supply chain.

• 47:49Speaker 01

  You know, how do you get, if you're a food pantry, how do you make sure you've got the right supply to, like, manage the demand? And how do you map that over time? And like, stuff like that. Like, that was my sort of job. And it was so rewarding and so interesting. And I was also volunteering as a sort of aide slash companion to people with AIDS in San Francisco. And this is in the early 2000s. And so got to start to see, like, this different face of the same disease that had been so pivotal in my upbringing. And to see, honestly, the ways in which the same problems... Existed. Now we had enter-retrovirals. But these men, they were primarily gay, white men who I was caring for and being in

• 48:30Speaker 01

  community with, were isolated, stigmatized. They'd lost many of their loved ones during the height of the epidemic. And they were also struggling with social needs. They were struggling with housing, with food, as rent started to go up in San Francisco. And so seeing that other shape of this was really pivotal for me because it started to open my eyes a little bit to the inequities in health access and outcomes in the US that I hadn't experienced as a student, you know, on my little student insurance program. You know, that was a very different perspective.

• 49:02Logan Bartlett?

  It's interesting to have the same disease attack two different skin color, probably economic, like access to care, all of that, right? I imagine that was pretty pivotal in seeing the experience of that and probably how care was administered.

• 49:20Speaker 01

  Yeah, yeah.

• 49:21Logan Bartlett?

  And so I know Sierra Leone was an impactful experience for you. You ended up over there. Can you talk a little bit about that?

• 49:29Speaker 01

  Yeah, so after San Francisco, I moved to England. I did a master's degree first in international development because I was really interested in learning some of the skills I hadn't learned as a pre-med, basically, you know, history, economics, sociology, just sort of to get this broader global context for what I was seeing. And then loved England so much, I decided to stay for medical school. And so I was there for four years and got to see a socialized healthcare system, which had its pros and cons. At the time, what I loved about that was just the focus on primary care and preventative care. In the UK, particularly at the time that I was training, primary care doctors, general practitioners,

• 50:08Speaker 01

  were the highest paid doctors in the healthcare system. And they had power to determine how healthcare dollars were spent downstream, right? Like, they owned the referral kind of decision. They were, the way that they provisioned and funded the health system was actually on a regional basis that was risk-adjusted for the complexity of the population. And then the pool of resources were then spent across specialty and primary care and hospital acute care, with the understanding that everyone should have a primary care doctor and that they were accountable for outcomes. And so seeing that was actually a really interesting playbook for how one might orient a healthcare system around primary care, very different from the US, but I really enjoyed it.

• 50:50Speaker 01

  And I was at the time spending a lot of time overseas during my training, really just getting a different perspective and starting to think about what I wanted to do next. And spent a couple of months in Sierra Leone as a medical student. And was pretty blown away and pretty traumatized, I have to say, by just how broken things were then. This was about a decade after the very well-known civil war that the country had gone through. Healthcare system had been completely decimated and outcomes were terrible. And I was just struck by how much opportunity there was, but also how painful it was to watch people suffer for things that we knew how to prevent and treat.

• 51:34Speaker 01

  And at the time, the infant mortality rate was one of the highest in the world. And I was working at a hospital where one in four, one in five kids that came into the hospital didn't make it out alive. And, you know, on thousands of admissions a week, we were just seeing this just trail of despair that was really pretty heartbreaking. And so I decided, along with a couple of other friends that I'd met over time there, to spend in dedicated time building a nonprofit to try to improve the quality of healthcare that was provided in this hospital. We picked one hospital, partnered with the government, raised money and started to just do health system strengthening work,

• 52:17Speaker 01

  which is at the time was saying, there's no running water, there's no electricity, there's no blood bank, there's no intensive care unit, there's no oxygen supply. Let's just get this to work like a hospital. And that was a really interesting experience for me. It was my first sort of entry point, I think, into real operations and realizing that there's one thing to kind of know medicine, which I did. I finished medical school, I knew how to diagnose and treat. But it's a very different thing to actually make. Make outcomes different. If you don't have the tools and resources to do that. One of the biggest lessons for me was after several years of doing this work and I eventually came back to the US for residency, but I would go back and forth. And the nonprofit, you know, we hired a staff, we sort of continued to scale.

