How new primary care model can reverse health disparities and improve primary care delivery

Health equity means providing all people with patient-centered care that's built on trust, empathy and understanding. Fulfilling that vision, however, is often difficult. 

Becker's Hospital Review recently spoke with Akofa Bonsi, head of provider engagement strategy at Cityblock Health, about new primary care models based on trust and how digital health can reverse health disparities and improve primary care delivery. 

Note: Responses edited for length and clarity.

Question: Can you describe your journey as a leader in health equity and the work Cityblock does to address social determinants of health and inequitable health outcomes?

Akofa Bonsi: My journey in health equity stems from the fact that I'm a public health nerd at heart. I've always been fascinated by understanding the healthcare system. That's shown up in many different ways throughout my career and in my growth as a leader. I started off with a degree in Medical Ethics and Bioethics. I did a lot of research around why certain communities and populations are healthier than others and what role the government and social safety nets play. That work led me into public policy, but I recognized that wasn't the best way to fix healthcare. 

Next, I worked at safety net hospitals and academic medical centers serving vulnerable communities. Pretty quickly, that led me to become an advisor and consultant at The Chartis Group, which is a mission-driven advisory firm focused on radically changing healthcare. While I was at Chartis, I had an opportunity to join this really remarkable startup called Cityblock Health. We are changing the healthcare experience for underserved individuals in some of the most vulnerable communities in the country. 

My initial role at Cityblock Health was leading our mobile integrated care function, which meets members where they are to provide urgent care. Most often, that care is provided in people's homes, avoiding an unnecessary visit to the emergency department. I've been at Cityblock Health for over a year and recently took on a new role building out partnerships with other providers. 

Q: What is the role of digital health and new care models in reversing health disparities?

AB: One of Cityblock Health's tenets is to meet people where they are — and a lot of people are on their phones and computers. Providing care virtually has helped increase our access to members. The work we do via mobile integrated care uses a hybrid approach. In some of our markets, we have employees called community care clinicians who are trained as paramedics or EMTs. They visit individuals in the home. At the same time, either physicians or advanced practice providers like nurse practitioners or physician assistants participate virtually in those home visits. This hybrid approach to urgent and emergent care in the home can only happen using digital health. Digital health has allowed us to really connect with people in a real way. 

The other important part of digital health is that it promotes collaboration between clinicians and other care team members like social workers. During a home visit, we can have instant collaboration and bring the right expertise to the table quickly. 

Q: What does it look like to have trust in primary care delivery, and why is that so important?

AB: Cityblock Health strives to build trust with people first and then uses that trust to help them reach their healthcare goals. Once we have trust, we can work with people to identify what's impacting their care. It's not usually the clinical stuff. It's all the other things that people have going on in their lives. Trusting that you are a participant in your care is extremely important. For a person to be part of their care, they need to feel comfortable sharing everything that's going on physically, mentally, socially, and emotionally. All our community health partners come from the community. Having that shared background builds trust in a genuine way. 

Q: When it comes to impacting health, what are some examples of what successful community partnerships look like?

AB: Good community partnership starts with a level of humility and recognizing you aren't the only one doing this work. You must seek out other organizations who are aligned in mission, goals, and economics and then build coalitions. I think that's where the most fruitful community partnerships are born. We work very closely with federally qualified healthcare centers, as well as social service organizations. Our goal is never to replace. It's only to enhance, connect, and collaborate. 

The other thing that's important is listening not only to members and patients, but also to the community. At Cityblock Health hubs, care of all kinds happens, whether it's clinical, physical, social, or emotional. We listen to what members want, such as exercise classes, a farmer's market, or offering space for groups to meet. Listening and responding with whatever resources you have reflects a good partnership.

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