Source: HMH HOSPITALS CORPORATION submitted to
HACKENSACK MERIDIAN HEALTH FRESH MATCH INITIATIVE (HMHFM)
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
OTHER GRANTS
Reporting Frequency
Annual
Accession No.
1031530
Grant No.
2023-70415-41165
Cumulative Award Amt.
$500,000.00
Proposal No.
2023-05805
Multistate No.
(N/A)
Project Start Date
Sep 15, 2023
Project End Date
Sep 14, 2025
Grant Year
2023
Program Code
[FIP]- FINI Project
Project Director
Harris-Hollingsworth, N.
Recipient Organization
HMH HOSPITALS CORPORATION
343 THORNALL ST
EDISON,NJ 08837
Performing Department
(N/A)
Non Technical Summary
The Hackensack Meridian Health Fresh Match Initiative (HMHFM) will engage 2 cities, Plainfield and Perth Amboy in the eastern region of NJ. The cities of focus are both NJEDA-designated food deserts and rank 24th and 26th compared to 50 other cities in the state. Both cities are majority Hispanic/Latino with (Plainfield at 54.58% and Perth Amboy at 77.8%) Based on this designation, both cities have disproportionate rates of obesity and other health factors impacted by food such as diabetes, hypertension, and congestive heart failure.Economically, these cities have proportionately higher rates of SNAP/WIC utilizing community members, poverty rates, and unemployment by block group. These factors are coupled with low access to grocery stores and retailers that offer healthy choices with low walkability scores and remarkably low CDC modified retail food environment index scores, a measurement that takes not only food access into account but specifically healthy food access.Perth Amboy, located in Middlesex County, is in the 98th percentile for the amount of households currently earning below the federal poverty line compared to other cities in the United States. This city has an active network of over 11 food pantry sites including weekly, healthy food distribution services. The Raritan Bay YMCA provides SNAP Navigator services, community education on SNAP programming, and comprehensive assistance in applying for benefits. Nutrition education is being offered by Rutgers University including healthy meal preparation and budgeting classes.Plainfield, located in Union County, has an average per capita income of only $23,767 and it is home to 11 food pantries and several soup kitchens that all culminate in the Plainfield Coalition of Emergency Food Providers. These providers offer services including regular access to pantry staples and fresh foods as well as connections to community identification cards, clothing, counseling services, assistance with health and childcare services, and navigating applying to assistance programs such as SNAP. Since the advent of COVID-19 in 2020, a common household occurrence is the loss of primary income earners to illness or even death, leaving families without means to meet their basic needs including food. HMHFM would assist in not only supplement income for food assistance, but also increased dollars for fresh, healthy F&V for struggling families in Plainfield.A critical need for these two communities is healthy/affordable food access. According to a report from Community Food Bank of NJ, 9% of the state's population (approximately 800,000 people) are food insecure, and 1 in 12 individuals currently face hunger. Based on the NJ Department of Health statistics, less than 30% of NJ adults consume 5 or more F&V per day, and the top 10 leading causes of death include chronic, diet-related diseases, such as heart disease, cancer, and diabetes. Since the mass unemployment and related impacts caused since the COVID-19 pandemic began in the spring of 2020, the prevalence of these issues has worsened throughout the state. In 2020, 285,000 NJ households did not have reliable access to affordable, nutritious food according to the Hunger and Its Solutions in NJ report, released in May 2022 by the Food Action and Research Center. According to the Healthcare Foundation of NJ, the number of NJ residents receiving Supplemental Needs Assistance Program (SNAP) support rose 23% from February 2020 to January 2021, the most recent data available. In January 2021, 815,000 NJ residents, including more than 360,000 children, received SNAP. Most recently, SNAP households are no longer receiving emergency SNAP benefits or the maximum benefit for household size. Until the minimum distribution is raised, households who have depended on these maximized SNAP allotments are receiving an estimated $82 less per person in monthly benefits, leaving families with significantly less purchasing power and decreased access to healthy food. Juxtaposed with these statistics is the reality that NJ is the Garden State with a robust network of regionally-grown F&V. It boasts nearly 10,000 farms, $1.1 billion in farm revenue per year, and is one of the country's top 5 leading producers of popular produce, including eggplant, bell peppers, peaches, and tomatoes.The HMHFM Initiative will provide a benefit to the community by facilitating the availability of additional resources, through the GusNIP initiative, to implement a place-based strategy to provide participants with nutrition incentive dollars that can be used to access FF&V in participating brick and mortar firms. Working in collaboration with community partners and participating firms we would raise awareness of the program for participants, facilitate twelve month access to fresh produce for SNAP EBT users at participating grocery stores, and contribute to enhanced conversations around regional food procurement.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70460991010100%
