Cityblock Exec Details Expansion of Advanced Behavioral Health Program

Cityblock Health piloted an Advanced Behavioral Health program designed for patients with psychotic disorders or severe substance use disorders. Based on the promising results seen in its Washington, D.C., market, the company has since rolled the model out in all seven of its markets. Ruby Mehta, M.S.W., M.B.A., head of behavioral health for the value-based care company, recently spoke with Healthcare Innovation about this work and the details of a recently published study in 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, medications for opioid use disorder, medications for alcohol use disorder, contingency management, care coordination, and social care navigation. 

In the study period, members enrolled in the program for a period of 10 months had a statistically significant 19.7% decrease in inpatient utilization and an 11.5% decrease in total per-member, per-month cost of care compared with a quasi-control group. 

Healthcare Innovation: Ruby, I’m interested to hear about this Advanced Behavioral Health program, but before we do that, could you talk briefly about your background before coming to Cityblock?

Mehta: I’ve been at Cityblock a little over three years. Prior to that, I was clinical director at a small startup called Tempest that focused on individuals with alcohol use disorder and trying to get them into care. We used a peer recovery model there. Prior to 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 started off 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 I worked at a day treatment program for adults with serious mental illness.

HCI: What was intriguing about coming over 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 portion. If you think about Maslow’s hierarchy of needs, if you’re not fulfilling the social needs, there’s no point in thinking about the mental health piece. The two can be very closely related. And Cityblock has this model where they covered that piece of it, which was really attractive. 

HCI: Could you describe the elements of this Advanced Behavioral Health program and the types of patients that it’s designed for?

Mehta: We do a lot of population health management. When we were looking at what’s driving healthcare utilization in our population, we were seeing a lot of people hospitalized for schizophrenia and a lot of people hospitalized for alcohol and opioid use disorder. That was the genesis of the program about three years ago. Even though it is a small percentage of the population, it’s driving a lot of the utilization and the hospitalization. So we decided to design a targeted intervention for this population. 

When you think about the research behind what’s effective for schizophrenia, medication compliance is a big deal. Members often fall out of care — especially the population we work with, a lot of them have housing insecurity, so they lose their medications or they forget to take them. So that was one of the key interventions, making sure that folks in this program are being evaluated, have had a recent psychiatric evaluation, are attending their appointments, are taking their antipsychotic medications, which is the treatment for schizophrenia. 

We also have our social services. For this population, of course, stress exacerbates schizophrenia symptoms. Housing insecurity and food insecurity makes these conditions worse, makes really any condition worse. And so we want to make sure in the program we evaluate members for food insecurity and housing insecurity, and see how we can help individuals obtain food and housing.

HCI: I read that that the model is led by specialized community health workers. And I was wondering if Cityblock had already had experience deploying community health workers. This seems like it is using them with a really targeted 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 physicians, 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 that have some experience working with individuals with behavioral health needs and have undergone additional training internally to understand those needs and the interventions, but it is consistent with our model of relying on community health partners. 

HCI: Did you start with an initial pilot of this in one specific location?

Mehta: We started in the D.C. market. We had to train the community health partners. We had to train the whole team to understand the interventions. And it’s a lot more resource-intensive. The pilot was successful and the outcomes were very positive. Because of that, in 2023 we expanded it to all seven states we operate in. 

HCI: I know that Cityblock is a value-based care company and it focuses on total cost of care, but how does it work in the reimbursement and finance side of this particular program? 

Mehta: For most of our contracts, we are paid per member per month, and that cost will essentially cover all of a member’s physical health and behavioral health needs. 

HCI: And is that getting paid by a Medicaid managed care organization? 

Mehta: That’s right. We’re taking on the risk of hiring community health partners. And this goes beyond this program itself, but just in general, fee for service in the healthcare world doesn’t reimburse well, if at all, for community health partners, and peer support is just starting to get reimbursed. We are getting the per member per month for this service, and we’re taking the bet that this is going to 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 now measure in the other markets to see that that success is replicated?

Mehta: We’re in the process of doing that. Massachusetts was the next market that we started this program in, and we have some pretty good outcomes there. We have an internal team that’s looking through this program in all markets. 

HCI: Are there any other projects you have in the work for 2025 that you want to mention?

Mehta: We want to continue to optimize and implement this program in any new market. On the behavioral health side, we also provide general integrated behavioral health services. A behavioral health clinician, a master’s level clinician, is embedded into all of our care teams. So, for me, the next project is to evaluate the efficacy of that model in general — just to have that behavioral health specialist to be able to do a warm handoff to and to do quick episodic care.