• 53:02Speaker 01

  And a few years into it, I went back and started looking at a retrospective on our mortality data. I was really, I'd always been really just obsessed with this idea that, you know, one in four, one in five kids in the hospital didn't make it out alive. Like, we've got to change this fundamental KPI, like mortality for a hospital that is serving, you know, pediatric population. And I went and looked at the data and what we found was that despite the complete transformation in terms of the quality of care we were providing and the resources that were at the hospital over the last, I don't know, four or five years, we had made no dent in mortality. And I was like, it was, it was like inexplicable when I, when I finally got the numbers back and I was like, you've got it. And this was like, you know, manual chart reviews or pulling, so it took forever. Yeah, you didn't have a data scientist. There was no data scientist.

• 53:46Speaker 01

  I mean, like, this room was just like charts stacked in the back, right? But like, it was, it was not clear to me that we'd actually changed mortality rates. And so then I started doing like actual chart reviews and started looking through the charts and I was like, I don't understand what's going on here. These kids were coming from communities that I could, I could throw a stone at. They were so close. They were walking distance from the hospital. Hospital was free. We had running water, we had electricity, we had doctors on call, we'd started a residency program, we had an ICU. Like, this, this should work, but it didn't seem to be working. And so we started to try to problem solve this and ultimately decided to do some focus groups in the, in the local community to say, like, help us understand what's going on here. And, and there were all these hypotheses that the doctors and nurses had, had started to throw up in the hospital.

• 54:32Speaker 01

  People are uneducated. They don't know when their kids are sick and so they're ignorant, they keep them home too long. People don't care. They have so many children, they can't care about them. They don't listen when we tell them what to do. You know, the sort of, the usual sort of. Subtle and not so subtle stigmatization of the sick person, which I saw, by the way, all the time in America, right? Like, we call our patients noncompliant. We talk about the, you know, the IV drug user who came in with this and left against medical advice. All of it's laced with this idea that it's kind of their fault that they're sick. It was that language.

• 55:04Logan Bartlett?

  Isn't it like two and a half times the language gets used about like noncompliant or something with people of color versus?

• 55:11Speaker 01

  That's right. That's right. And it's all like, it's just code.

• 55:13Logan Bartlett?

  Subtle, like sort of racism.

• 55:15Speaker 01

  Code. It's code. It's totally code. And it's not even that subtle anymore. You don't know what to listen for it. You know, you're just like, okay. And so, and so that was what was hearing from, from my colleagues in the, in the system. And so we said,

• 55:26Logan Bartlett?

  But this is also probably people of color talking about their patients.

• 55:29Speaker 01

  It's not just, it's, it's, it's not just, this is the thing. It's like, humans find a way to sort of create an us versus them dynamic.

• 55:37Logan Bartlett?

  To other people.

• 55:38Speaker 01

  Other people, no matter what. And it, it happens across every dimension you can imagine. So here we've got healthcare workers in Sierra Leone saying of the people that they're serving, they're just, they're too ignorant. They didn't, they don't understand when their kids are sick. They don't listen to us when we tell them what to do. It's code for it's their fault.

• 55:55Logan Bartlett?

  Yeah.

• 55:55Speaker 01

  See, the same thing in, you know, in the US. You see, it's just, it's just pervasive, right? This is what people do. And so, uh, so started doing focus groups and I would just, I went into the community and I think we sat on radio, like invited people to come in and talk to us. And I started with asking, I invited anyone who identified as a caregiver of a child to come and talk to us about their experiences. And they, and I said, so how do you know when your kid is sick? And these moms and aunties, they hadn't been to school. They couldn't read or write. They were like, when their body is warm, when they're not eating as well, when they, you know, sleep too much. Like, they knew exactly what the symptoms were. When they, when their, when their chest goes like this, they would demonstrate to me. I was like, these people know exactly when their kids are sick. They're not ignorant. They know exactly what's going on. Then I said, well, what do you do when your kid is sick?

