Cityblock Health piloted an advanced behavioral health program designed for patients with psychotic disorders or serious substance use disorders. Based on promising results seen in its Washington, DC market, the company has since implemented the model in all seven of its markets. Ruby Mehta, MSW, MBA, director of behavioral health at the value-based care company, recently spoke with Healthcare innovation about this work and the details of a recently published article study at NEJM Catalyst about it.
Cityblock’s Advanced Behavioral Health program is led by specialized community health workers and is designed to boost access to interventions such as second-generation long-acting injectable antipsychotics, opioid use disorder medications, alcohol, contingency management, care coordination and Social Care Navigation.
In the study period, members enrolled in the program over a 10-month period had a statistically significant 19.7% decrease in inpatient utilization and an 11.5% decrease in total cost of care per member and per month compared to a quasi-control group. .
Healthcare Innovation: Ruby, I’m interested in learning about this advanced behavioral health program, but before I do, could you briefly talk about your background before coming to Cityblock?
Mehta: I’ve been at Cityblock for just over three years. Before that, I was clinical director of a small startup called Tempest that focused on people with alcohol use disorder and tried to provide them with medical care. There we use a peer-to-peer recovery model. Before that, I worked in a variety of different mental health settings. I’m a social worker and I did a lot of social work in New York City. I began working at two community mental health centers, one in the Bronx and one in Brooklyn. I worked at an outpatient addiction treatment center and then worked at a day treatment program for adults with serious mental illness.
HCI: What was intriguing about coming to Cityblock? What did you like about their model and their approach?
Mehta: I love the integration piece, because I think it’s hard to separate mental health from physical health. So that was the driving force, especially the social needs part. If you think about Maslow’s hierarchy of needs, if you’re not meeting social needs, there’s no point in thinking about the mental health part. The two can be closely related. And Cityblock has this model where they covered that part, which was really attractive.
HCI: Could you describe the elements of this advanced behavioral health program and the types of patients it is designed for?
Mehta: We do a lot of population health management. When we looked at what drives healthcare utilization in our population, we saw many people hospitalized for schizophrenia and many people hospitalized for alcohol and opioid use disorders. That was the genesis of the program about three years ago. Although it is a small percentage of the population, it is driving much of the utilization and hospitalization. So we decided to design an intervention aimed at this population.
When you think about the research behind what is effective for schizophrenia, medication compliance is a big issue. Members are often left without care, especially the population we work with, many of them are housing insecure, so they lose their medications or forget to take them. That was one of the key interventions: ensuring that people in this program are being evaluated, have had a recent psychiatric evaluation, are attending their appointments and are taking their antipsychotic medications, which is the treatment for schizophrenia.
We also have our social services. For this population, of course, stress exacerbates the symptoms of schizophrenia. Housing and food insecurity worsens these conditions, in fact it worsens any condition. So we want to make sure that in the program we screen members for food and housing insecurity, and see how we can help people get food and housing.
HCI: I read that the model is led by specialized community health workers. And I was wondering if Cityblock had already had experience deploying community health workers. It sounds like you are using them with a really specific high needs group.
Mehta: That’s exactly right. That is Cityblock’s bread and butter. They are the bridge between the communities we work with and the doctors, the nurse practitioners, because in the communities we work with there can be a very justified mistrust of the medical system. With this program, in particular, we have our community health partners who have some experience working with people with behavioral health needs and have received additional training in-house to understand those needs and interventions, but it is consistent with our model of trusting the community health. partners.
HCI: Did it start with an initial pilot of this in a specific location?
Mehta: We started in the DC market. We had to train community health partners. We had to train the entire team to understand the interventions. And it requires many more resources. The pilot was successful and the results were very positive. Therefore, in 2023 we expanded it to the seven states in which we operate.
HCI: I know Cityblock is a value-based care company and focuses on the total cost of care, but how does it work on the reimbursement and financing side of this particular program?
Mehta: For most of our contracts, we are paid per member per month, and that cost will cover essentially all of a member’s physical and behavioral health needs.
HCI: And that is paid for by a Medicaid managed care organization?
Mehta: That’s how it is. We are taking the risk of hiring community health partners. And this goes beyond this program itself, but in general, fee-for-service in the healthcare world is not reimbursed well, if at all, for community health partners, and peer support is just starting to be reimbursed. We are paid per member per month for this service and we are betting that this will improve health.
HCI: In the study, you found a decrease in total cost of care and a decrease in inpatient utilization, correct?
Mehta: Exactly.
HCI: Are you going to measure now in other markets to see if that success is replicated?
Mehta: We are in the process of doing it. Massachusetts was the next market we started this program in and we had some pretty good results there. We have an internal team that analyzes this program in all markets.
HCI: Are there any other projects you have underway for 2025 that you want to mention?
Mehta: We want to continue optimizing and implementing this program in any new markets. For behavioral health, we also provide general integrated behavioral health services. A behavioral health physician, a master’s level physician, is integrated into all of our care teams. So for me, the next project is evaluating the effectiveness of that model overall, just having that behavioral health specialist who can provide a warm handoff and provide rapid episodic care.