Knowledge Area
704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
1010 - Nutrition and metabolism;
Goals / Objectives
The goal of the HMHFM Initiative is to increase accessibility to fresh F&V benefits for SNAP recipients through the use of the nutrition incentive program in Perth Amboy and Plainfield, NJ.Objective #1: To launch and run HMHFM for five individual brick and mortar (B&M) retailers across two cities including regional and local grocery store locations over two years. Successful implementation of the objective will be demonstrated through commencement of benefit redemption activities across in person retailing for SNAP beneficiaries in five grocery stores across the timeframe of 3Q2023 through 3Q2025.Objective #2: To maintain purchasing levels of fresh F&V for SNAP recipients through program utilization in Perth Amboy and Plainfield, NJ.The minimum SNAP benefit allocation in NJ is $95 per month, per household. Through the administration of a $5 weekly benefit, there will be an increase of up to 26.3% per month over the currently offered minimum State benefit. Successful implementation of the objective will be demonstrated through retailers maintaining their fresh produce purchasing ratios for SNAP recipients. The timeframe is 2023 Q3 through 2025 Q3.Objective #3: To strengthen the partnerships among participating grocers, local fruit and vegetable producers, and community-based stakeholders in order to support regional food systems. Successful implementation of the objective will be demonstrated through three stakeholder meetings per program year targeting leaders in regional food systems and inviting community stakeholders to increase overall engagement and education. The timeframe is 2023 Q3 through 2025 Q3.
Project Methods
The evaluation process consists of the use of individual and group processes to convene, share best practices, solve challenges, and improve overall program process and outcomes. The evaluation process will also include reviewing metrics and troubleshooting, meetings will be held with key staff and core consultants quarterly to evaluate process and outcomes. The Fresh Match Initiative's evaluation process will use the NTAE model. Process Assessment will consist of a monthly analysis of Fresh Match's process, challenges, and success of implementation and operations across the following activities:(1) Partnerships with 5 Grocery stores in Perth Amboy and Plainfield; (2) Distribute incentive program marketing materials and NI funds (3) Train/educate relevant staff/team members (4) Convene key stakeholders to meet and align on food centric prioritiesAssessment of Firm Level results will include (1) function of loyalty account use in conjunction with SNAP purchases. (2) Analysis of total number of SNAP purchases contrasted with FFV purchases and FFV benefits distributed (3) review of effectiveness and participation in local community partners Nutrition Education activities offered at the firm locations and (4) documentation and effectiveness analysis of Firm Marketing activities including store signage, print advertisements, multilingual promotions, and QR code use. Also included in these firm-level metrics are documented efforts to convene stakeholders around regional food priorities.The Outcomes Assessment will document the project's effectiveness in increasing fruit and vegetable purchases among SNAP/NAP participants. HMHFM has submitted the project for preliminary review by the Institutional Review Board (IRB) and has received the following statement: "The proposed project involves human subjects in that participants will be asked to take an optional survey. The survey for participants will include a space for the optional release of identifiable private information. While this information will be protected, it is private information for which the identity of the subject is or may readily be ascertained by the investigator or associated with the information by the investigator only. The IRB has reviewed the proposed project and will grant approval for the submitted survey process upon receipt of the award."Additional outcome assessments include collecting core firm-level and participant-level metrics, the aggregated firm-level metrics, as well as any aggregated participant-level metrics at the store and program-wide levels, will be shared to ensure transparency, compliance SNAP requirements and alignment with goals/sustainability.The following Firm-level Nutrition Incentive (NI) Core Metrics will be collected from each site on a monthly basis and provided to HMH/NTAE for reporting. The metrics include number of NI redemption firms, number of newly onboarded sites and associated expenses, financial instrument used for each site, FFV products eligible for incentive purchase, number of SNAP transactions per site, number of