Progress 09/01/19 to 08/31/23
Outputs
Target Audience:DC Medicaid adult patients experiencing diabetes, prediabetes, or hypertension who attend one of our partner cilnics (18locations) located throughout the District of Columbia. The benefit amount changed to a tiered amount system based on household size, so the household was also a target of the program. Changes/Problems:Through various forms of community feedback we understood that our participants experienced major barriers to utilizing Produce Rx. Some of those barrier included: Lack of grocery options- Previously we only worked in Giant. With only seven Giants in all of DC, and only five in neighborhoods we work in, it was not accessible. In addition, many participants did not want to shop at Giant, as it was not convenient for them or did not have great produce. Checking card balance- This may seem small, but participants had no way to check the balance left on their benefit. Participants were not going to take two buses to the grocery store to find out they have $5 left on their benefit. Many dollars were left on the table every month and made the program under-utilized because of this barrier. Multiple steps- The program model had multiple steps involved to be able to use the PRx benefit. Participants had to go to the clinic to enroll/ fill Rx, then stand in line at the pharmacy to load the Produce Rx, then shop. These multiple steps to use their benefit was a barrier. Administratively burdensome- On the DC Greens end, were not as integrated into the clinic workflow, so it was so administratively burdensome to implement the program to over 1,000 residents. Every participant had to get a new Rx every 3 months, everyone was on a different cadence, trying to track participants individual cadence was a challenge. With the priority of centering participant voice, we adapted our entire program model accordingly, to one that met the needs of our participants. The full adoption of the Fresh Connect platform and technology in our Produce Rx program in June 2023 was a monumental achievement for DC Greens. Fresh Connect is now used by all Produce Rx participants throughout the District. With his new model, participants can: Check their balance, their dollars get automatically loaded at 1st of the each month Participants can shop at any Walmart, Safeway and Giant in DC, Maryland and Virginia Changed requirements from 3 month check-up to 6-month check-up with healthcare provider, making it less burdensome but also acknowledging a need for a touch point with the healthcare system to continue the Food is Medicine intervention Created a household inclusive program model. Participants' monthly benefit allotment is tiered based on household size, starting at $80/ month, with an extra $10/ month per household member, capped at $120/ month or 5 household members. ? The overall outcome is a program model that is more accessible, efficient, effective, equitable, and scalable. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We have created a concise and easily digestible version of the 2019-2020 pilot cohort evaluation to disseminate to stakeholders including MCOs, clinics, funders, etc. We have already disseminated said report to DHCF and are in the process of creating a dissemination plan to the rest of our community. ? What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
1. Implement the Produce Rx program to lower food insecurity among Medicaid patients experiencing hypertension, prediabetes and diabetes through strategic partnerships with food retailers, federally qualified health centers (FQHC), a managed care organization (MCO), and the city's department of health. Through this grant, agreements were established with Socially Determined, all 3 DC MCOs, 6 FQHC, and 18 clinic locations. Clinics include: Whitman Walker Health, Unity Healthcare, Community of Hope, Providence, So Other Might Eat (SOME), Bread for the City. In the continuation of better integrating PRx into clinic workflow, the PRx team began working with clinics, specifically creating a concise EHR (electronic health records) process for our clinics to implement into their eCW to ensure accurate tracking of Produce Rx participants in their EHR systems. To facilitate the EHR template process, PRx Coordinator Emily Corry met with DCPCA (DC Primary Care Association) and clinic partners. DCPCA provides support to many of our clinic partners in a variety of ways, including EHR template creation, and Emily sought to explore this connection in order to familiarize DCPCA with Produce Rx and our goal of a standardized EHR template. The outcome was a streamlined History of Present Illness (HPI) template in eCW that all 6 of our health care network partners replicated. Emily has trained all clinics in this new system so they can begin to implement it into their eCW. We are thrilled to be able to create this process to move one step closer to deeper integration of the Produce Rx program into the healthcare system. Over 3,000 participants were enrolled during the grant period, with 858 enrolled as of 8/31/2023, with over 1,000 enrolled for one full year. Over $1.5 million dollars were redeemed by program participants to purchase fresh fruits and vegetables. 