The Integration Layer Has Working Models. Two of Them.
The second edition of The HealthIMPACT Brief, a new editorial series amplifying the conversations happening on the stages and in the hallways of healthcare’s best events.
An action plan from the Digital Health Innovation Summit for health system leaders who could not be in the room.
The Integration Layer Has Working Models. Two of Them.
Two keynotes from the Digital Health Innovation Summit showed what the panels were pointing at.
In last month's Brief, I argued that the four panels at day two of the Digital Health Innovation Summit collectively surfaced the same opportunity. The integration layer that connects emerging science, digital infrastructure, patient behavior, and aligned financial incentives into something operationally sustainable is the next major opening in healthcare. Most companies are not yet built for it.
What I left out, because it deserves its own piece, is that the day's two keynotes were already showing what that integration layer can look like when someone has built one.
Caitlin Donovan of General Catalyst opened the morning with an interview of Dr. Toyin Ajayi, co-founder and CEO of Cityblock Health, the recipient of this year's Digital Healthcare Innovator Award. Later in the day, Gil Addo, formerly CEO of RubiconMD, sat down with Todd Park, co-founder and executive chairman of Devoted Health.
Cityblock and Devoted serve almost completely different populations and operate under different reimbursement structures. Cityblock works with Medicaid and dually eligible members, the population Stephen Klasko challenged the longevity panel about, the population most digital health companies do not actually reach. Devoted is a payvider serving Medicare Advantage members, the senior population whose care complexity is the test case for whether technology-enabled coordination can outperform traditional fragmented care.
What the two have in common is the answer to the question every panel of the day was circling.
Aligned incentives plus integrated workflows produce the integration layer. Both companies have built it. Both make the case that value-based care at the operator level is not a terrible business model. It is the only model under which their unit economics work.
Source: DHIS Boston April 2026
Cityblock: the integration layer for the population most companies don't serve
Toyin Ajayi's interview was a master class in why equity and integration are the same problem.
Cityblock serves Medicaid and dually eligible members, populations with the highest medical complexity, the highest behavioral health and social needs, and the lowest engagement with traditional primary care. The traditional fee-for-service economics are hostile to this population. Volume-based primary care cannot fund the wraparound services these members actually need. Most digital health companies have built around the affluent, self-motivated, commercially insured patient because that is where the unit economics close.
Cityblock built around the opposite premise.
Each member gets a dedicated care team. Doctors, nurses, social workers, community health partners, and behavioral health specialists, working in person, virtually, and in the home. The care model integrates medical, behavioral, and social needs (food, housing, transportation) because all three drive outcomes for this population, and managing one without the others fails. The economic model partners with Medicaid managed care plans under value-based arrangements, which means Cityblock generates margin when members get healthier, stay out of the ER, and avoid preventable inpatient admissions.
That is the integration layer in practice. Not as a digital health concept. As a daily operating reality for hundreds of thousands of members across multiple states.
The implication for the conversation that ran through DHIS is direct. Equity is not a separate problem from the integration layer. Equity is the test case for it. If you can build aligned incentives, integrated workflows, and digital infrastructure that work for Medicaid and dually eligible members, you have demonstrated that the model holds in the population where the math is hardest.
That Cityblock won the Digital Healthcare Innovator Award this year matters for reasons beyond the company. It signals that the industry is starting to recognize equity-focused integration as the work, not as a separate category sitting next to the work.
Source: DHIS Boston April 2026
Devoted Health: the integration layer when the payer and provider are the same company
Todd Park's interview was a different proof point for the same thesis.
Devoted Health is a payvider, an integrated insurer and provider built from the ground up around Medicare Advantage. The economic model removes the friction every operator panelist named earlier in the day. There is no mismatch between what reimbursement pays for and what care actually delivers. There is no contract negotiation between the plan and the provider, because they are the same entity. The integration layer is not bolted on. It is the company.
Devoted Medical is a virtual-first in-house medical group that delivers primary care, house calls, and telehealth. Devoted Health Guides are dedicated navigators members describe as a guardian angel, the human layer of the integration. Orinoco is the proprietary technology platform that integrates data across plan, clinical, and member touchpoints to anticipate what each member needs before they ask.
