Progress 06/15/23 to 06/14/24
Outputs
Target Audience:In the last year, The Food Trust's (TFT's) Food Bucks Rx (FBRx) program has successfully engaged numerous participants and other stakeholders across the public and private sector. Patients: The FBRx program reaches patients in key regions of Pennsylvania (PA) and New Jersey (NJ) who are enrolled in eligible state-sponsored insurance plans (primarily Medicaid or dual eligible) and who are experiencing or at risk of diet-related disease. Eligible patients are provided "prescriptions'' in the form of FBRx coupons or cards to be used to purchase fresh fruits and vegetables at eligible firms, including the majority of firms participating in TFT's point-of-purchase nutrition incentive program (known as Food Bucks). Patients receive FBRx in a variety of settings, including hospital-based nutrition programs, chronic disease management programs, pediatric offices and community clinics. As families continue to recover from the pandemic and face additional financial challenges due to the end of emergency SNAP allotments along with rising food costs due to inflation, this program can be crucial for maintaining a healthy diet. Through this GusCRR project in the past year, over 2,300 patients received FBRx coupons from their healthcare providers, with over $240,000 redeemed for fresh fruits and vegetables (note: this represents approximately $75,000 in USDA funds, with additional non-federal funding supporting the project). Healthcare Providers: In the past year, TFT worked with 15 healthcare partners across 40 clinical distribution locations in NJ and PA to provide FBRx to eligible patients. Partners included the following (sites with multiple settings shown in parentheses): Adult Primary Care (may align with specific programs such as blood-pressure management or nutrition-focused services; partners with more than one participating site indicated with number) Community Health Clinic, Inc. (Western PA - 2) Congreso Health Center (Philadelphia, PA) Delaware Valley Community Health (Philadelphia, PA - 3) East Liberty Family Healthcare Center (Pittsburgh, PA) Einstein Healthcare Network-Jefferson Health, including a Centering Parents program and Accountable Care Organization (Philadelphia, PA - 3) Magee Women's Hospital (Pittsburgh, PA) North Side Christian Healthcare Center (Pittsburgh, PA) Penn Family Care-Penn Medicine (Philadelphia, PA) Primary Care Health Services Inc. (Pittsburgh, PA - 2) Stephen Klein Wellness Center (Philadelphia, PA) UPMC Primary Healthcare Center Turtle Creek (Pittsburgh, PA) Vale-U-Health (Monongahela, PA) Pediatric Primary Care Children's Hospital of Philadelphia (CHOP) Cooper Pediatric Care (Camden, NJ) UPMC Children's primary care and Endocrinology (Greater Pittsburgh, PA -8) Hospital-based Nutrition Programs Allegheny Health Network's Healthy Food Centers (Pittsburgh, PA - 4) Virtua Healthy Food Farmacy (Camden, NJ) Additional Health Center Programs Henry J Austin Health Center, Centering Families + Nutrition Services (Trenton, NJ - 2) Camden Coalition, Complex Care services (Camden, NJ) National Nurse-led Care Consortium nurse home visit programs (Philadelphia, PA -2) UPMC Center for Kidney Disease (Pittsburgh, PA) Armstrong Center for Medicine and Health (ACMH, Kittanning, PA) In addition to serving as partners in project implementation, providers and other healthcare staff report that being able to offer FBRx improves their own sense of well-being and efficacy in caring for their patients. Many resources offered in response to needs identified during social determinants of health screening involve an application process and a wait for services even if the patient is found eligible. Healthcare staff appreciate that, in contrast, they can hand patients the FBRx as soon as they screen eligible and respond to a short survey. Retail Redemption Firms: In the last year, over 100 firm locations participating in the FBRx program redeemed over $240,000 for fresh produce (with GusNIP and leveraged funding, noted above). The FBRx program aligns closely with and benefits from the infrastructure of TFT's Food Bucks program, which began over a decade ago and is currently funded under a separate GusNIP award. The Food Bucks program distributes incentives to shoppers using SNAP benefits at the point of purchase. Most firm locations serve as redemption sites for both the Food Bucks and FBRx programs. These retail partners include supermarket chains such as Save A Lot, Shop N' Save and ShopRite, as well as neighborhood healthy corner stores, food co-ops, farmers markets and mobile markets. Additionally, in the last year TFT scaled up a card based program that allows patients to shop at large supermarket chains, like Giant Eagle and Walmart and services like Instacart that were not traditionally part of the FBRx redemption network. Over $50,000 in FBRx was redeemed at farmers markets and mobile markets, and many of the brick and mortar firms also sell locally grown produce. TFT adds unique value and expertise in expanding healthy food retail by operating a network of farmers markets and providing technical assistance to other markets, supporting corner store owners in sourcing and marketing fresh produce, and working with supermarket operators to open or expand in underserved communities. These close ties with various types of retailers provide a substantial benefit to patients participating in FBRx. TFT has maintained a large network of retail partners throughout PA and NJ with over 100 redemption locations. In order to provide patients more options to redeem their produce prescriptions, TFT's card program provided increased access to a much larger network of large grocery stores and Instacart-affiliated retailers. Other Government and Community Partners: Along with healthcare and retail partners, TFT engaged with many other nonprofit organizations, foundations and community partners to enrich the FBRx program, especially as this grant covers several geographies. In Camden and Trenton, TFT continued internal and external collaboration with NJ Department of Health, SNAP-Ed, as well as partnerships that grew out of the Campbell Soup Healthy Communities Initiative and the BUILD Health "Roots to Prevention" project, which facilitated expansion of FBRx distribution to new healthcare partners and developed connections with urban growers. In southeastern PA, TFT continued longstanding partnerships to enhance FBRx programming, including the American Heart Association and COACH (Collaborative Opportunities to Advance Community Health), a group of hospitals and nonprofit partners (including TFT) that work together on community health efforts. In Pittsburgh and western PA, strong partnerships with Just Harvest (an anti-hunger organization), the Greater Pittsburgh