• 56:39Speaker 01

  And they said, well, we, you know, different things. I go to their herbalist down the street. I go to their birth attendant who, who delivered my kid at home. I ask my cousin. I go to my grandmother. So and so in the neighborhood is known for making potions and, and, and tinctures. So I go to them. I pray. I take them to church. I said, okay, that's interesting. Why don't you go to the hospital? Well, everyone who goes there dies. When I get there, people are super mean to me. They don't ask me why I'm here. They don't listen to me. They wake my kid up in the middle of the night, give him medicine. They won't explain to me what it is. They make me feel like it's my fault. And they, they're rude. And I was like, wait a second. So all the things we just did are the reasons why people are choosing something else over this hospital,

• 57:24Speaker 01

  despite the fact that it actually could be life-saving. And that was such an unlock for me. It seems really subtle, but it was such an unlock for me. It's like, there's something about not just the what, but the how, that is critical to changing outcomes. If we don't show up with respect, we don't treat people with dignity, we don't make them feel like they matter, they will choose something else. And irrespective of if they are poor, irrespective of if they're at death's door, irrespective of if this care is actually pretty good. Like, you can't say you're providing access simply because you have a building that sits in the community. You actually have to show up and mean it. Why that was so important to me was I then found myself in Boston,

• 58:09Speaker 01

  you know, bastion of medical education and medical technology. This incredible place where, you know, if anyone over across the world would want to be there for a life-saving treatment, and yet the patients I was seeing in the community health center, I saw people not infrequently, who hadn't seen a doctor in 30 years. And when I said, "Why?", it was, "Well, the last time I went there, I was pregnant with my kid, I was struggling with addiction, they took my baby away, treated me like I was really like scum of the earth, and I swore to myself I would never go back." "Why didn't you go to the doctor? I'm afraid. I'm afraid of what they're gonna say to me. I'm afraid that they won't listen to me." "Why did you leave against medical advice? Well, I've got a kid at home with autism who I have to pick up from school. And when I told the caseworker, they told me that it was my fault.

• 58:54Speaker 01

  And I, basically what I was saying was I'd rather die." Like, it was the same story over and over and over again. I was like, "We have the pieces." But they're not translating into an experience that is actually engaging and engage and frankly worthy of the people we're trying to serve. Because it's us and them. And because we've created so many barriers to actually like showing up for people and like listening to what matters for them. And so that Sierra Leone experience was like, it was so resonant here and has been a theme for me as we've built City Block is to say like, it's not just, do we have the doctors? Do we have the medications? Do we have the protocols? It's how? How do we show up? How do we actually earn the right to care for people?

• 59:38Speaker 01

  How do we make them feel valued so that they want us? Because people will vote with their feet. And when a patient goes to the emergency room at 10 o'clock on a Friday night, instead of going to their psychiatrist six weeks before, they're making a choice that is rational for them. And that choice is, I would rather wait until things get so bad that I have no choice but to go to the emergency room than subject myself to indignity, disrespect, the cost of taking a day off work, or of finding childcare for my kid, or the experience of being lectured at for 40 minutes and not having my problem solved. Like, there's something there that made them make that choice. And we have to understand what that is.

• 1:00:19Speaker 01

  And we have to be accountable for creating a preferential option that actually is aligned with better outcomes for them.

• 1:00:26Logan Bartlett?

  And so, from, I'm sure that informs so much of how you have built and architected City Block. And how did you actually decide to start the commercial entity to embed a lot of these learnings into servicing the Medicaid population?

• 1:00:42Speaker 01

  I mean, I'd love to say that this was like, we made the intentional choice and then we like, that's not how it happened. Like, I had no idea what this path would look like and certainly didn't know that it was even an option available, right? Like, I'm a doctor. I didn't go to business school. I was ironically in Silicon Valley as an undergrad at the sort of height of, you know, tech. And I had no, like, I had one friend who was a software engineer.

• 1:01:04Logan Bartlett?

  Yeah, yeah.

• 1:01:04Speaker 01

  And like, I didn't understand anything about this ecosystem. So it was not an intentional choice for me. My co-founder, Aya, however, I think was really starting to see and understand where the opportunity to capitalize the type of company we wanted to build was.