2. Leverage innovative data-sharing agreements to evaluate health-related outcomes, among individuals with hypertension, prediabetes, or diabetes, and building a robust evidence base that drives increased healthcare system investments in food-related social determinants of health. Through a new partnership with DC Healthcare Finance (DHCF), which manages Medicaid and Medicare in DC, Socially Determined was able to access claims data for participants of all DC Medicaid providers. We have finalized an agreement between DHCF and Socially Determined that allows Socially Determined to receive health claims data from DHCF. Socially Determined completed the evaluation for the 2019-2020 pilot cohort. Conclusion: Results from the program evaluation found high Produce Rx voucher redemption and program satisfaction, but low engagement with auxiliary education supports. Over a third of participants across all biometric analyses saw improvements in their biometric readings: 39% of participants had a reduction in HbA1C levels; 35% of participants had a reduction in BMI; and 34% had a reduction in blood pressure. A time-series impact analysis found that impacts on health care utilization and health care costs were mixed. Primary Care Provider and Emergency Department visits decreased, but inpatient stays increased. Additionally, costs associated with Primary Care Visits and Inpatient stays decreased, but costs associated with Emergency Department visits increased. Both the 22-month intervention period and the one-year post-intervention impact period were affected by the onset of the COVID-19 pandemic. Unprecedented disruptions in health care, the economy, and the social safety net impacted program and health care engagement and may have impacted the integrity of the data provided to the evaluation team. Therefore, results from this evaluation should be interpreted with caution. 3. Expand Produce Rx program across Washington, DC by strengthening existing partnerships and building new partnerships (FQHCs, MCOs, and food retailers), and integrating new technology. The program maintained over 500 active participants throughout the entirety of the grant, reaching over 1,300 in 2023. During the grant period, the Produce Rx program expanded to include a total of 18 clinic partner locations across the District, exceeding our goal. In June 2023, the program expanded to implement Fresh Connect, a technology enabled food prescription platform and card. This technology enables DC Greens to track and record participants' program redemption and utilization. We are currently able to see to date the amount of dollars spent by participants and by food retailer location. The Fresh Connect platform enables our team to easily and efficiently support participants in navigating the program. In addition, Fresh Connect allows participants to shop at any Walmart, Giant, and Safeway in DC, Maryland and Virginia, encompassing over 100 store locations. DC Greens built partnerships with all 3 DC MCOs (Amerihealth, Carefirst and Medstar), signing agreements to support in data transfers and program implementation.
Publications
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Progress 09/01/21 to 08/31/22
Outputs
Target Audience:DC Medicaid adult patients experiencing diabetes, prediabetes, or hypertension who attend one of our partner cilnics (16 locations) located throughout the District of Columbia. Changes/Problems:1. The evaluation completion of the 2019-2020 cohort has been held up due to challenges around retrieving the health claims data from DC Healthcare Finance (DHCF). See detailed explanation above in the section on leveraging data-sharing agreements. 2. We revised the digital system at Giant for an extended time period to use Produce Rx dollars: System will allow for distribution of $240 for a three month period, through a bonus card (previously participants recieved $80 dollars every month). This change was implemented as a way to make the program more accessible, as participants go to the pharmacy less frequently and are given more time to use their PRx dollars. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We have shared preliminary findings with partners (clinics, Giant, AmeriHealth, Medstar, CareFirst, and DC Health Care Finance) and are working with our evaluators to complete the final evaluation and disseminate widely. What do you plan to do during the next reporting period to accomplish the goals?In the next period, September 2022- September 2023 we plan to: Complete the evaluation of the 2019-2020 Produce Rx Program. Enroll at least 1,000 participants. Nurture our partnership with DC Healthcare Finance and other stakeholders to scale up our program. Develop a pilot program to test a new payment technology, Fresh Connect, a technology enabled food prescription platform used to track and record health costs, outcomes, and increase food access across multiple retailers.
Impacts
What was accomplished under these goals?
