Cityblock Health Makes The Home ‘even More Central,’ Expands Long-term Services, Supports

Value-based health care provider Cityblock Health has expanded its long-term services and supports (LTSS) offerings across its 10-plus state footprint, making the home “even more central” to the company’s offerings.

The expansion, announced Thursday, expands upon the provider’s existing LTSS program in Massachusetts and its coordination services in New York, North Carolina and Indiana.

Cityblock’s long-term services and supports include regular in-home engagement, as well as virtual and phone-based care. These services help people in need of help with daily activities due to chronic illness or disability, many of whom are dually eligible Medicare and Medicaid enrollees.

“Delivering services in the home allows us to better understand members’ lived environments, identify unmet clinical and social needs and intervene earlier,” Libby Graves, Cityblock’s senior vice president of regional markets and market vice president for Massachusetts, told Home Health Care News in an email. “As the population of dually eligible members continues to grow, the home is all the more important given that these individuals are more likely to be older or have a disability, have multiple chronic conditions and live in poverty.”

Brooklyn, New York-based Cityblock was founded in 2017 as a tech-driven provider of medical care, behavioral health and social services for marginalized populations with complex needs. The company serves over 100,000 members and has partnered with national and regional Medicaid health plans and health systems in more than 10 states. Cityblock’s former chief health officer, Dr. Kameron Matthews, previously told HHCN it aims to create a one-stop shop for in-home primary care. This model aims to improve outcomes and eventually lower costs, Matthews said. 

Cityblock’s LTSS program differs from others, Graves said, by taking on risk for both LTSS and medical spend. This incentivizes increased investments in LTSS to lower medical utilization and cost – and ultimately improve outcomes, according to Cityblock.

The company’s integrated interdisciplinary team allows it to “right-size” LTSS, Graves said. For example, the company can leverage its primary care providers to send medications to a pharmacy that will pre-package the patient’s medication, allowing them to graduate from a Visiting Nurse Association faster.

Home- and community-based services (HCBS) represent over 60% of LTSS spend in the U.S., Graves said, “so as Cityblock expands our LTSS capabilities, the home becomes even more central.”

This growing population of dually eligible members often face barriers to accessing care, including housing instability, food insecurity and a lack of transportation, Graves said, making the home all the more important.

Cityblock learned lessons from its existing Massachusetts LTSS program before launching the program across its entire footprint. Among these lessons, the company learned to proactively see members in their homes and connect them to services early, rather than waiting for a crisis, Graves said.

The company also learned to understand the local landscape, including where care services are delivered, and to closely integrate services with members’ primary care, behavioral health support needs and specialists, Graves said.

“LTSS is critical, and LTSS is often left out of the coordination,” Graves said.

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