• 1:01:22Speaker 01

  And so with him, had the opportunity to come to Sidewalk Labs in New York. So we're both working in Boston at the time. Sidewalk is, was sort of part of the alphabet family of companies and was really thinking about doing things differently in innovation, using technology to improve quality of life for people living in urban settings. And they had a number of different projects, but we're also looking to incubate a business, specifically around healthcare. And so when it looked like we had the opportunity to pitch them on, let's do this in Medicaid, and let's take, you know, technology, data in particular, analytics, to help inform and help build a business that was focused on the Medicaid population, because it, to that

• 1:02:05Speaker 01

  point, had been pretty untapped, wide open, like huge, huge, huge TAM, right? Like, these are millions of people who receive their insurance through Medicaid. Very few companies innovating, if any at all, innovating in that space. Like, huge opportunity to grow and scale a business. You know, there was inefficiencies that we described in the sort of incumbent status quo. There's massive TAM, real opportunity to create, to create economic value and to create a very different business model. Like, it's a ripe place for entrepreneurship. And so, you know, if I was sort of thinking about this from first principles, probably would have landed in the same place, but like, it just sort of happened.

• 1:02:47Speaker 01

  And in some ways, like, I've been sort of carried along that wave ever since.

• 1:02:51Logan Bartlett?

  It's a fascinating journey, sort of like, yeah, servicing all of that. So you were originally president of the business, and Ia was the CEO. And Ia has been public about his battles with depression over the years, and he, probably a year ago, 18 months ago, took a step back, six months, wanted to figure out, prioritize his own mental health as you guys were building, building the business. At some point, we've talked about having that conversation from his perspective of all this. But from your perspective, to go from co-founder, president to, I think there was an office of the CEO originally set up with Andy Slavitt and a few other people that were involved there, then ultimately

• 1:03:36Logan Bartlett?

  becoming CEO, what was that, I mean, having someone that you started, you talked about I was sort of the commercial one that wanted to go after this problem originally. What was that like from your perspective to sort of have a co-founder step back? And then he's still a board member today, right? So he's still involved in the business, but not necessarily day to day. So we'd love to hear that from your perspective.

• 1:03:57Speaker 01

  Yeah, I mean, I think maybe to contextualize it, like, and I think founders really know this, like, the entire experience of founding a company, especially a company that grows as fast as we have, as we had, is like, it's constant change. And, you know, yes, I had the title, but like, my role shifted probably every six months and has done, and will continue to do so, I think, in the business, right? And so I'm, I think part of, for me, what has been the most constant part of this journey has been change and adaptation to change. There's something really wonderful about building something with other people. And, and doing so with, with people who share your mission and your vision and your values,

• 1:04:41Speaker 01

  and who create kind of that confidential, safe place to like, problem solve. It's really special. Like, I'm, I'm a team sport kind of person, and I love teams. And so from that respect, I think, you know, having someone, one of, one of our founding team members, like, you know, the person who was sort of arm in arm, stepped back from the business was hard, for sure. And also, you know, I think we're so fortunate that we've built a team of others around the business who were committed and, and just brilliant. And so I've, I've really had to sort of build and rebuild relationships over the entire course of the business.

• 1:05:19Speaker 01

  But it's been it's been par for the course in some ways. You know, it doesn't feel like the sort of big dramatic shift so much as it's an evolution. And and I'm sure the next evolution will come in some way, shape or form, probably less visibly to the external world. But as we shift and grow the business, as I bring on more folks on the team, as we expand and and continue to just, you know, really advance what we do, my day to day shifts all the time. And and that's, I think, appropriate for for this stage of the company.

• 1:05:50Logan Bartlett?

  Yeah. Now, on the hiring side, I'm sure you have people that are very mission driven, that want to work at City Block and are very passionate about City Block. We've we've gone through this period of debate about politics in the workforce. And it was large, I mean, I guess Me Too was originally, and then I think George Floyd was a big reckoning moment for for people. And then we sort of saw some pushback from different executives, Brian Armstrong, Corin Davis, Toby Lukey from Shopify, that sort of said, hey, some of these things are getting too divisive within the the company culture and and and we're going to put these social issues to the side and not allow discourse around that.

• 1:06:31Logan Bartlett?

  I imagine that wouldn't fly particularly well from from within the company or your leadership style. How do you think about the balance of having people that are mission driven and passionate about the the cause of what you're doing and also allowing the appropriate discourse to exist within the organization about the host of topics that are that are going on at any individual point in time?