1. Implement the Produce Rx program tolowerfood insecurity among Medicaid patients experiening hypertension, prediabetes and diabetes through strategicpartnerships with food retailers, federally qualified health centers (FQHC), a managed care organization (MCO), and the city's department of health. We finished enrollment of our 2021 cohort on December 31, 2021. We haveenrolled 473 partcipants thus farin our 2022 cohort, which began in January 2022. We revised the digital system at Giant for an extended time period to use Produce Rx dollars: System will allow for distribution of $240 for a three month period, through a bonus card (previously participants recieved $80 dollars every month). We secured grant funding from DC Health Care Finance (DCs Medicaid Agency), continung our partnership with DHCF. For our 2021 cohort we have collected 454 baseline surveys and 56 endline surveys. For the reporting period, $167,078.50 of PRx dollars were redeemed amongst 614 participants. In 2022 thus far, $123,952.70 PRx dollars have been redeemed. 2.Leverage innovative data-sharing agreements to evaluate health-related outcomes, among individuals with hypertension, prediabetes, or diabetes, and building a robust evidence base that drives increased healthcare system investments in food-related social determinants of health. Our external evaluatorSocially Determined has established agreements with all clinic partners, Giant Food, Carefirst, andAmeriHealthand they are currently receiving all survey, program utilization, and health data from each partner (DC Greens, Giant Food, and clinics, respectively). Some shifts in DC Medicaid in October 2020 created challenges for the process to receive healthcare utilization data for all participants enrolled in the Produce Rx. The shifts shuffled Medicaid patients across Managed Care Organizations, which meant that some participants who were previously AmeriHealth members were now members of a different MCO. Since Socially Determined did not have agreements in place with the other MCOS, accessing these participants' healthcare utilization data became challenging. To facilitate the retrieval of this data and move our vision of embedding Produce Rx in the healthcare system, we established agreements with all three DC MCOs (adding Carefirst and Medstar), and a new partnership with DC Healthcare Finance (DHCF), which manages Medicaid and Medicare in DC. Through this partnership specifically, Socially Determined will be able to access claims data for participants of all DC Medicaid providers. We have finalized anagreementbetween DHCF and Socially Determinedthat allows Socially Determined to receive health claims data from DHCF. We are in the final stages of Socially Determined receiving health claims data for our 2019-2020 pilot cohort. 3.Expand Produce Rx program across Washington, DC by strenghtening existing partnerships and building new partnerships (FQHCs, MCOs, and food retailers), and integreting new technology. In the reporting period from June 2021-July 2022 we have enrolled 894 new participants. As of June 30, 2022 there were 1,141 participants enrolled in the program. We have expanded the program to include 4new partner clinic locations across the city: So Others Might Eat, Unity Health- Parkside, Bread for the City (2 locations) We expanded to three new Giant locations (Brentwood NE, H Street NE, O Street NW). Participants are now able to load and use their PRx dollars at five Giant locations across DC. We have expanded our eligibility criteria to include DC Health Care Alliance paitents. DC Health Care Allaince isalocally funded safety net program that serves low-income District residenst and provides medical assistance to those who have no other health insurance and are not eligible for Mediciad or Medicare.
