Source: REINVESTMENT PARTNERS submitted to NRP
SUPER SNAP - FINANCIAL INCENTIVES TO ENCOURAGE FRUIT AND VEGETABLE CONSUMPTION BY SNAP RECIPIENTS ACROSS NORTH CAROLINA
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
Reporting Frequency
Annual
Accession No.
1015951
Grant No.
2018-70025-28161
Cumulative Award Amt.
$1,000,544.00
Proposal No.
2018-01995
Multistate No.
(N/A)
Project Start Date
Jun 1, 2018
Project End Date
May 31, 2022
Grant Year
2018
Program Code
[FLSP]- FINI Large Scale Project
Recipient Organization
REINVESTMENT PARTNERS
110 E GEER ST
DURHAM,NC 27701
Performing Department
(N/A)
Non Technical Summary
SuperSNAP is designed to address the cost of healthy food to improve health outcomes for SNAP recipients who have very limited money to spend on food. The SuperSNAP program offers incentive funds for SNAP recipients to consume more fruits and vegetables by providing a dollar for dollar match for every SNAP-eligible food purchase at Food Lion, up to a maximum of $40 per month. The incentive dollars earned can be used only to purchase qualifying fruits and vegetables from Food Lion, the participating authorized SNAP retailer.Unhealthy diets that lack fruits and vegetables are connected to poorer health. According to Duke University, overweight and obesity were the second leading causes of preventable death in North Carolina in 2010. Only 7% of North Carolinians eat the recommended amount of vegetables each day and only about 10% eat the recommended amount of fruit.SuperSNAP will increase access to healthy food by making it more affordable, which will lead to better health for participants across North Carolina. Eight local federally qualified health centers and public health departments, which serve 20 counties across North Carolina, will refer participants to SuperSNAP and provide wraparound services to clients with nutritional needs.If the participant buys SNAP eligible food at a participating Food Lion, they will receive a dollar for dollar match up to $40 per month in incentives on their loyalty card. The incentives can be used at a future time to purchase approved fruits and vegetables by using the Food Lion loyalty card at the point of sale. Food Lion will provide monthly reports and receive reimbursement for incentives redeemed.SuperSNAP is a partnership between Reinvestment Partners, Food Lion, Federally Qualified Health Centers, and county health departments. Eight FQHCs and public health departments in multiple counties across North Carolina have committed to partnering on SuperSNAP:AppHealthCareBlue Ridge HealthGaston Family Health ServicesMedNorth Health Center (New Hanover Community Health Center)Piedmont Health ServicesRoanoke Chowan Community Health Center through Hertford Health AccessSurry County Health & Nutrition CenterWilkes County Health DepartmentThe program will serve the following NC counties:GastonLincolnIredellDavidsonCatawbaForsythOrangeChathamAlamanceCaswellBertieHertfordAlleghanyAsheWataugaPolkTransylvaniaWilkesSurryNew Hanover
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
7046010308050%
7036010302050%
Goals / Objectives
Increase the affordability of fruits and vegetables to increase consumption of fruits and vegetables and establish healthier eating habits. 1. The cost of fruits and vegetables is one of the primary barriers to healthy eating. The program will offer up to $40 per month in matching funds to SNAP recipients for the purchase of fruits and vegetables.2. Help SNAP recipients buy and consume more fruits and vegetables on a monthly basis.3. Enroll SNAP recipients through community health centers to help establish the "food as health" connection.Increase awareness of healthy eating principles and strategies.1. Partner with Federally Qualified Health Centers, public health departments, and other health programs that serve low-income communities to offer wraparound services that will help participants increase awareness of healthy eating principles and strategies and work toward the larger goal of improved health.Increase awareness of barriers to healthy eating. 1. Use community based focus groups to better understand barriers to healthy eating for low-income residents.2. Better understand the challenges participants face and adapt SuperSNAP to make it easier for participants to make healthy food choices.3. Share learnings with health and food security agencies.
Project Methods
RP and our partners, the local FQHCs and public health departments, will undertake the following activities to achieve the goals of Super SNAP and reach 2,000 families annually.PlanningIn the planning phase, RP will coordinate with the health clinics to ensure successful outreach and implementation of the program. RP will work with partners to develop marketing materials to be distributed at entry points within the health systems. RP has developed a web portal through which partners will enroll participants in the program. We will train partners on use of the portal and work with health centers on implementation strategies. Each of the FQHCs and public health departments serve different communities and have slightly different wraparound services. We will meet with each of the clinics and work to determine how to best implement the program within their community contexts to be effective.Super SNAP intends to use Food Lion's loyalty card for the collection and redemption of the incentives. Food Lion's loyalty system has the capacity to label customers as participants in the SuperSNAP program when the customer scans their loyalty card and EBT card at the point of sale. The technology can restrict redemption of the earned incentive funds to FINI qualifying fruits and vegetables. Food Lion has developed the technology for the program for the Bull City Bucks FINI project in Durham. This technology is replicable to the new locations that will be served in this FINI Large Scale Project.We will work with the clinics to develop a training program and protocol for their personnel that will be engaged with the program. We will also create reimbursement and information sharing protocols with Food Lion, in compliance with SNAP confidentiality requirements.ImplementationThe FQHCs or public health departments will screen patients with nutrition related health issues about their access to healthy food. The providers will ask if the client receives SNAP benefits, inform them about the SuperSNAP program, and, with the client's permission, enroll them in the program.Partners will use a web portal to enroll participants in the program. During this process, participants enroll electronically into SuperSNAP and connect their Food Lion MVP card to the SuperSNAP program, which will allow the participants to accumulate FINI incentives on their MVP cards. If a potential participant does not have a Food Lion MVP card, the web portal will prompt the participant to sign up for an MVP card and will generate an MVP number electronically, which can then be used to enroll in the program and connect the MVP card.Participants will have to swipe their EBT card at the point of sale to earn the incentives, since the incentives are provided on a dollar for dollar match for SNAP-eligible purchases. If the family buys SNAP eligible food at a participating Food Lion, they will receive a dollar for dollar match up to $40 per month in incentives on their loyalty card. The incentives can be can then be used at a future time to purchase approved fruits and vegetables using the Food Lion loyalty card at the point of sale.Food Lion will provide monthly reports to RP and receive reimbursement for incentives redeemed.EvaluationRP will track SuperSNAP redemptions based on Food Lion's monthly reports. The monthly reports will provide information on how much is being spent on fruits and vegetables and show how many unique participants are taking part in the program.Food Lion's reports will also allow analysis of shopping cart behavior and how it changes for participants in the program. We will be able to track participants over time to evaluate the percentage of fruits and vegetables in their shopping cart and evaluate if and how it changes over time.We will evaluate the program and adapt to better serve participants on an ongoing basis. We may conduct survey and focus groups of participants for feedback to better understand the impact of the program, barriers to healthy eating, and attitudes toward healthy eating.