• 1:06:55Speaker 01

  It's so interesting, the extent to which things that I consider, and we're a healthcare company, right?

• 1:07:01Logan Bartlett?

  Yeah.

• 1:07:02Speaker 01

  So it's so interesting, the things, the extent to which things that I consider, and I think that against the data objectively would support, are just health issues, have become politicized, right? And so and and so I think the approach that I've taken is to say, let's first, as a company that focuses on healthcare and health outcomes for marginalized people, that is at the forefront of really not just appreciating, but also intervening on.

• 1:07:33Speaker 01

  The totality of factors that drive health and health outcomes for a population, we gotta talk about this stuff. We have to talk about racism and we have to talk about barriers to access to housing. We have to talk about prejudice and bias because they impact health outcomes. Right, it was just what last week that the New York Times published on the front page, data that supports the notion that demonstrates that black families and black health outcomes are worse than for white people, even when, even, even at the highest level of income. Right? And that's not because there's something genetically about me that means that I should

• 1:08:15Speaker 01

  be more likely to die in childbirth, as an example, than, than a white woman with the same education, same medical history, same risk factors as I have. Like, there's, there is nothing, except our society and the way that we think about black people as an example, that would determine that outcome. And so, we have to talk about it. We have to acknowledge it. We have to look at the data. We have to grapple with it and then we have to ask what we're gonna do about it. So when, you know, George Floyd's murder happened, we didn't get into a big debate about, you know, any of the politics. It was a fun, it was a moment of grief for us because our workforce reflects the population whom we serve, which means we are significant, predominantly actually, people of color in

• 1:09:00Speaker 01

  our workforce. There are people in our company who personally feel what it feels like to be at risk of death anytime they interact with the criminal justice system. Like, they feel that every day. That's all I need to talk about. Like, there's, like, that was it. You know, we have to talk about it because people are coming to work with grief and with fear and with pain and with the recognition that this translates into the horrible health outcomes that we're seeing in our population trying to address. You know, same thing when, when, when we saw the repeal of Roe versus Wade. Right, this is a health issue. We know it's a health issue. There's plenty of data to demonstrate that access to abortion is a, a health issue that...

• 1:09:47Speaker 01

  Again, disproportionately impacts lower-income women, and people of color, and directly translates into our ability to care for our people, who we're accountable for caring for. We need to talk about it. And without getting into a political debate, but being fact-based and really being sensitive to what we know as a society about what impacts health outcomes, we have to address these issues and talk about these issues. And so that's how we've approached it.

• 1:10:19Logan Bartlett?

  You were cognizant of all these things, right? And believe them.

• 1:10:24Speaker 01

  Yeah, but that's not to say we don't have people with different political beliefs.

• 1:10:27Logan Bartlett?

  Yeah.

• 1:10:28Speaker 01

  I don't think those two things are mutually exclusive. Like, I don't think who you vote for on principle, or the other issues that you care about, preclude you from also caring about access to healthcare.

• 1:10:40Logan Bartlett?

  Yeah, yeah.

• 1:10:40Speaker 01

  And preclude you from also being able to engage in a conversation about the determinants of health outcomes. Or preclude you from being able to participate in a multicultural, multi-ethnic workforce.

• 1:10:51Logan Bartlett?

  Yeah, yeah.

• 1:10:52Speaker 01

  You know?

• 1:10:53Logan Bartlett?

  All of that, I guess, there's elements of self-selection, probably. Because of the community you serve and because of the representation that exists within the company, there's probably elements of self-selection that exist in some of those beliefs. But it sounds like you have people across political spectrum from a viewpoint standpoint, right? So how do you think about that within the company? Like, is it just the people that also recognize the evidence-based considerations and also have empathy for people of different races, different backgrounds, different income levels, all that?

• 1:11:29Speaker 01

  Yeah, I mean, I think that's right. I think, you know, there's obviously the sort of, we've really managed to politicize a lot of things that I frankly don't think have its base in the political discourse. It shouldn't be politicized in that way. And so, you know, we have, and, you know, I spend time with people with very different sort of political views than I have. That doesn't preclude them from also caring about and recognizing the ways in which race and racism, access to education, all the things we talked about, impact health outcomes. It doesn't preclude them from engaging with evidence-based clinical practices for reproductive health. Like, those two things are not mutually exclusive at all.