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Progress 09/01/20 to 08/31/21
Outputs
Target Audience:DC Medicaid adult patients experiencing hypertension, prediabetes or diabetes who attend our partner clinics (9 FQHCs located mainly in Wards 6, 7, and 8) Changes/Problems: The evaluation completion of the 2019-2020 cohort has been held up due to challenges around retrieving the health claims data from DC Healthcare Finance (DHCF). See detailed explanation above in the section on leveraging data-sharing agreements. COVID-19 drastically reduced the clinics' capacity to conduct any outreach efforts to participants. In order to provide this support to clinics, DC Greens executed new agreements with each healthcare system, which took longer than anticipated. Although we had originally planned to start enrollment at all clinics in January 2021, we were not able to onboard all clinics until the end of May 2021. This pushed back our enrollment period and alsoimpacted the pace at which we were able to enroll participants in the program. We hope to achieve our goal of enrolling 700 participants by the end of September 2021. The switch to the digital offer has been positive for participants as they have more flexibility on using their Produce Rx dollars (With the paper vouchers participants were forced to purchase a minimum of $20 worth of fruits and vegetables). While this has been good for participants, the switch from paper to digital also changed the expiration of Produce Rx dollars thus impacting our redemption rates. In the previous year, paper vouchers expired at the end of the year meaning that participants could save their vouchers and used them at any point during the lenght of the program. With the digital offer the Produce Rx dollars expire every 30 days and thus our current redemption rates seem to be lower compared to the previous year. While it would be challenging to compare both years in terms of redemption rates, we believe the digital offer set up gives us a better understanding of the amount a person may use/need in a month. Since we are seeing lower redemption rates this year due to the change in incentive distribution, we are also reaching out to participants who have loaded their dollars at the pharmacy, but have not used them to purchase fruits and vegetables to better understand what barriers they may be experiencing. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We have shared preliminary findings with partners(clinics, Giant, AmeriHealth and DC Health Care Finance) and are working with our evaluators to complete the final evaluation and disseminate widely. What do you plan to do during the next reporting period to accomplish the goals?In the next period, September 2021 - August 2022 we plan to: Complete the evaluation of the 2019-2020 Produce Rx Program. Create partnerships with a one new healthcare system and two additional clinics at an already participating healthcare system. Enroll at least 700 participants in the 2021 cohort. Nurture our partnership with DC Healthcare Finance and other stakeholders to scale up our program.
Impacts
What was accomplished under these goals?
Implement the Produce Rx program tolowerfood insecurity among Medicaid patients experiening hypertension, prediabetes and diabetes through strategicpartnerships with food retailers, federally qualified health centers (FQHC), a managed care organization (MCO), and the city's department of health. We were able to digitize the Produce Rx dollar distribution and redemption system and switched all participants to this system in December 2020. This system allows participants to load their monthly allotment of Produce Rx dollars onto a Giant Food (supermarket) loyalty/bonus card once a month. It provides participants more flexibility and autonomy on how they can use their dollars. Previously, participants had to make sure their produce choices added up to exactly $20 to ensure no dollars were left on the table. However, the bonus card system allows participants to use any dollar amount ($1 apple or $80 worth of groceries at once). Our 2019-2020 cohort completed the program on December 31, 2020. We are currently working with our evaluators to finalize the evaluation for this cohort. A total of 668 participants were enrolled in the program by the end of 2020. The last quarter of 2020 (October-December), we distributed $55,400, of which $42,901 were redeemed, reaching a 77% redemption rate. Overall voucher distribution and redemption for 2020: distributed $222,700, of which $188,129 was redeemed, reaching an 84% redemption rate. We collected 209 end-line surveys by the end of January 2021. We started a new 2021 cohort at 9 clinics (5 Unity Healthcare, 1 Community of Hope, 1 Providence Health, 2 Whitman Walker Health). Across all clinics, we have enrolled 456 participants in the program. From February- July 30, 2021, we distributed $33,760 dollars. $13,549.28 dollars were redeemed, reaching a 40% redemption rate. Redemption rates have been lower in this cohort due to delays in getting enrollment started. A significant portion of our 456 enrollees were enrolled in the program in June and July. The switch to a digital system for distributing the dollars has also reduced redemption rates because it has created a larger lag in data. There is a 3-week lag time in getting complete data on how many dollars distributed in each month were redeemed. Leverage innovative data-sharing agreements to evaluate health-related outcomes, among individuals with hypertension, prediabetes, or diabetes, and building a robust evidence base that drives increased healthcare system investments in food-related social determinants of health. Socially Determined established agreements with all clinic partners, Giant Food, and AmeriHealth and has received all survey, program utilization, and health data from each partner (DC Greens, Giant Food, and clinics, respectively). Some shifts in DC Medicaid in October 2020 created challenges for the process to receive healthcare utilization data for all participants enrolled in the Produce Rx. The shifts shuffled Medicaid patients across Managed Care Organizations, which meant that some participants who were previously AmeriHealth members were now members of a different MCO. Since Socially Determined did not have agreements in place with the other MCOS, accessing these participants' healthcare utilization data became challenging. To facilitate the retrieval of this data and move our vision of embedding Produce Rx in the healthcare system, we established a new partnership with DC Healthcare Finance (DHCF), which manages Medicaid and Medicare in DC. Through this partnership, Socially Determined will be able to access claims data for participants who are no longer AmeriHealth members. We have are currently working with DHCF and Socially Determined to establish and agreement that allows Socially Determined to receive health claims data from DHCF. Expand Produce Rx program across Washington, DC by strenghtening existing partnerships and building new partnerships (FQHCs, MCOs, and food retailers), and integreting new technology. We enrolled 668 participants in the 2019-2020 cohort that finished on December 31, 2020. We have enrolled 456 participants in the 2021 cohort, which started in February 2021. We have been able to expand to a second Giant location (Columbia Heights area). Participants are able to load their PRx dollars and use them at this new Giant location. By the end of July 2021, we have expanded to an additional healthcare system (Providence Health) and added on new clinics within already participating healthcare systems (1 new clinic at Unity Healthcare and 1 new clinic at Whitman Walker Health). We have executed agreements with the other two MCOs in DC (CareFirst and MedStar Family Choice) and have been enrolling CareFirst members since February2021 and MedStar members since mid-July 2021.