nutrition incentives distributed per site, and number of nutrition incentives redeemed.Per NTAE guidance, partnership, and provided evaluation materials, an optional survey will be administered via a QR code linked to a Qualtrics survey or paper survey to all HMHFM participants. Participants will be notified of the survey via the QR code on their incentive and through quarterly in-store, paper survey administration events in order to accommodate technological barriers. The survey will include questions regarding SNAP use (length of time), locations of NI use, dose of NI Program use, NI Program satisfaction, FFV consumption, food security, health status, COVID-19 impact, sociodemographics, and geography.The lead applicant for the Fresh Match Initiative, Hackensack Meridian Health, has as evaluation partners, the Hackensack Meridian School of Medicine and the Rutgers School of Public Health - Rutgers Biomedical and Health Sciences, which will serve as the evaluators for HMHFM and will conduct community-based participatory research. These organizations have engaged in multiple agricultural producer alignment/process, outcome, and impact evaluation experiences that have involved SNAP/NAP participants or other related food programs.Dr. Downs from the Rutgers School of Public Health - Rutgers Biomedical and Health Sciences and the Rutgers NJ Institute for Food Nutrition and Health Center for Childhood Nutrition Research and Center for Agricultural Food Ecosystems is the lead evaluator on this initiative.The HMHFM Initiative will cooperate with and contribute core data to the NTAE center and all core data and metrics will be collected regularly and provided to the NTAE.

Progress 09/15/23 to 09/14/24

Outputs
Target Audience:The Fresh Match Initiative targets SNAP recipients in Plainfield and Perth Amboy, New Jersey, two communities disproportionately burdened by diet-related diseases and facing significant barriers to healthy food access. Residents of these communities struggle with high rates of obesity, diabetes, and heart failure, exacerbated by high poverty and unemployment, and further compounded by the economic fallout of COVID-19. The pandemic deepened existing hardships, including loss of income, making it even harder for families to afford nutritious food. Data underscores the urgent need in both locations. Perth Amboy, in Middlesex County, has a 77.8% Hispanic/Latino population and is designated a food desert by the NJEDA. It ranks 24th out of 50 New Jersey cities for food need and falls within the 98th percentile nationally for households below the poverty line, with an average household income of $56,239. Nearly 20% of residents are SNAP-eligible, often relying on a network of 11 food pantries. Plainfield, in Union County, faces similar challenges. With a 54.6% Hispanic/Latino population and a per capita income of $28,788, 22% of residents receive SNAP benefits. Also a designated food desert, Plainfield ranks 26th in the state for food need. Limited access to healthy food retailers, low walkability, and a poor retail food environment further restrict access to nutritious options. The Plainfield Coalition of Emergency Food Providers, a network of 11 food pantries and several soup kitchens, plays a crucial role in supporting residents. The Fresh Match Initiative directly addresses these challenges by providing an unlimited match of benefits for fruit and vegetable purchases with SNAP dollars at five local retailers. This increased purchasing power is critical for SNAP recipients, allowing them to stretch their limited resources and access more produce. Partnerships with community organizations like the YMCA, WIC offices, senior centers, daycares, and food pantries extend the initiative's reach and amplify its impact. By making healthy food more affordable and accessible, the Fresh Match Initiative empowers residents of Plainfield and Perth Amboy to improve their diets, health outcomes, and overall well-being. It also strengthens the efforts of community partners working tirelessly to combat food insecurity and build a healthier future for these communities. Changes/Problems:On July 1, 2023, 3 million dollars in a New Jersey state appropriation was awarded to HMH for the Fresh Match initiative. A $3 million state appropriation allowed Fresh Match to expand from an five stores to thirteen and increase the benefit from a $5 weekly limit to an unlimited match. This represents significant growth and increased potential impact. The state appropriation dollars were allocated from July 1, 2023 to Jun 30, 2024. While this was a major accomplishment of the program, it presented a change in program structure. With both allotments of funding, the Fresh Match team needed to obtain the Equal Treatment Waiver which allows for the use of the state funds toward SNAP recipients only. This process took nearly 60 days to complete which set back the launch date of the program by close to two months. HMH is grateful for the technical assistance of the Nutrition Incentive Hub staff in navigating the use of both sets of funding. ? Additionally, select grocery store partners had legal approval wait times that took nearly 3 months. This was the case with Wakefern