Community Food Bank, the Pittsburgh Food Policy Council, Duquesne University and the Allegheny County Health Department continued to enhance the FBRx program. New partnerships with UPMC Health Plan and the American Heart Association leveraged additional funding to enroll more patients in southwest PA, including expanding the card-based program that started in April 2023. Finally, TFT strengthened relationships with other grantees through the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center providing technical assistance and support to grantees and core partners. Changes/Problems:Overall, the project is being implemented in line with the proposal, and there were no significant changes in approach. Below are a few challenges and modifications: Evaluation: While project staff are strongly committed to documenting outcomes of the GusNIP program, most reporting from healthcare and retail partners is not directly within TFT's control. Additionally, patient health data is stored in electronic health records, which project staff cannot directly access. Lastly, there is limited funding within the GusCRR budget to support research staff, especially with the need to undergo an IRB process. To address these challenges, project staff have identified several solutions to reach evaluation goals: Some healthcare partners have analyzed and shared de-identified aggregate data to show clinical findings connected to produce prescriptions. Outside funding has allowed for hospital and academic partners to pursue IRB approval for research studies. Some of these studies experienced delays and final data is not yet available, though early data shows promising results. Number/Types of Redemption sites: While TFT has surpassed the total goal for number of FBRx redemption sites, the balance between brick-and-mortar stores versus non-traditional retail outlets and farmers markets has been different than expected. As a response to the COVID-19 pandemic, dozens of farmers markets and farm stands operated by partners in Philadelphia transitioned entirely to emergency food distributions; most of these sites had previously served as FBRx redemption sites. Still, there are a significant number of farm-direct and non-traditional retail outlets, including food co-ops and produce markets, that participate in this project as redemption sites. Also, in response to patient demand, TFT has also onboarded many more brick-and-mortar redemption sites than proposed. Issues adding small stores into card program: A few of TFT's existing retail partners have expressed interest in joining InComm's network, thus providing access not only to FBRx patients that receive their benefits in a card, but other shoppers whose insurance benefits get loaded into OTC cards. For TFT, this would also provide a step forward into integrating card and paper FBRx programs, which may simplify the program and how it gets communicated to patients and healthcare providers. However, the process of onboarding corner stores has not been as straightforward as it seemed due to technology challenges with stores' POS Systems. What opportunities for training and professional development has the project provided?Opportunities for professional development have been provided both for project staff and for retail and healthcare partners: ? Ongoing training on implementation, tracking, data collection and promotion of the FBRx program was provided to all retail and healthcare partners. TFT staff work closely with healthcare partners to ensure they are able to screen patients for eligibility, accurately track and report FBRx distributions, and administer patient surveys using online survey tools. In the Philadelphia area, recurring COACH (Collaborative Opportunities to Advance Community Health) meetings offer strong networking and training opportunities with healthcare partners interested in food insecurity. Students from Temple University and other schools gained experience in produce prescription programming by assisting with program administration and data analysis. TFT is participating in the Nutrition Incentive Hub, GusNIP's NTAE Center, both as a grantee in a learning capacity and as a partner/TA provider. TFT staff are convening the NI Hub's communities of practice focusing on incentive programming in corner stores, as well as SNAP-Ed/nutrition education, and are participants in the produce prescription community of practice. Staff have also benefited from the NI Hub's annual convening, a brick & mortar community of practice, and webinars on a variety of topics pertaining to nutrition incentives and healthy food retail. TFT's healthcare and retail partners have also participated in NI Hub programming and utilized NI Hub resources. How have the results been disseminated to communities of interest?Results have been shared through a variety of venues to reach interested stakeholders. Findings from this grant were shared in the following settings: ? TFT staff and healthcare/evaluation partners participated in two convenings through the Nutrition Incentive Hub and shared about the FBRx program TFT staff participated in the Pennsylvania Nutrition Education Network (PA NEN) for its 2024 Annual Conference and shared with PA SNAP-Ed staff and others about FBRx and other GusNIP programming TFT staff presented at Live Well Allegheny Coalition meetings (supported by the Centers for Disease Control REACH grant); these findings were later presented at a CDC Showcase by county health staff TFT presented alongside Food Bucks Rx partners at the Food is Medicine Summit (Chicago, IL) in May 2024 TFT presented at the Pittsburgh Food Systems Summit in May 2024. TFT presented at the Community Connections Advisory Group of Childrens Hospital in Pittsburgh in July 2024. What do you plan to do during the next reporting period to accomplish the goals?TFT has nearly met or surpassed all goals for project reach, therefore the final year of activities under the GusCRR award will allow us to maintain FBRx programming at current scale and plan for sustaining the program beyond GusCRR. TFT will prioritize distribution settings where patients have more frequent interactions with their healthcare providers to compound the positive impacts of the FBRx program. Some healthcare partners have committed or identified funding to help sustain and expand the program. Another priority in the upcoming year will be to continue data collection for the GusCRR cohort of the national produce prescription evaluation. TFT has been working closely with the Center for Nutrition and Health Impact and Virtua Health to finalize a second research study, this time focusing more specifically on patients receiving treatment for diabetes. TFT will also continue to seek opportunities with other healthcare partners to deepen evaluation.