Publications
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Progress 09/01/19 to 08/31/20
Outputs
Target Audience:Medicaid adult patients with a diagnosis of hypertension, diabetes and prediabetes who attend our partner clinics - 6 FQHCs located in Wards 6, 7, and 8 in Washington, DC. Changes/Problems: Participant enrollment took longer than we had anticipated. This delay in enrollment was mainly due to the nature of creating new partnerships and implementing new workflows. Once participant enrollment picked up, COVID-19 hit, which had a major impact on our clinic partners and we had to stop enrollment at some of our clinics closed or changed operations to address the COVID-19 public health crisis. We are currently working with our clinic partners to identify ways to adapt the Produce Rx program to their new workflows and make sure we are able to continue enrollment and participant engagement efforts. Due to the enrollment window for the first iteration of the program being extended we had to adjust the timeline for evaluation as well. We are planning to continue to collect data until December 2020 and have our first draft for the evalution results in May 2021. Due to COVID-19 we implemented the following changes to the program: Due to COVID-19 participants are not required to visit their provider as a way to renew prescriptions. Prescriptions arerenewed automatically until we are able to integrate Produce Rx to the new workflows at our partner clinics. Partner clinics are slowly reopening and using more telemedicine and we are tring to identify new processes for Produce Rx program that allign with new clinic workflow. Include frozen fruits and vegetables as eligible items to purchase with Produce Rx vouchers. We worked with Giant to identify a list of frozen whole and cut fruits and vegetables without added sugars, fatsor oils, and salt. Allow participant to get all Produce Rx vouchers for the month. This change was to make sure we decrease the amount of times our participants had to visit the store and thus decreasing exposure to COVID-19. Participants still get an equivalent of $20 per week but they get all their coupons for the month at once. COVID-19 also delayed our plans to implement a new payment method at Giant. This new payment method will allow for a expansion to other Giant store in Washington, DC. Unfortunately due to the delay in testing this new technology we expect to fully integrate this new payment technology at the end of 2020 and thus begin expansion to a new store in early 2021. Expansion to new stores is also a major factor to expansion to other clinics. During the first year of implementation of the Produce Rx program, we have learnedthat the pharmacy is an important component of the Produce Rx program. Because of this, we propose for our expansion to be to more Giant locations as opposed to other food retailers. The system that Giant is currently testing will allow us to expand to other locations.Giant has a large footprint and DC and we believe expansion to other Giant locations will give us the opportunity to expand to more FQHCs and serve more patients in Washington, DC. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?During this grant period we participated in the following events: June 9: Webinar organized by The Rockefeller Foundationa and The Aspen Institute"Produce Rx Addressing Inequity and Promoting Health During the Pandemic." June 17: DC Medical Residents at Unity Healthcare "Food access and Food as Medicine in Washington, DC" June 22: George Washington University School of Medicine Community Panel "Working Effectively with Community Partners" July 29: ACPM Anual Meeting "Expanding the Boundaries of Health Care Systems - Social Determinants and Community-oriented Health Care Delivery." What do you plan to do during the next reporting period to accomplish the goals?In the next period (9/2020-8/2021) we plan to: Complete evaluation of first iteration of the Produce Rx program. Implement new payment structure that will allow us to expand to other Giant locations. Expand toat least one additional Giant store. Finalize agreement with one additional MCO - CareFirst. Create partnerships with 2additional FQHCs. Enroll additional participants to maintain 500 active participants. Pursue a partnership with an additional MCO (MedStar) in DC to allow us to serve all DC Medicaid patients.