Corp. in that the legal review of their MOU took nearly 6 months to complete. Two out of the five participating grocery stores were ShopRites which significantly impacted the benefit's expenditure rate. The delayed contracting with the two stores accounted for 40% of the budget. There were no special and/or additional reporting requirements specified in the award Terms and Conditions. What opportunities for training and professional development has the project provided?Under the goal of the program, Fresh Match was supported by four (4) Food Security Specialists, completing their graduate programs in public health and health administration with a focus on food security. This position and associated responsibilities led these team members to develop new skills and refine existing ones to meet the demands of the programs and the evolving food security sector.The Fresh Match program was supported by four (4), full-time, paid Food Security Specialists through HMH's Social Determinants of Health Department. Each of these positions completed their professional degree supervised practicum experience, led network-wide creation and implementation of Social Determinants of Health (SDOH) initiatives, and has been provided with access to the full breadth of HMH professional development opportunities. This position and associated responsibilities led these team members to develop new skills and refine existing ones to meet the demands of the programs and the evolving food security sector. To achieve this objective the Fresh Match team focused on understanding the POS system technologies and how to most effectively ensure participants received and utilized their benefit. Meeting this objective involved training opportunities for store staff to learn how to engage customers at the cash registers and customer service desks to increase awareness of the benefit and how to utilize it. Convenings and conversations with different stakeholders throughout the New Jersey food system provided opportunities for more community members to understand the program. They also provided professional development to Fresh Match team members by way of information sharing on available resources and opportunities. How have the results been disseminated to communities of interest?Advertising and marketing for this program has been made public through out the use of social media, press releases, and flyers and posters throughout the program service area. In addition, HMH has both convened and participated in convenings of partners to share knowledge of the program to the public. Fresh Match collects firm-level, programmatic data results, changes, and impacts monthly. This includes how the Fresh Match incentive program is helping to increase the state minimum benefit for NJ SNAP recipients. The data is analyzed and translated into concise reports that highlight key achievements and challenges, and provide interpretation and visualization. These reports are provided to store leadership and community stakeholders every quarter. This increase in benefit usage and dollars provided to NJ SNAP families has also been included in the regular, aggregate, firm-level data reports to stakeholders. Fresh Match team members meet with all other GusNIP grantees in the state to share out on our strategy, next steps, connections made in the community and opportunities for partnership and growth. The results of these conversations have been shared during these meetings. What do you plan to do during the next reporting period to accomplish the goals?In the next reporting year, HMH will continuing to work with stores to provide the nutrition incentive benefit, market the Fresh Match program to new participants and provide community education to the public. In the next reporting period, Fresh Match will increase accessibility to fruits and vegetables through providing unlimited matching dollars at the five, participating grocery retailers. Fresh Match will also utilize the increased use of geotargeted, social media marketing, NJ Transit Marketing, and direct mailers to residents within a certain radius of the grocery store zip codes. These methods will help increase the awareness and participation of recipients. This increase in participation and redemption will provide more dollars to NJ SNAP recipients. In the next reporting period, Fresh Match will continue to increase awareness and participation in the initiative. To do this, Fresh Match will utilize the increased use of geotargeted social media marketing, NJ Transit Marketing, and direct mailers to residents within a certain radius of the grocery store zip codes. These methods will help raise awareness and participation of recipients. Additionally, this increase in participation and redemption will increase not only the number of participants in the program but also the percentage increase to the minimum state benefit of SNAP dollars provided. In the next reporting period, Fresh Match will continue to increase the engagement in regional food system convenings. These convenings are opportunities for grocery store procurement partners to communicate and connect with regional fruit and vegetable procurement producers and community-based stakeholders.