Progress 06/01/21 to 05/31/22

Outputs
Target Audience:SuperSNAP serves SNAP beneficiaries who are food insecure and are diagnosed with a diet-related chronic condition. Participants are enrolled into SuperSNAP through 9 participating Federally Qualified Health Centers across North Carolina. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?RP disseminates results to communities of interest regularly through outreach calls and presentations. What do you plan to do during the next reporting period to accomplish the goals?RP will continue to distribute nutrition assistance benefits through SuperSNAP through the Spring of 2022, which is the end of the grant.

Impacts
What was accomplished under these goals? In 2021, SuperSNAP distributed just over $537,000 to 2500 participants. This increased the affordability of fruits and vegetables among participants. RP continued to strengthen our relationships with FQHCs through this work. 80% of all enrolled participants used their benefits to try new foods and new ways of eating. RP replicated the SuperSNAP model with other agencies including the state and private health plans.

Publications


    Progress 06/01/18 to 05/31/22

    Outputs
    Target Audience:SuperSNAP is designed to address the cost of healthy food to improve health outcomes for SNAP recipients who have very limited money to spend on food. The program served the following NC counties: • Gaston • Lincoln • Iredell • Davidson • Catawba • Forsyth • Orange • Chatham • Alamance • Caswell • Bertie • Hertford • Alleghany • Ashe • Watauga • Polk • Transylvania • Wilkes • Surry • New Hanover Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?We distributed information to community health partners, state legislatures, philanthropic partners. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

    Impacts
    What was accomplished under these goals? Increase the affordability of fruits and vegetables to increase consumption of fruits and vegetables and establish healthier eating habits. 1. The program offered up to $40 per month in matching funds to 2,512SNAP recipients for the purchase of fruits and vegetables. 2. The program helped 2,512SNAP recipients buy and consume fruits and vegetables costing $971,275.79. 3. The program enrolled 2,512 SNAP recipients through community health centers to help establish the "food as health" connection. Increase awareness of healthy eating principles and strategies. 1. The program partnered with Federally Qualified Health Centers, public health departments, and other health programs that serve low-income communities to offer wraparound services to help participants increase awareness of healthy eating principles and strategies and work toward the larger goal of improved health. Increase awareness of barriers to healthy eating. 1. The program used community based focus groups to better understand barriers to healthy eating for low-income residents. 2. The program betterunderstood the challenges participants faced and adapted SuperSNAP to make it easier for participants to make healthy food choices. 3. The program shared learnings with health and food security agencies.