Park has been making a version of this argument for two decades, going back to his time at Athenahealth and as US Chief Technology Officer in the Obama administration. Healthcare's central problem is fragmentation. Fragmentation is fundamentally a workflow problem dressed up as a financing problem. Aligned incentives create the room to fix the workflow. The technology is the means by which the fix happens at scale.
For health system leaders, Devoted is the cleanest case study available for what aligned incentives plus integrated technology actually produce. The payvider model is not viable for every health system, but the operating principles behind it are portable. The integration layer Devoted has built is the kind of capability health systems will need to assemble for their own risk-bearing entities, joint ventures, and clinically integrated networks if they intend to compete in a world where Medicare Advantage continues to grow and risk-based care expands.
What both keynotes have in common
Cityblock and Devoted look different on the surface. Different populations, different reimbursement, different geography, different scale. The structural similarities matter more.
Both started with a population whose existing care model was fundamentally broken under fee-for-service.
Both built an aligned-incentive contract structure as the starting point, not as a future-state aspiration.
Both built integrated, multidisciplinary care teams supported by proprietary technology rather than stitching together point solutions.
Both treat the home, the community, and the digital touchpoint as primary care environments, with the clinic as one node in a longitudinal model rather than the center of it.
Both treat patient experience and clinical outcomes as the same problem.
Both have produced measurable improvements in outcomes, utilization, and member experience that traditional fee-for-service models have struggled to match for decades.
That is the integration layer in production. Not as a venture pitch. Not as a strategic aspiration. As an operating company.
What this means for health system leaders
The panels framed the question. The keynotes showed the answer. For health system leaders thinking through what this means at their own organization, three takeaways carry the most weight.
1. Aligned incentives are the precondition, not the bonus. Cityblock and Devoted both started with the contract structure and built the operating model from there. Health systems trying to layer integrated care on top of fee-for-service revenue will hit the same friction every operator panelist named. Decide which side of the contract wall you intend to be on, then build the digital and clinical infrastructure to match.
2. The integration layer is built, not bought. Neither company assembled their model by stitching together third-party point solutions. Both built proprietary platforms because the integration layer was their core product, not a feature. Health systems do not need to build everything internally, but the integration layer itself, the connective tissue between data, workflow, and incentives, is not something you can outsource to a vendor whose investors believe value-based care is a terrible business model.
3. Equity is the test of whether the model actually works. Cityblock's recognition this year reflects something the industry has been slow to absorb. The companies that can operate sustainably for the most complex, underserved populations are demonstrating capability the rest of the industry has not yet matched. If you cannot deliver care for the bottom 50 percent profitably under aligned incentives, your model is not actually solving the integration problem. It is just serving the easiest patients with better software.
Cambridge VIP curated DHIS in a way that made these points without forcing them. The panels did the analytical work. The keynotes provided the operating proof. By the end of the day, the case was made on both sides of the argument.
The integration layer is not theoretical. It is being built. Cityblock and Devoted are not the only models that will work, but they are proof that models exist. The work now is figuring out which version aligns with your organization's strengths, populations, and contracting trajectory, and committing to it before the consumer-facing ecosystems make the choice on your behalf.
That is the strategic decision the keynotes asked every health system leader in the room to take seriously. The ones who do will define the next decade. The ones who don't will spend it explaining why their digital strategy is a feature in someone else's platform.
Coming next: a closer look at why prevention has never paid in healthcare, and what the operator panel revealed about why that may finally be changing.
Interview with the Recipient of the 2026 Digital Healthcare Innovator Award: Toyin Ajayi, Co-Founder & CEO, Cityblock Health, interviewed by Caitlin Donovan, Partner, General Catalyst.
Innovating for Impact: A Fireside Chat with Todd Park, Co-Founder & Executive Chairman, Devoted Health, interviewed by Gil Addo, Co-Founder & Former Chief Executive Officer, RubiconMD.
Both keynotes: Day two of the Digital Health Innovation Summit (DHIS), a two-day event from Cambridge VIP, Seaport Hotel, Boston, April 28.
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Todd Park
Co-founder and Executive Chairman
Devoted Health
Dr. Toyin Ajayi
Co-founder and CEO
Cityblock Health