Scoop: $6B Cityblock Health names Toyin Ajayi CEO

Cityblock Health, a hybrid primary care company focused on Medicaid patients, has named Toyin Ajayi its new chief executive officer, Ajayi tells Axios exclusively.

Why it matters: Valued at $5.7 billion, New York-based Cityblock has planted a firm stake in ground that most health tech startups have long skirted. Rather than courting the reasonably healthy and wealthy, Cityblock takes on financial risk to serve people most in need.

• With the pandemic highlighting systemic inequities, it has shown "how important it is to deliver care in a trusted environment," Ajayi tells Axios. "Now I’ve got even more fire in my belly to do this and do it well."

Context: The appointment follows the permanent departure of co-founder and former CEO Iyah Romm, who took a leave of absence last fall to focus on his mental health.

• "Building Cityblock with you all is one of the greatest joys of my life," Romm wrote in his message. "But in order to continue to build our company for scale and for impact, now is the time for me to get healthy."
• Former federal policymaker and health care investor Andy Slavitt took the reins as interim head of the office of CEO.
• Ajayi and Romm co-founded Cityblock in 2017, and Ajayi has been president.

How it works: Every year, Cityblock gets a lump sum from Medicaid managed care companies to cover its patients. If Cityblock keeps those patients out of the hospital, it shares the savings with insurers. If its patients get sicker, Cityblock loses money.

• The company matches each patient with a team of caregivers — nurses, physicians, pharmacists, therapists and a community health partner — all of whom collaborate using a central digital platform.
• The community health partner is one of the company's "most critical roles," says Mitch Betses, Cityblock's COO, because they are hired from within the communities they serve to build a trusted relationship with each patient.
• Venture backers in Cityblock include some of the industry's heaviest hitters, from SoftBank and Tiger Global to General Catalyst, 8VC, Town Hall Ventures and Maverick Ventures.

What they're saying: Ajayi has played a crucial role in steering Cityblock from startup to now a nearly $6 billion company, according to former and current colleagues.

• Ajayi "runs towards the places she can help people — places where there may be holes or gaps. She jumps into problems or challenge areas and deals with them head-on," Slavitt tells Erin.
• "She’s been the vision-setter for this organization to-date," says Betses.

What's next: Cityblock's biggest forthcoming obstacle will be scaling while sticking to its core principles of trust and relationship-building, according to employees and outside industry observers.

• "The challenge is: How do you replicate our model in the same way in each new area of the country you move into?" says Betses.
• "Building a strong culture with fierce commitment to anti-racism, while also growing and scaling very quickly was hard," Romm tells Axios.
• "It is harder certainly to maintain trust at scale, but it’s also possible — and it’s our mission," says Ajayi. "Because the flipside is a number of small, sub-scale experiments that are unable to sustainably care for people."