Cityblock Health's Alexander Billioux on how a Medicaid-focused startup can succeed

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Despite looming Medicaid cuts, companies like Cityblock Health still see an opportunity in serving the 1 in 5 people in the US—nearly 75 million adults and children—with the public health insurance option for people with disabilities or low income.

Launched in 2017 as a spinout from Sidewalk Labs—part of Google’s parent company, Alphabet—the value-based and tech-driven care provider partners with national and regional health plans and providers to give medical, mental, and social care to over 100,000 Medicaid and dual-eligible members across 11 states. The startup has raised over $800 million in total funding and has an annual recurring revenue of over $1 billion, Chief Health Officer Alexander Billioux told us.

Billioux came to Cityblock in March. Prior to this job, he had a five-year stint at UnitedHealthcare, where he was most recently government programs chief medical officer.

We talked to him about why he came to Cityblock and the company’s strategy for success.

This interview has been lightly edited for length and clarity.

What drew you to Cityblock?

I admired it for a long time. When this opportunity came up to join the team I was like, “100%.” We’re delivering and about to deliver at scale what I think the country needs right now in a healthcare organization: marrying value-based care with population health management and actual care delivery for some of those vulnerable populations.

Government insurance, especially Medicaid, is not an area that many people think of as a lucrative sector. Why did Cityblock, a for-profit company, choose to focus on this population?

I think it is the harder path to take…The benefit is that this is a group that nobody has built toward. Nobody starts with Medicaid. Our healthcare system was not designed to serve the most vulnerable. And what we find is if you engage with people authentically and you prioritize their health needs, and even more so their social needs, you get a lot of engagement and traction, which is the secret sauce to any intervention in healthcare working.

How is Cityblock using AI to try to achieve its goals?

What’s so needed in engaging a population that’s been historically disenfranchised and discriminated against in healthcare settings is really spending your time on the critical relationship with the individual.

As we lean into enabling automation where it makes sense through AI, we’re able to reduce [administrative] costs and have almost all of our person [operating expenses] really focused on time with somebody that actually makes a meaningful impact on their engagement, on their trust, on their care.

Are there any misconceptions people might have about your job?

I think that there’s a general misconception about the status of value-based care in this country right now. I think the reality is that a tremendous amount of value-based care companies and value-based care contracts are still focused on relatively low-hanging fruit or process optimization within health systems.

The bigger opportunity—and the opportunity that I think Cityblock is really going after—is population health management.