Impacts
What was accomplished under these goals?
Objective 1: Increase purchase and consumption of fresh fruits and vegetables by patients who receive FBRx across health systems in a multi-state region, particularly in tandem with COVID relief efforts Major Activities Completed TFT partnered with 40 clinical distribution sites associated with 15 healthcare partners and over one hundred redemption sites to bring FBRx to patients in and near Pittsburgh and Philadelphia, PA, and Camden and Trenton, NJ, and meet the increased need for produce prescriptions following COVID-19 by customizing and refining FBRx programs in a variety of settings, including nutrition-focused programs at hospitals, chronic disease management programs, care coordination, and adult and pediatric primary care; staff identified champions in a variety of roles at each healthcare site Staff worked with each firm to create or sustain systems to collect the number and value of FBRx distributed and redeemed, using various data collection methods (e.g., paper tracking, point-of-sale (POS) systems, spreadsheets, SFTP transfers) to serve as inputs for TFT's database, where FBRx distributions and redemptions were tracked individually by serial number TFT continued to partner with researchers at Children's Hospital of Philadelphia (CHOP), Virtua Health and the GusNIP NTAE to conduct research studies evaluating the impacts of FBRx in combination with other interventions TFT worked with other healthcare partners to collect shorter program evaluation surveys from the majority of patients or caregivers receiving FBRx Summary Statistics and Key Outcomes Healthcare partners distributed at least $330,000 in FBRx (*some data still pending from partners) to approximately 2,300 patients, with most participants receiving $50-$100 per month depending on household size. Over $240,000 was redeemed for fresh produce, the highest annual FBRx redemption total to date (note: some redemptions were funded using non-GusNIP leveraged sources). A study with Virtua recently concluded and will be analyzed for the final report. According to 2023 data, among Food Farmacy participants receiving FBRx initially (n=110), the percent reporting eating vegetables at least once a day over the past month increased from 26% at baseline to 35% at 3 months to 43% at 6 months Across distribution sites utilizing the TFT survey template, over 1073 surveys were collected from patients receiving first-time FBRx and "refills": 55% of patients using FBRx (n=242) reported having eaten vegetables at least once per day over the past week and 53% having eaten fruit at least once per day, compared to 42% for vegetables and 42 % for fruit among those who had not yet used FBRx (n=224) Of patients who had used FBRx, 97% reported that Food Bucks Rx were important (20%) or very important (77%) in helping them purchase fruits and vegetables, and 80% reported that their consumption of fruits and vegetables had increased since they started using FBRx. Participant-reported impacts: "It has been a blessing. Has been able to consume more fruits and vegetables without worrying about the cost. Able to afford organic produce and eat the best fresh fruits and vegetables." "My A1C is down to 5.3! It helps me buy the fresh produce. It's a great program" Healthcare partners report high engagement, appreciation, and usage of the program. Several providers reported that patients are able to purchase fresh produce which they were not able to prior to receiving the Food Bucks Rx and are able to make direct changes to their consumption of fruits and vegetables. Objective 2: Reduce food insecurity and improve dietary health among households that utilize the FBRX program Major Activities Completed See above regarding ongoing research studies Provided FBRx as a component of wrap-around nutrition interventions offered to patients by partner sites, including Allegheny Health Network and Virtua, to combat food insecurity and address diet-related disease Connected patients at many sites with TFT's Online Learning Hub, a video collection presenting SNAP-Ed approved recipes and nutrition education lessons, including lessons focused on stretching food dollars and selecting, storing, and preparing fresh produce Summary Statistics and Key Outcomes Healthcare partners have reported an increase in patients screening positive for food insecurity, especially since emergency allotments ended last year and exacerbated by high food prices Among 463 TFT surveys from patients who answered food security questions, 35% of those who had not participated in FBRx yet (n=93) often worried that their food would run out compared to 24% of FBRx users (n=81), and 30% of those who had not participated yet had often had their food run out without funds to get more compared to 21% of FBRx users. Based on 2023 data, among a sample of 126 patients at the Allegheny Health Network (AHN) Healthy Food Centers that received FBRx, 95% reported decreased stress and 99% reported better access to healthy foods. A sub-sample of patients who received FBRx in 2023 (n=45) also showed larger decreases in A1c (0.55 for FBRx, 0.3 for non-FBRx). Based on 2023 data, among Virtua Food Farmacy study participants receiving FBRx to date (n=110), the percent reporting that they had often run out of food in the past 30 days without funds to purchase more decreased from 35% at baseline to 18% at 3 months to 16% at 6 months. Those who reported being able to consistently afford balanced meals increased from 20% at baseline to 43% at 3 months to 45% at 6 months. Healthcare partners reported that providing FBRx to patients not only assists in meeting food needs but also enables them to resolve other social needs, e.g. housing, because patients are more responsive to follow-up and remain in care navigation or other services longer Healthcare Provider-reported impacts: "Wonderful support when SNAP gets cut/frozen/short. [FBRx] is an "on ramp" for some in our services. One family reports using it to build math and money management skills with her 5 and 8 year old children. That is a real crossover win for our work!!" "We see people that lose weight, improve existing health conditions (heart disease, blood pressure). [Patients are] getting more fruits and vegetables in their diet...eating less junk food and losing weight." Participant-reported impacts: "Very grateful, even with food stamps with the inflation fresh produce is high. Now I am able to afford food as well as my produce." "Thank you so much for everything you've given me. If it wasn't for these coupons I would not have been able to purchase the things I need. My food stamps have been cut off and this was a lifeline!" Objective 3: Increase number of redemption locations for FBRx, especially those that are open for increased hours and/or that sell regionally-grown produce Major Activities Completed Over 100 locations are available as FBRx redemption sites: 46 farm-direct firms, 27 small grocery retail locations, 24 supermarkets (not including those used by patients enrolled in the card-based pilot), and a mobile farmers market and mobile grocery store (with multiple locations); most brick-and-mortar firms are open 7 days/week Expanded the FBRx cards utilizing the InComm OTC platform and a restricted spend debit card for produce, enabling participants in western PA to redeem their produce prescriptions at two major retail chains (Giant Eagle, Walmart and Instacart) and a network of farmers markets. Summary Statistics and Key Outcomes Over $240,000 redeemed by retail partners for fresh fruits and vegetables. Expanded the card-based program from a pilot of 300 in 2023, to over 700 patients receiving FBRx through this mechanism. Several patients shared that they made their first ever visit to the farmers market after receiving FBRx.