• 1:12:14Speaker 01

  I think we sometimes, in the media, like to sort of portray them that way. And I think there's a lot of folks who frankly peddle in discourse that makes it seem as though those two things are like mutually exclusive. They're not. Like, caring for the health and wellbeing of people who don't necessarily look like you, or don't necessarily share your same experience, but who are human and who are deserving of care, is not a political issue. Caring about, understanding the evidence about what drives health outcomes and addressing those factors, that's not a political issue. And that's where we focus. And so I think we've been able to create an environment where folks from very different backgrounds and walks of life,

• 1:12:59Speaker 01

  very different political views, can come together around a shared and collective mission to improve health outcomes for people with low income, for people who are marginalized, for people with mental health challenges and physical health challenges and social challenges, and to do so in a way that's evidence-based. That's it. That is the prerequisite for participation. And then we require people to engage in respectful dialogue, even around their differences. And what we found is that it creates an environment that is inclusive, that is promoting of diversity across every dimension you can imagine, and that allows people to sort of bring their best selves to work around a very focused mission, that is, to improve health outcomes

• 1:13:43Speaker 01

  for the population whom we serve.

• 1:13:45Logan Bartlett?

  What about on the hiring side? So I think before we got going, you said 70% of your employee base are people of color?

• 1:13:53Speaker 01

  Yeah.

• 1:13:53Logan Bartlett?

  And about 70% women as well? That's amazing. And I have companies that I work with that struggle to get to even a quarter of the gender, let alone race, right? How have you built your hiring structure and funnel? Are there best practices that you would recommend for companies that are struggling with this? How does the funnel work? How does the decisioning work? How do the considerations around diversity actually work at a granular level at the, maybe the hiring point or the management point or whatever it is?

• 1:14:29Speaker 01

  Yeah, I think the first thing, the first sort of advice is you got to start early, right? And so, because, you know, people from diverse backgrounds will look at face value, literally at face value, at the composition of a team and make some assumptions about whether they would be welcome there, right? And so to be the first one, and I've been the first many, many times, it's a really uncomfortable position. Nobody wants to be first, right? And so if you have a team of all guys, that first female hire is going to be difficult. And the bigger the team of all guys is, the harder it is to start to create diversity. So I see teams and I see founders early on, your sense of urgency, got to go, got to go, got to go. It's actually that's the moment at which you should decide, like, what is the composition

• 1:15:14Speaker 01

  of the team I'm trying to build? And how do I take the time now to start to reflect that early? Because, you know, we think about diversity, equity, inclusion, like diversity is really representation. Representation really, really matters and it begets more representation. If you think about the way that people hire, and we know this, it's driven by heuristics more often than not. It's like, I like to hire people who are like me.

• 1:15:36Logan Bartlett?

  Sure.

• 1:15:37Speaker 01

  Right? And often that's behavioral, educational, but often it's also just like, you remind me of me a couple of years ago. I think you're going to make a great PM, you know? And so if you think that like some proportion of hiring, especially when you're moving quickly, is heuristic driven, which means it's bias driven. If you have a team that is balanced... That bias actually works in your favor for perpetuating it over time. Right. And so it's not to say you don't have to do the work, but it is to say that like, starting early is so, so, so important. So that's thing number one. I think the second is, is being really explicit and intentional about what your desires are and what your beliefs are around diversity. I think a lot of companies put this sort of requisite like, we care about diversity.

• 1:16:22Speaker 01

  We hire people, blah, blah, blah. Like, and they just throw it on a website and then call it a day. That's not it. Like, everybody at City Block, hiring managers, individual contributors, like, everybody talks about how important diversity is to us because it matters. And it matters to our business, right? Remember, we're serving a population of folks that reflects lower income populations, people of color, people with complex needs. Like, in order for us to engage with them well, we have to be representative in some way, shape or form. And so it was a business priority. We made it clear that it was a business priority for us to have a diverse company and explain to people why it translates into overall our success.

