Inside politics of broken, unaffordable U.S. health care, Cityblock CEO Toyin Ajayi sees opportunity

For the first time in decades, people are having real conversations about health care, “from the ground up,” says Dr. Toyin Ajayi. That has her feeling optimistic.

“We’re in a moment where health and health care — and what it means to be healthy — is the subject of a national discussion,” the co-founder and chief executive officer of Cityblock Health told CNBC Senior Media & Tech Correspondent Julia Boorstin in the latest episode of the “CNBC Changemakers and Power Players” podcast.

“I’ve never seen that,” Ajayi said.

Amid cuts in federal funding for scientific research, the introduction of polarizing policies under President Trump’s Health and Human Services Secretary Robert F. Kennedy Jr., and a charged political debate over how the U.S. funds health care that precipitated the longest U.S. government shutdown on record, this sort of optimism might seem counter-intuitive.

But Ajayi says the interest and attention the U.S. health-care system is getting now is exactly what is needed to spur change. “Health care is so unaffordable in the United States, inexplicably unaffordable,” Ajayi said.

“We’re not healthier as a result of all the spending we’re making. We as a country spend more per capita on health care than any other developed country, and we have some of the worst health outcomes. Doctors and nurses are burned out. They’re leaving the profession in droves. We’re having a hard time attracting people to do really amazing work, like being primary care doctors in rural areas. … And we’re aging, and the needs are greater. … the status quo wasn’t working. Everybody’s kind of mad about it,” she said.

Ajayi was named to the 2025 CNBC Changemakers list.

The “Make America Healthy Again” movement is one example of a recent public discussion that Ajayi sees as a positive, “whether or not I agree with certain people’s positions,” she said.

“There are people who identify as being part of a movement around health. That’s incredible,” she said. “Who can I elect who is more likely to help me live a healthy life and help my children live a healthy life? … For the first time, certainly in the last couple of decades, people are having real conversations, not in the halls of Congress, not in the state houses, but actually on the ground about what health means,” she said. 

Cityblock provides health services to individuals across clinical, behavioral health, and social needs, serving patients who are on Medicaid or are dually eligible for both Medicare and Medicaid. The company, which has more than 100,000 members and partners across more than 10 states, employs community health workers who conduct hyper-local, in-home assessments and coordinate care, and also connects patients to social services, like food banks and transportation.

With trust in the U.S. health-care system “at an all time low,” according to Ajayi, the most important thing Cityblock is focused on is earning and retaining patient trust, she said.

It’s a message she shares with all of her investors, shareholders and teams. “Medicine for so long kind of operated on a hierarchy — it was us and it was them,” said Ajayi, who during her education as a medical student and career as a medical doctor has seen the inner workings of underfunded, under-equipped pediatric care units in Sierra Leone and high-tech hospitals in Boston. “We had the white coats and all the data and information, all the years of training, and they were our subject… That doesn’t work and I think that we have a real opportunity in health care and in public health to regain trust by actually meeting people where they are,” she said.

That means going into people’s homes, connecting with them on their smartphones or in their social media feeds. “Wherever people are we’ve got to go there and we’ve got to show up using language that is relatable to them and intelligible to them,” Ajayi said.

She is bullish on the potential of AI to do just that, and to help Cityblock make care even more accessible, trustworthy and understandable. The company is investing in AI technology with the aim of ensuring benefits reach patients on government health plans, not just the wealthy, “so that we can look back 10 years from now and say, you know what, we as a society developed AI tools that actually make the world and lives better for people who didn’t have a seat at the table and wouldn’t otherwise have been built for,” she said.

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