    Publications

    • Type: Journal Articles Status: Published Year Published: 2021 Citation: Berkowitz SA, Curran N, Hoeffler S, Henderson R, Price A, Ng SW. Association of a Fruit and Vegetable Subsidy Program With Food Purchases by Individuals With Low Income in the US. JAMA Network Open. 2021 Aug 2;4(8):e2120377. doi: 10.1001/jamanetworkopen.2021.20377. PMID: 34379125; PMCID: PMC8358732
    • Type: Other Status: Published Year Published: 2022 Citation: BlueCross BlueShield of North Carolina Foundation. (2022). Reinvestment Partners Case Study. https://www.bcbsncfoundation.org/wp-content/uploads/2022/05/Reinvestment-Partners-Case-Study-April-2022.pdf


    Progress 06/01/20 to 05/31/21

    Outputs
    Target Audience:SuperSNAP serves patients of North Carolina Federally Qualified Health Clinics who receive SNAP benefits and are receiving care for diet-related chronic illness. We significantly expanded our care provider partnerships during this reporting period and enrolled over 7300 new eligible participants into SuperSNAP in 2020. Changes/Problems:During COVID, we receivedCARES Act funds to expand SuperSNAP. We formed a new partnership with a statewide care management agency to enroll SNAP beneficiaries across North Carolina. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?A manuscript is currently under review in JAMA Open which presents preliminary findings from our project. What do you plan to do during the next reporting period to accomplish the goals?Keep on keeping on.

    Impacts
    What was accomplished under these goals? Increase the affordability of fruits and vegetables to increase consumption of fruits and vegetables and establish healthier eating habits. We have distributed approximately $408,000 to over 7,000 SNAP beneficiaries in this reporting period. Independant evaluation of SuperSNAP has found that participants spend approximately $35 of their alloted $40/per month. Participants double their fruit and vegetable purchases while on the program and decrease their purchase of unhealthy items, especially sugar-sweetened beverages. Increase awareness of healthy eating principles and strategies. Participants report a 94% satisfaction rate with our program. Participants report that SuperSNAP helped them and their families eat healthier, try new foods, and change food purchasing behavior. Increase awareness of barriers to healthy eating. We have learned that participants struggle with "loading" funds onto their MVP cards by making a transaction with their SNAP EBT card. Future programming will be informed by this.

    Publications


      Progress 06/01/19 to 05/31/20

      Outputs
      Target Audience:SuperSNAP serves patients of North Carolina Federally Qualified Health Clinics who receive SNAP benefits and are receiving care for diet-related chronic illness. Changes/Problems:We have made improvements to our enrollment portal that makes the enrolling process more efficient and clearer. COVID-19 has challenged our program, as many clinics closed or operated reduced hours during the pandemic. We successfully worked with clinics to enroll patients over the phone so that patients avoided in-person contact at clinics. What opportunities for training and professional development has the project provided?We train enrollers at clinics on our technology platform. How have the results been disseminated to communities of interest?We send a newsletter to partners that shares program news. We participate in regular calls with multiple stakeholder groups to share information. What do you plan to do during the next reporting period to accomplish the goals?We will continue to strengthen relationships with clinic staff and enroll more patients into the SuperSNAP program.

      Impacts
      What was accomplished under these goals? Increase the affordability of fruits and vegetables to increase consumption of fruits and vegetables and establish healthier eating habits. Our program and technology platform have enrolled 1,028clinic patients with $40 per month for the purchase of fruits and vegetables. To date, participants have spent $71,049.78 on WIC-approved fruits and vegetables at Food Lion stores. Our program is helping people eat healthy foods that they normally would not have had access to. Increase awareness of healthy eating principles and strategies. All of the Federally Qualified Health Centers that enroll patients in SuperSNAP also offer nutrition education or counseling to SuperSNAP participants. SuperSNAP participants not only receive funds for healthy foods, but they also receive information about how healthy eating improves their health. ?Increase awareness of barriers to healthy eating. We work closely with clinics to understand how our program can better fit the needs of their patients. We routinely solicit feedback from clinics about how to improve our program and help patients eat better.

      Publications


        Progress 06/01/18 to 05/31/19

        Outputs
        Target Audience:SuperSNAP will serve patients of North Carolina Federally Qualified Health Clinics who receive SNAP benefits and are receiving care for diet-related chronic illness. The program is still in development and has not issued any funds to patients. Changes/Problems:As with our prior USDA FINI grant, we have changed the dissemination structure from a 1:1 SNAP:FINI match to alloting $40 each month after the first SNAP EBT purchase of every month at a participating Food Lion. Food Lion's POS technology was unable to provide a 1:1 match. This change was approved by USDA program staff. What opportunities for training and professional development has the project provided?Reinvestment Partrners has had multiple opportunities to share our work with the leadership of North Carolina's Dept of Health and Human Services. We have consulted on DHHS's changes to the state Medicaid program. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?We continue to encourage Food Lion to complete the technology fixes needed to start implementing SuperSNAP. We expect these corrections to be completed and to roll out the program in the next reporting period.

        Impacts
        What was accomplished under these goals? Goal 1: We have worked diligiently with Food Lion to refine the technological process for loadingand redeeming the benefit funds. We also are working with Food Lion to eliminate discrepencies in the transaction data we recive. We are waiting until these items are complete before we begin distributing SuperSNAP benefits. Goal 2: We have had multiple meetings with our health partners to discuss program goals and implementation strategies. We have distributed educational materials to help explain to patients how the program works. Goal 3: We have not started working towards this goal yet.

        Publications