Impacts
What was accomplished under these goals?
1. Implement the Produce Rx program tolowerfood insecurity among Medicaid patients experiening hypertension, prediabetes and diabetes through strategicpartnerships with food retailers, federally qualified health centers (FQHC), a managed care organization (MCO), and the city's department of health. DC Greens has established agreements with Socially Determined, AmeriHealth, Community of Hope, Unity Healthcare,Whitman Walker Healthand Giant. We have a system and workflow that works for all partners (clinics, grocery store/pharmacy). In this grant period we used paper vouchers as a way to distribute the Produce Rx incentive and worked on a plan to further integrate the Produce Rx program into the system of our partner grocery store/pharmacy. On July 20th we started a test period for the new system that will eliminate paper vouchers and instead load the Produce Rx incentive in the store loyalty card of participants. We are testing this new system with a sub-group of our participants and plan switch completely to this system after a 3-month testing period (~November 2020). Our enrollment period was extended to April 30, 2020 and we reached 677patients in the program. Due to enrollment period extansion and COVID-19 we are planning to complete the fist iteration of the program on December 31st, 2020 as opposed to June 20, 2020. During the period of March 2020 - June 2020 we distributed 5096 vouchers which is equivalent to $101,920. Of these vouchers, 3267 ($65,340) were redeemed reaching a 64% redemption rate. Collection of end-line surveys will not be completed on December 2020 and any data around food insecurity will not be available until end-line surveys are collected. 2.Leverage innovative data-sharing agreements to evaluate health-related outcomes, among individuals with hypertension, prediabetes, or diabetes, and building a robust evidence base that drives increased healthcare system investments in food-related social determinants of health. Socially Determined has established data sharing agreementswith AmeriHealth, Community of Hope, Unity Healthcare, and Whitman Walker Health. They are still in the process of executing agreement with Giant but this process has been initiated. We have collected the following data from participants: Baseline survey Clinics submit clinical markers for participants who have visited their provider on a monthly basis. Reports include BMI, A1c levels and blood pressure. The agreement between AmeriHealth and Socially Determined was signed on June 2020. Socially Determined is working on the data validation from health claims data received from AmeriHealth and the baselinereport is scheduled for September 2020. The evaluation to understand the impact of the Produce Rx program is underway. We have most agreements in place and our evaluators have received data from clinic partners and surveys. We are still working on getting health claims data and redemption data but we expect this data to be available by the end ofSeptember 2020. 3. Expand Produce Rx program across Washington, DC by strenghtening existing partnerships and building new partnerships (FQHCs, MCOs, and food retailers), and integreting new technology. Wehave 677participants in the program. We have not expanded to additonal Giant locations in the program due to challenges with COVID-19, which delayed our plans to test new systems to allow us to expand to more locations. We plan this expansion to happen in early 2021. We have expanded to 3 additional FQHCs reaching a total of 6 FQHC partners. All clinics are located in close proximity to Giant grocery store on 1535 Alabama Ave, SE, Washington, DC. We started conversations withCareFirst one of the three MCO's in Washington, DC. We are in conversations to execute agreements and are working on getting them on board and start enrollment for CareFirst members in November 2020. During the first year of implementation of the Produce Rx program, we have learnedthat the pharmacy is an important component of the Produce Rx program. Because of this, we propose for our expansion to be to more Giant locations as opposed to other food retailers. The system that Giant is currently testing will allow us to expand to other locations.Giant has a large footprint inDC and the region and we believe expansion to other Giant locations will give us the opportunity to expand to more FQHCs and serve more patients in Washington, DC.
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