Publications
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Progress 06/15/22 to 06/14/23
Outputs
Target Audience:In the last year, The Food Trust's (TFT's) Food Bucks Rx (FBRx) program has successfully engaged numerous participants and other stakeholders across the public and private sectors. Patients: The FBRx program reaches patients in key regions of Pennsylvania (PA) and New Jersey (NJ) who are enrolled in eligible state-sponsored insurance plans (primarily Medicaid or dual eligible) and who are experiencing or at risk of diet-related disease. Eligible patients are provided "prescriptions'' in the form of FBRx coupons or cards that can be used to purchase fresh fruits and vegetables at eligible firms, including the majority of firms participating in TFT's point-of-purchase nutrition incentive program (known as Food Bucks). Patients receive FBRx in a variety of settings, including hospital-based nutrition programs, chronic disease management programs, pediatric offices and community clinics. As families continue to recover from the pandemic and face additional financial challenges due to the end of emergency SNAP allotments along with rising food costs due to inflation, this program can be crucial for maintaining a healthy diet. Through this GusCRR award, over 2,500 patients received FBRx coupons from their healthcare providers, with over $215,000 redeemed for fresh fruits and vegetables (note: this represents $160,000 in USDA funds, with additional non-federal funding supporting the project). Healthcare Providers: In the past year, TFT worked with 18 healthcare partners across 43 clinical distribution locations in NJ and PA to provide FBRx to eligible patients, with three new healthcare partners and 21 new clinical distribution locations added since this grant commenced. Partners included the following (sites with multiple settings shown in parentheses): Adult Primary Care (may align with specific programs such as blood-pressure management or nutrition-focused services; partners with more than one participating site indicated with number) Community Health Clinic, Inc. (Western PA - 2) Congreso Health Center (Philadelphia, PA) Delaware Valley Community Health (Philadelphia, PA - 3) East Liberty Family Healthcare Center (Pittsburgh, PA) Einstein Healthcare Network-Jefferson Health, including a Centering Parents program and Accountable Care Organization (Philadelphia, PA - 3) Magee Women's Hospital (Pittsburgh, PA) North Side Christian Healthcare Center (Pittsburgh, PA) Penn Family Care-Penn Medicine (Philadelphia, PA) Primary Care Health Services Inc. (Pittsburgh, PA - 2) Stephen Klein Wellness Center (Philadelphia, PA) UPMC Primary Healthcare Center Turtle Creek (Pittsburgh, PA) Vale-U-Health (Monongahela, PA) Pediatric Primary Care Children's Hospital of Philadelphia (CHOP) Cooper Pediatric Care (Camden, NJ) UPMC Children's primary care and Endocrinology (Greater Pittsburgh, PA - 8) Hospital-based Nutrition Programs Allegheny Health Network's Healthy Food Centers (Pittsburgh, PA - 4) Virtua Healthy Food Farmacy (Camden, NJ) Additional Health Center Programs Adagio Health WIC/Medical Office (New Castle, PA - 2) Duquesne University School of Pharmacy community nutrition study (Pittsburgh, PA - 2) Henry J Austin Health Center, Centering Families + Nutrition Services (Trenton, NJ - 2) Camden Coalition, Complex Care services (Camden, NJ) National Nurse-led Care Consortium nurse home visit programs (Philadelphia, PA -2) UPMC Center for Kidney Disease (Pittsburgh, PA) In addition to serving as partners in project implementation, providers and other healthcare staff report being able to offer FBRx improves their own sense of well-being and efficacy in caring for their patients. Many resources offered in response to needs identified during social determinants of health screening involve an application process and a wait for services even if the patient is found eligible. Healthcare staff appreciate that, in contrast, they can hand patients the FBRx as soon as they screen eligible and respond to a short survey. Redeeming Firms: In the last year, firms participating in the FBRx program redeemed over $215,000 for fresh produce (with GusNIP and leveraged funding, noted above). The FBRx program aligns closely with and benefits from the infrastructure of TFT's Food Bucks program, which began over a decade ago and is currently funded under a separate GusNIP award. The Food Bucks program distributes incentives to shoppers using SNAP benefits at the point of purchase. Most firm locations serve as redemption sites for both the Food Bucks and Food Bucks Rx programs. These retail partners include supermarket chains such as Save A Lot, Shop N' Save and ShopRite, as well as neighborhood healthy corner stores, food co-ops, farmers markets and mobile markets. Also, in the last year TFT launched a card-based pilot that allowed patients to shop at large supermarket chains, like Giant Eagle and Walmart, that were not traditionally part of the FBRx redemption network. Over $40,000 in FBRx was redeemed at farmers markets and mobile markets, and many of the brick and mortar firms also sell locally grown produce. TFT adds unique value and expertise in expanding healthy food retail by operating a network of farmers markets and providing technical assistance to other markets, supporting corner store owners in sourcing and marketing fresh produce, and working with supermarket operators to open or expand in underserved communities. These close ties with various types of retailers provide a substantial benefit to patients participating in FBRx. TFT continued to recruit and onboard additional retail partners as FBRx redemption firms during the grant period, bringing the total number of sites across PA and NJ to 122 and providing patients with more options to redeem their prescriptions. Other State and Community Partners: Along with healthcare and retail partners, TFT engaged with many other nonprofit organizations, foundations and community partners to enrich the FBRx program, especially as this grant covers several geographies. In Camden and Trenton, TFT continued internal and external collaboration with SNAP-Ed, as well as partnerships that grew out of the Campbell Soup Healthy Communities Initiative and the BUILD Health "Roots to Prevention" project, which facilitated expansion of FBRx distribution to new healthcare partners and developed connections with urban growers. In southeastern PA, TFT continued longstanding partnerships to enhance FBRx programming, including the American Heart Association and COACH (Collaborative Opportunities to