Impacts
What was accomplished under these goals? Under the goal of the program, the Fresh Match initiative launched and operated nutrition incentive benefits to NJ SNAP recipients in five (5) brick-and-mortar stores in Perth Amboy and Plainfield, NJ.Under objective 1, the Fresh Match initiative was planned, initiated, and has reached full operational status for customers in reporting year one. During this first reporting period, five brick-and-mortar retailers became Fresh Match partners with signed and completed MOUs. These partners are comprised of three different retailers, Supremo LLC., Krausdale Foods, and Wakefern Corp. Each retail partner and associated store(s) utilizes a unique point of sale (POS) technology to administer the benefit. HMH worked closely with each partner to review POS options for nutrition incentives and select, fund, test, and run the benefits administration technology that would benefit the customers most effectively. Fresh Match team members also trained and provided regular program updates to store staff on how to administer the benefit to customers. These 12-month, full-scale grocery retailers are located in New Jersey cities with high rates of SNAP recipients with no preexisting nutrition incentive programs. Additionally, the demonstration of this program through the use of the GusNIP grant led to HMH being awarded three million dollars in a New Jersey State appropriation in support of the initiative. With these additional dollars, Fresh Match expanded from five (5) brick-and-mortar retailers to thirteen (13) retail partners in total. The benefit redemption amount was also expanded from a $5 weekly match to an unlimited match on SNAP dollars spent on USDA-defined fruits and vegetables.During the first GusNIP grant reporting year, Fresh Match provided $71,505.95 in redeemed dollars for fruits and vegetables to New Jersey SNAP recipients. These dollars were redeemed at the five participating retailers in Perth Amboy and Plainfield, New Jersey. Under objective 2, Fresh Match has increased the $5-a-week benefit to unlimited matching dollars on fruits and vegetables for participating NJ SNAP recipients in five (5) brick-and-mortar firms. The increase of the benefit to unlimited has provided over the anticipated amount in nutrition incentive benefits to participating, SNAP households. The increase in the benefit has leveraged the average percent redemption rate for Fresh Match Coupons to be 37%. This rate is much higher than the national average redemption rate for grocery paper coupons, which is < 2% and the national average redemption rate for grocery electronic coupons, which is ~7%. This exceeds the 26.3% increase in the state minimum SNAP benefit to participants. Under objective three, Fresh Match participated in three (3) convenings of the Food Democracy Collaborative which included conversations with regional food producers, community-based organizations that specialize in food security efforts, and local government offices. These convenings included regional food procurement businesses such as Zone 7 and Common Market to gain insight on local fruit and vegetable producers. In addition, the Fresh Match food security team outreached over three hundred different community-based organizations in order to build awareness of the program and develop partnerships with SNAP Navigators. SNAP Navigators from the Raritan Bay YMCA and community-based stakeholder partnerships have regularly attended store tabling events to assist customers with SNAP applications.

Publications