• 1:17:05Speaker 01

  And then we talk about it and we think about it and we problem solve around it. We look at the data around diversity at every step along the funnel, every promotion cycle. We audit our promotions to see who was put up for promotion? Does it reflect the demographics of the, of the population of our workforce as a whole? Who was selected for promotion? Does that reflect, like, are there some anomalies here that are surprising? Did we, you know, under, do we see an under-representation of some group as we look at who was put up for consideration? Was there an under-representation of those folks who were then selected? Like, let's just understand that. Let's have more conversation. And so really making sure that that, it's not just a by the way, and we put it on a thing, but it's actually like embedded within our practices was really important.

• 1:17:51Speaker 01

  We've tried different approaches to, to sort of standardizing the hiring process. But the thing, the most effective approach has been to say, we require that the funnel and the pipeline of talent is diverse. So you cannot hire a job for a job where you did not see a diverse slate of candidates. That's been just critical because all we're looking to do is create an equal opportunity, equal playing field for diverse candidates. And we're putting the onus on our teams upstream to go find people who have the skills, have the qualifications, have the capacity to do the work, who represent diversity in that organization. Bring them all together and let them compete for the job.

• 1:18:31Speaker 01

  And sure enough, like, you can create the outcomes that you want to get just by ensuring that that funnel is nice and diverse. Those are the types of things that we've done that have been really important. Really important, though, alongside that, that is, what do you do to retain talent? And how do you ensure that you're creating an environment that's inclusive? And that has been just as important as the representation part for us. And again, it comes back to what are our programs? What are our systems for supporting people? How do we think about? We've leveraged employee resource groups. They're incredible. We've got a number of ERGs across a whole host of dimensions of identity, not just race, disability status, our veterans ERG, our faith-based ERG.

• 1:19:12Speaker 01

  It's just a really warm, cross-organizational kind of opportunities for people to just share, build affinity, and also create awareness for other groups, right? And so there's a lot of work that happens across these ERGs. We compensate the leadership roles there, so people are incentivized to do it. And we recognize that work because often people of color in particular in organizations are asked to do extra work on behalf of the company to bring in diversity, to mentor, to what have you, and it becomes a burden. And there's data that shows actually that the people who volunteer for those roles are sometimes disadvantaged in terms of their ability to advance their careers because it seems like they're distracted.

• 1:19:55Logan Bartlett?

  Oh, totally. I mean, you can't manage what you don't measure, right? And so managing the pipeline and all that. But it is interesting with the ERGs and making sure you have a diverse hiring panel of people that are actually in the room and making those decisions. It goes back to your first point of if you don't start early, then you're overburdening. Not only is it hard to be that first person for all the, you know, whatever in-office type things to stand out, but then also you get tasked with

• 1:20:21Speaker 01

  That's right.

• 1:20:21Logan Bartlett?

  always interviewing, you get tasked with all the ERGs, you get tasked with all the... And so it ends up being an undue amount of burden

• 1:20:28Speaker 01

  That's right.

• 1:20:29Logan Bartlett?

  that's put on you that is not the core job that you signed up for.

• 1:20:33Speaker 01

  That's right.

• 1:20:34Logan Bartlett?

  Right? Yeah. How did the ERGs actually work? How do they actually manifest themselves?

• 1:20:38Speaker 01

  Yeah.

• 1:20:39Logan Bartlett?

  I'm sure everyone's a little unique, but...

• 1:20:40Speaker 01

  Yeah, so we've got, so they all have their own little names and they elect a leader, a couple leaders. It's typically a dyad for the year. They, the ERGs have regular meetings. They schedule events. They collaborate across each other. And so, and it's company-wide, it's individuals to the ERG. There's just a whole host of ways that they show up. And then we provide actual, like, project management support to them. So if they're, if it's, you know, Black History Month or something like that, like, we will, we'll provide support to the ERG to create company-wide events, to create awareness around the issue and the topic.

• 1:21:25Speaker 01

  It's just been, we have, I think about 40% of our workforce are a part of at least one ERG. It's really like, the engagement is huge. And folks are really, I think, find it to be a really fantastic opportunity.

• 1:21:36Logan Bartlett?