Advance Community Health), a group of hospitals and nonprofit partners (including TFT) that work together on community health efforts. In Pittsburgh and western PA, strong partnerships with Just Harvest (an anti-hunger organization), the Greater Pittsburgh Community Food Bank, the Pittsburgh Food Policy Council, Duquesne University and the Allegheny County Health Department continued to enhance the FBRx program. New partnerships with UPMC Health Plan and the American Heart Association leveraged additional funding to enroll more patients in southwest PA, including a card-based pilot that commenced in April 2023. Finally, TFT strengthened relationships with other grantees through the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center providing technical assistance and support to grantees and core partners. Changes/Problems:Overall, the project is being implemented in line with the proposal, and there were no significant changes in approach. Below are a few challenges and modifications: Issues with card-based pilot: The launch of the card-based pilot was delayed several months as the healthcare partners sought a new level of IT authorization to participate and TFT staff acquired the digital infrastructure and knowledge base to operate the program. Once the cards were issued to patients, they sometimes did not work as expected at the main retailers in the card company's network. Although these issues were ultimately resolved, it required significant additional staff time to field complaints from participating patients and submit IT requests to the company. Still, the benefit of adding large retailers where patients were eager to utilize their produce prescriptions made up for these challenges. Evaluation: While project staff are strongly committed to documenting outcomes of the GusNIP program, most reporting from healthcare and retail partners is not directly within TFT's control. Additionally, patient health data is stored in electronic health records, which project staff cannot directly access. Lastly, there is limited funding within the GusCRR budget to support research staff, especially with the increased expectation of an IRB process. To address these challenges, project staff have identified several solutions to reach evaluation goals: Some healthcare partners have analyzed and shared de-identified aggregate data to show clinical findings connected to produce prescriptions. Outside funding has allowed for hospital and academic partners to pursue IRB approval for research studies. Some of these studies experienced delays and final data is not yet available, though early data shows promising results. Number/types of redemption sites: While TFT has surpassed the total goal for number of FBRx redemption sites, the balance between brick-and-mortar stores versus non-traditional retail outlets and farmers markets has been different than expected. As a response to the COVID-19 pandemic, dozens of farmers markets and farm stands operated by partners in Philadelphia transitioned entirely to emergency food distributions; most of these sites had previously served as FBRx redemption sites. The original proposal contained a goal to "Expand the number of non-traditional retail outlets and farmers markets accepting FBRx incentives to 80," but with the loss of these markets as redemption sites, as well as ceased operations of a mobile market partner, that was no longer feasible. Still, there are a significant number of farm-direct and non-traditional retail outlets, including food co-ops and produce markets, that participate in this project as redemption sites. In response to patient demand, TFT has also onboarded many more 7-days/week brick-and-mortar redemption sites than the 25 proposed. What opportunities for training and professional development has the project provided?Opportunities for professional development have been provided both for project staff and for retail and healthcare partners: Ongoing training on implementation, tracking, data collection and promotion of the FBRx program was provided to all retail and healthcare partners. TFT staff work closely with healthcare partners to ensure they were able to screen patients for eligibility, accurately track and report FBRx distributions, and administer patient surveys using online survey tools. In the Philadelphia area, monthly COACH (Collaborative Opportunities to Advance Community Health) meetings offer strong networking and training opportunities with healthcare partners interested in food insecurity. During their blocks or semesters volunteering with the Nutrition Incentives team, medical school and public health students from Jefferson, Temple and Tufts University gained experience in produce prescription programming by assisting with program administration and data analysis. TFT is participating in the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center, both as a grantee in a learning capacity and as a partner/TA provider. TFT staff are convening the NI Hub's communities of practice focusing on incentive programming in corner stores, as well as SNAP-Ed/nutrition education, and are participants in the produce prescription community of practice. Staff have also benefited from the NI Hub's annual convening, a brick & mortar community of practice, and webinars on a variety of topics pertaining to nutrition incentives and healthy food retail. TFT's healthcare and retail partners have also participated in NI Hub programming and utilized NI Hub resources. How have the results been disseminated to communities of interest?Results have been shared through a variety of venues to reach interested stakeholders. Findings from this grant were shared in the following settings: TFT staff and healthcare/evaluation partners participated in the annual Nutrition Incentive Hub Convening and shared about the FBRx program TFT staff participated in the Communities Joined in Action 2022 National Conference, representing the Roots to Prevention BUILD Health collaboration, which included expansion of FBRx and local sourcing in Camden, NJ TFT staff participated in the Pennsylvania Nutrition Education Network (PA NEN) for its 2023 Annual Conference and shared with PA SNAP-Ed staff and others about FBRx and other GusNIP programming TFT staff presented at Live Well Allegheny Coalition meetings (supported by the Centers for Disease Control REACH grant); these findings were later presented at a CDC Showcase by county health staff TFT presented at Pittsburgh Food Justice Committee meetings and Philadelphia Promise Zone meetings Academic Institutions: Jefferson University's Urban Health