2018 Conference

Physician sees disparities in health care, makes fighting them her mission

When Toyin Ajayi, MD, began practicing as a board-certified family physician, it didn’t take long for her to decide that fighting disparities in health care would become her life’s work.

“My training and ongoing encounters with patients highlighted the limitations of traditional office-based primary care,” says Toyin. “The systems, processes and approaches tend to focus on the perspective of the clinician – not the patient. The prevailing system is patriarchal, rigid and disease-focused, and gives clinicians limited tools – and limited time – with which to engage and support our patients.”

According to Toyin, one real-life example – the experience of a 60-something year old gentleman who struggled with alcoholism and homelessness – underscores how the system is lacking. The man was living with numerous chronic conditions and had been admitted to the hospital close to 20 times during the year. His prescription list included dozens of different medications, consisting of an inhaler, must-be-refrigerated insulin and a water pill that would make him have to pee frequently, among others. All the medications were indicated for him to take according to a strict schedule according to “evidence-based guidelines,” which were blind to the fact that he spent each night on a park bench.

“On one occasion when he had been readmitted again after just a couple weeks, he was medically ready for discharge,” recalls Toyin. “The team was preparing the paperwork and prescriptions and we walked through his long list of medications. It became immediately obvious that this list of pills and instructions would be difficult for just about anyone to manage, even if they had a roof over their head, a solid support network and a refrigerator full of food. For this gentleman who was struggling for daily survival, the task was almost ludicrous. I asked him, ‘What do you think you can handle? How many medications can you take?’ He said five. He explained that he could not have anything that looked valuable, could not take anything more than once a day, and obviously, had no place to refrigerate anything.”

Toyin asked her team to figure out which five medicines to recommend to the patient, and which medications they would remove from his discharge list. Some members of her team expressed dismay, recognizing that Toyin’s instructions went against the evidence-based guidelines that they had been trained to follow.

“The rules were not built for this guy,” says Toyin. “I want to be in partnership with the patient – to do what’s right for them, on their terms. So we sat with him and talked through the risks and benefits of each of the five prescriptions, explaining why we thought they were important, and what the trade-offs had been with the meds that hadn’t made the list. Together, we made a plan. In spirit, that’s the type of health care we should be providing.”

Since then, Toyin’s career has focused on providing care to underserved populations and to challenging the status quo. “It became obvious to me that to be the type of doctor and citizen I wanted to be, I would need to be part of growing a different model of health care,” she says.

Just last fall, she relocated to New York City as co-founder and Chief Health Officer of Cityblock Health to create an innovative model for caring for Medicaid and Medicare patients, using the principles of trust, empathy and partnership to make sure people feel heard and cared for.

“We’re challenging the notion that people with complex health and social needs must make do with a health care system that is fragmented, impossible to navigate, and costly. We can create a sustainable model that meets people where they are, is responsive to their needs, and which consistently delivers high value.”

Join Toyin at What’s the Fix? on May 17 to hear more about her story and how she’s taking action to change health care.

About Toyin:

Toyin is a primary care physician dedicated to improving health care for people with complex needs. She’s currently the Chief Health Officer at Cityblock Health, an organization in New York City that aims to build a scalable solution to address the root causes of health for underserved urban populations. Prior to Cityblock, Toyin served as Chief Medical Officer of Commonwealth Care Alliance. In this role, she led all clinical operations; spearheaded care delivery innovations; and oversaw multi-disciplinary teams of more than 500 clinicians, community health workers, and administrators, serving more than 20,000 beneficiaries across the state of Massachusetts.

Toyin received her undergraduate degree from Stanford University, an MPhil from the University of Cambridge, and her medical degree from King’s College London School of Medicine. Having completed her residency training at Boston Medical Center, Toyin is a board-certified family physician and continues to practice primary care and hospital medicine focused on patients with chronic, complex, and end-of-life needs. Internationally recognized as a leader in care for populations with complex needs, Toyin advises organizations such as the Center for Health Care Strategies, the Commonwealth Fund, and Institute for Healthcare Improvement.