  My partner Elliot, who led our investment in City Block, I think he said, I asked him before we did this, questions, and he wasn't particularly helpful with questions. But he did say you are one of the most inspiring leaders that he's, that he's ever had a chance to interact with or work with, and that the people within City Block would run through walls for you, is at least his perception on this. I guess, any lessons for executives, other CEOs, people that are aspiring to be in these leadership roles, about how to go about setting an example? I get the feeling for you, like, the mission,

• 1:22:20Logan Bartlett?

  and there's a level of authenticity that exists with what you're doing. But anything that you would, you would say has been uniquely helpful in sort of setting an example for the company?

• 1:22:31Speaker 01

  Well, first of all, those are really kind words. I'm very grateful for them. You know, I think the, I think there's two things. So the first, I think, is your point about authenticity, right? It's taken me a long time to get to a place where I'm just comfortable being me and showing up as I show up. You know, can't, can't sort of hide my own identity, right? It's exhausting. I just don't, I just, you know, like, for so long, there's, there's nobody like me ever in the room. No one looks like me in the room. So how do I show up? How do I, what do I, how do I sound? What do I talk about? How do I show myself? And having the confidence to do that has taken a long time. And so I think authenticity, your point, is really important, right?

• 1:23:15Speaker 01

  Like, I'm here doing this work. I'm an accidental entrepreneur. I didn't ask for this. I didn't ever wake up, you know, as a young person being like, I want to be a CEO. That's not it. I'm here because I care deeply about the work that we're doing. And I believe we have a, like, a unique, once-in-a-generation opportunity to shift the paradigm for marginalized populations and to do so in a sustainable and scalable business model. Like, I'm really committed to the business part of this because it is so tied into the mission. And, and, and so that's been, that's, that's key, right? It's like showing up, like, pretty authentic about who I am, why I'm here, what I care about, and helping people understand how those two things tie together, how their job and how their focus on metrics and performance and outcomes

• 1:24:00Speaker 01

  and how our business performance is affirming of the mission, right? Like, these things are tied together, and I think I'm uniquely positioned to tell that story. But it comes from a very personal place, right? I really believe in this. I think that's the first. I think the second, for me, has been, I say this to, you know, to founders and CEOs, you have to figure out how to master yourself and your energy. It's an exhausting job. And, and, you know, Elliot and I have laughed about this retreat that I went on or whatever, and I've, I've tried many things. But figuring out, you know, how to stay balanced, how to be present, how to be rested, and how to be your best self every single day while you're doing really, really hard work. Um, for me has been key and, and it's, you know,

• 1:24:43Speaker 01

  self-care is kind of like cliche and I think a little, it's not quite descriptive of this to me. It's actually about self-mastery, you know? And, you know, I hate to tell people, but like it's, it's the stuff they all tell you. It's like sleep, exercise, like really good social relationships outside of work, good balance, lots of water. Like all that stuff really matters, right? Like we can't lead if we're the kind of folks who show up every day and nobody knows what persona you're going to inhabit. And you're yelling and flipping out and stra- like that's just not it. Like this is, this is hard work. People need consistency and they deserve a leader who is ma- has mastered their emotions such that they can show up their best.

• 1:25:25Logan Bartlett?

  Well, Dr. Toyin Ajayi.

• 1:25:28Speaker 01

  Just Toyin is good.

• 1:25:30Logan Bartlett?

  Toyin, thank you for doing this. This is great. Covered a lot of ground and yeah, I appreciate you making the time and going through all this stuff.

• 1:25:35Speaker 01

  Thank you.

• 1:25:36Logan Bartlett?

  It's an inspiring story, a unique business. And we are very fortunate to be along the journey. It's been, it's taken, I've tried to be sensitive to doing too much Red Point propaganda, uh, portfolio companies. But I've wanted to have you on for a while because the, the story, your, your background, the mission, all that stuff is so impressive. So thank you for doing this.

• 1:25:54Speaker 01

  Thank you for having me. This was a great conversation. I really enjoyed it.

• 1:26:02Logan Bartlett?

  So that'll do it for the 53rd episode of The Logan Bartlett Show. Thank you to Dr. Toyin Ajayi for coming on. Thank you to Justin and Rashad for their efforts with the show. And thank you to everyone for, for listening, for supporting the show. And look forward to seeing you back here next week on the 54th episode of Logan Bartlett Show. Have a good weekend, everyone.