Symposium, Drexel University School of Public Health presentation What do you plan to do during the next reporting period to accomplish the goals?Because TFT has nearly met or surpassed most goals for project reach and is currently at capacity with approximately 3/4 of incentive funds spent, the next year of activities under the GusCRR award will focus on maintaining FBRx programming and planning for sustaining the program beyond GusCRR. Established partnerships with existing healthcare providers will facilitate the addition of new clinical distribution sites, and planning is also underway with healthcare and retail partners in new areas of PA and NJ. TFT will prioritize distribution settings where patients have more frequent interactions with their healthcare providers to compound the positive impacts of the FBRx program. Some healthcare partners have committed or identified funding to help sustain and expand the program, including funding from Medicaid Managed Care. In addition to expanding the number of clinical distribution sites, TFT will continue to onboard new redemption sites, with a focus on firms that are open for increased days/hours and/or sell locally grown produce. Building on the InComm produce debit card pilot, TFT will explore onboarding small retail partners to accept the InComm FBRx cards and will evaluate and potentially pilot card-based FBRx utilizing other platforms. In Central PA, TFT will launch a produce prescription with a farmers market and supermarket partner, possibly leveraging a loyalty platform-based technology currently used for point-of-purchase nutrition incentives. TFT will also continue to work with farmers markets and other non-traditional retail outlets as redemption sites, providing patients access to fresh, locally grown produce. Another priority in the upcoming year will be to continue data collection for the GusCRR cohort of the national produce prescription evaluation. TFT has been working closely with the Gretchen Swanson Center for Nutrition and Virtua Health to initiate a second research study, this time focusing more specifically on patients receiving treatment for diabetes. TFT will also continue to seek opportunities with other healthcare partners to deepen evaluation.
Impacts
What was accomplished under these goals?
Objective 1: Increase purchase and consumption of fresh fruits and vegetables by patients who receive FBRx across health systems in a multi-state region, particularly in tandem with COVID relief efforts Major Activities Completed TFT partnered with 43 clinical distribution sites associated with 18 healthcare partners and over 120 redemption sites to bring FBRx to patients in and near Pittsburgh and Philadelphia, PA, and Camden and Trenton, NJ, and meet the increased need for produce prescriptions following COVID-19 by customizing and refining FBRx programs in a variety of settings, including nutrition-focused programs at hospitals, chronic disease management programs, care coordination, and adult and pediatric primary care; staff identified champions in a variety of roles at each healthcare site Staff worked with each firm to create or sustain systems to collect the number and value of FBRx distributed and redeemed, using various data collection methods (e.g., paper tracking, POS systems, spreadsheets) to serve as inputs for TFT's database, where FBRx distributions and redemptions were tracked individually by serial number TFT continued to partner with researchers at Children's Hospital of Philadelphia (CHOP), Virtua Health and Gretchen Swanson Center for Nutrition to conduct research studies evaluating the impacts of FBRx in combination with other interventions TFT worked with other healthcare partners to collect shorter program evaluation surveys from the majority of patients or caregivers receiving FBRx Summary Statistics and Key Outcomes Healthcare partners distributed over $400,000 in FBRx to approximately 2,500 patients, with most participants receiving $50-$100 per month depending on household size. Over $200,000 was redeemed for fresh produce, the highest annual FBRx redemption level to date (note: some redemptions were funded using non-federal leveraged sources). The Virtua study is ongoing, but among Food Farmacy participants receiving FBRx so far (n=110), the percent reporting eating vegetables at least once a day over the past month increased from 26% at baseline to 35% at 3 months to 43% at 6 months Across distribution sites utilizing the TFT survey template, over 1800 surveys were collected from patients receiving first-time FBRx and "refills": 48% of patients using FBRx (n=604) reported having eaten vegetables at least once per day over the past week and 44% having eaten fruit at least once per day, compared to 32% for vegetables and 27.5% for fruit among those who had not yet used FBRx (n=1213) Of patients who had used FBRx, 95% reported that Food Bucks Rx were important (20%) or very important (75%) in helping them purchase fruits and vegetables, and 86.5% reported that their consumption of fruits and vegetables had increased since they started using FBRx Participant-reported impacts: "This has really helped me keep fresh fruits and vegetables in my house. Otherwise, I would not be able to afford to eat them." "This program has helped me stay focused on eating fruits and veggies. My A1C has come down since I started using this program and I hope that it continues on" Objective 2: Reduce food insecurity and improve dietary health among households that utilize the Food Bucks Rx program Major Activities Completed See above regarding ongoing research studies Provided FBRx as a component of wrap-around nutrition interventions offered to patients by partner sites, including Allegheny Health Network and Virtua, to combat food insecurity and address diet-related disease Connected patients at many sites with TFT's Online Learning Hub, a video collection presenting SNAP-Ed approved recipes and nutrition education lessons Summary Statistics and Key Outcomes Healthcare partners have reported an increase in patients screening positive for food insecurity, especially since emergency allotments ended earlier this year and exacerbated by high food prices Among 887 TFT surveys from patients who answered food security questions, 35% of those who had not participated in FBRx yet (n=453) often worried that their food would run out compared to 22% of FBRx users (n=434), and 29% of those who had not participated yet had often had their food run out without funds to get more compared to 19% of FBRx users. This difference was greater among those enrolled in SNAP (n=613, 40% vs 25% worried, 33% vs 21% ran out). Among a sample of 126 patients at the Allegheny Health Network (AHN) Healthy Food Centers that received FBRx, 95% reported decreased stress and 99% reported better access to healthy foods. A sub-sample of patients who received FBRx in 2023 (n=45) also showed larger decreases in A1c (0.55 for FBRx, 0.3 for non-FBRx). Among Virtua Food Farmacy study participants receiving FBRx to date (n=110), the percent reporting that they had often run out of food in the past 30 days without funds to purchase more decreased from 35% at baseline to 18% at 3 months to 16% at 6 months. Those who reported being able to consistently afford balanced meals increased from 20% at baseline to 43% at 3 months to 45% at 6 months. Community health workers from the Camden Coalition's navigation program report that providing FBRx to patients receiving care navigation not only assists in meeting food needs but also enables them to resolve other social needs, e.g. housing, because patients are more responsive to follow-up and remain in navigation longer Participant-reported impacts: "I have answered 'never true' to both [food insecurity] statements only because with the coupons you give me and WIC we are doing well, I am grateful for these programs, otherwise my answers would be different." "Before this I was only able to get fruit and veggies the beginning of the month when I had money and food stamps, and sometimes that would run out the middle of the month." "It really helps with my health situation, living on a fixed income. Also helps with my recovery from cancer eating healthy. Please keep it up, Poverty is one thing but combined with health issues is another." Objective 3: Increase number of redemption locations for Food Bucks Rx, especially those that are open for increased hours and/or that sell regionally-grown produce Major Activities Completed 122 locations are available as FBRx redemption sites: 42 farm-direct firms, 24 small grocery retail locations, 47 supermarkets (including those used by patients enrolled in the card-based pilot), and a mobile farmers market and mobile grocery store; most brick-and-mortar firms are open 7 days/week Recruited and onboarded 13 additional redemption sites for paper FBRx vouchers; worked with new retail partners to implement tracking and reporting processes utilizing available technology, including saving copies of receipts from redeeming purchases at stores with limited technology (for quality assurance purposes) Of 30 redemption firms that responded to a retailer survey, 100% reported that participating in Food Bucks and FBRx was profitable (93%) or cost neutral for their business Piloted FBRx cards utilizing the InComm OTC platform and a restricted spend debit card for produce, enabling participants in western PA to redeem their produce prescriptions at two major retail chains (Giant Eagle and Walmart) and a network of farmers markets Summary Statistics and Key Outcomes Over $200,000 redeemed by retail partners for fresh fruits and vegetables, the highest annual FBRx volume to date 300 patients participated in the card-based pilot (250 pediatric patient caregivers and 50 adult patients), and despite technology challenges, appreciated the broad redemption network and convenience of the card, which reloads automatically each month; this technology has also offered an exciting new depth of shopping data that can inform program improvements Several patients shared that they made their first ever visit to the farmers market after receiving FBRx
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Progress 06/15/21 to 06/14/22
Outputs
Target Audience:As activities under this award begin in September 2022, The Food Trust (TFT) is building on its successful work to engage participants and other stakeholders across the public and private sectors in the Food Bucks Rx (FBRx) produce prescription program. Patients: The FBRx program serves families and individuals in key regions of Pennsylvania (PA) and New Jersey (NJ) who utilize eligible state-sponsored insurance plans (primarily Medicaid or dual eligible), and who are experiencing or at risk of diet-related disease. Eligible patients are provided with "prescriptions'' in the form of $10 FBRx coupons that can be used to purchase fresh fruits and vegetables at eligible firms, including the majority of firms participating in TFT's point-of-purchase SNAP incentive program (known as Food Bucks). Patients receive FBRx in a variety of settings, including hospital-located Healthy Food Centers/Food Farmacies, chronic disease management programs, pediatric offices and community clinics. Healthcare Providers: TFT works with healthcare providers in NJ and PA to provide FBRx to eligible patients. Below are the current healthcare partners and corresponding clinical sites, with plans to add more FBRx distribution sites over the upcoming year. Cooper University Health Care (Camden, NJ) Cooper Pediatric Care at Camden Camden Coalition of Healthcare Providers (Camden, NJ) Navigation services Virtua (Camden, NJ) Food Farmacy Einstein Hospital (Philadelphia, PA) Community Practice Center Einstein Care Partners Stephen Klein Wellness Center (Philadelphia, PA) Self-Monitored Blood Pressure Program Congreso Health Center (Philadelphia, PA) Self-Monitored Blood Pressure Program Delaware Valley Community Health (Philadelphia, PA) Fairmount Primary Care Girard Medical Center Penn Medicine (Philadelphia, PA) Penn Family Care Children's Hospital of Philadelphia (CHOP) CHOP South Philadelphia UPMC Children's Hospital (Pittsburgh, PA) General Academic Pediatrics - Main Hilltop Health Hub Children's Community Pediatrics Bellevue Children's Community Pediatrics Gil Allegheny Health Network's Healthy Food Centers (Pittsburgh, PA) West Penn Hospital Allegheny General Hospital Jefferson Hospital Forbes Hospital Adagio Health (New Castle, PA) WIC + Medical Office UPMC Health Plan (Western PA) Vale-U-Health/Mon Valley Hospital Duquesne University School of Pharmacy Redeeming Firms: The FBRx program aligns closely with and benefits from the infrastructure of TFT's Food Bucks retail network, which has been active for over 10 years and is funded under a separate GusNIP award. The Food Bucks program distributes incentives to shoppers using SNAP benefits at the point of purchase. Most of the 60+ Food Bucks retail partners are already redemption sites for FBRx or will serve as redemption sites as the program expands. These retail partners include supermarket chains such as Save A Lot and Fresh Grocer, as well as neighborhood healthy corner stores, farmers markets and mobile markets, to provide patients with a variety of redemption options and ensure ease of accessibility. TFT adds unique value and expertise in expanding healthy food retail by operating a network of farmers markets and providing technical assistance to other markets, supporting corner store owners in sourcing and marketing fresh produce, and working with supermarket operators to open or expand in underserved communities. These close ties with various types of retailers provide a substantial benefit to the success of FBRx. Additional Government and Community Partners: Along with healthcare and retail partners, TFT engages with many other nonprofit organizations, foundations and community partners to enrich the FBRx program, especially as this grant covers several geographies. In Camden, TFT continues to work with the Camden Food Security Collective and with multiple partners who collaborated on the BUILD Health "Roots to Prevention" project, which facilitated the expansion of FBRx distribution to new healthcare partners and developed connections with urban farmers. In southeastern PA, TFT continues longstanding partnerships to enhance FBRx programming, including the Philadelphia Department of Public Health, the American Heart Association (AHA) and COACH (Collaborative Opportunities to Advance Community Health), a group of hospitals and nonprofit partners (including TFT) that work together on community health efforts. In Pittsburgh and western PA, strong partnerships with Just Harvest (an anti-hunger organization), the Greater Pittsburgh Community Food Bank, the Pittsburgh Food Policy Council, the Allegheny County Health Department, UPMC Health Plan and AHA continue to enhance the FBRx program. Finally, TFT is strengthening relationships with other grantees through the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center, providing technical assistance and learning from other grantees and core partners. Changes/Problems:Activities under this GusCRR award were postponed until September 2022 with approval from USDA NIFA. The project team continued FBRx implementation under the 2019 GusNIP PPR award for an additional year, through August 2022, because of challenges and delays associated with the COVID-19 pandemic. In several clinical settings, the pandemic led to fewer in-person patient visits and therefore a lower volume of FBRx distribution, particularly during Year 1 of the project. Other healthcare sites required more time than expected to launch the FBRx program because staff capacity was limited by the pandemic response. In addition to supporting expansion to new sites, the GusCRR award will enable TFT to increase the firm budget and program reach for several clinics that were delayed in launching programs during the pandemic but are eager to offer produce prescriptions to patients facing nutrition insecurity as food and other costs continue to rise. What opportunities for training and professional development has the project provided?Activities under this award are beginning September 2022 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?The first year of activities under the GusCRR award will focus on continued expansion of the FBRx program to reach more patients in additional clinical settings and geographies. Established partnerships with existing healthcare providers will facilitate the addition of new clinical distribution sites, and planning is also underway with healthcare and retail partners in new areas of PA and NJ. TFT will prioritize distribution settings where patients have more frequent interactions with their healthcare providers to compound the positive impacts of the FBRx program. In addition to expanding the number of clinical distribution sites, TFT will continue to onboard new redemption sites, with a focus on firms that are open for increased days/hours and/or sell locally grown produce. TFT is currently pursuing a partnership with Snap2Save and InComm, which will enable patients to receive their FBRx in the form of debit cards that can only be used to purchase eligible fresh produce items. This partnership will be piloted in the Pittsburgh region, and will open a vast redemption network for patients, including Giant Eagle, a popular regional chain of supermarkets with 96 locations in Western PA. In Philadelphia, TFT will expand work with a Save A Lot supermarket and the Snap2Save technology provider to offer FBRx at the Maria de los Santos Health Center, the largest provider of primary healthcare services to Latinos in the City of Philadelphia. In Central PA, TFT will explore a loyalty platform-based produce prescription, building on technology currently used for SNAP incentives. TFT will also continue to work with farmers markets and other non-traditional retail outlets as redemption sites, providing patients access to fresh, locally grown produce. Another priority in the upcoming year will be to begin data collection for the GusCRR cohort of the national produce prescription evaluation. TFT has been working closely with the Gretchen Swanson Center for Nutrition to identify which healthcare partners will participate in this evaluation. Pre- and post-surveys will document the impacts of the FBRx program on produce purchasing and consumption, and on select clinical markers.
Impacts
What was accomplished under these goals?
Partnership building and project development under TFT's current GusNIP produce prescription award is laying the groundwork for activities under this GusCRR award. Planning is underway with future distribution and redemption partners that will enable TFT to offer produce prescriptions to patient populations who have not yet had access to FBRx programming. These include new partners in existing geographies to provide more comprehensive redemption networks and reach a wider range of households in those areas, as well as partners who will enable FBRx expansion into new geographies in PA and NJ. Data Collection: Staff work with each firm to create systems that collect the number and value of FBRx that are distributed and redeemed. Firms use various data collection methods (e.g., paper FBRx tracking, POS systems) to serve as inputs for TFT's database, where FBRx distributions and redemptions are tracked individually by serial number. Below are the metrics and other data collected from firms and program participants to assess impacts (note: not all metrics are collected from each site): ? Number of individual FBRx coupons distributed and redeemed at all sites ? Dollar amount of FBRx distributed and redeemed at all sites (and % redemption) ? Number of unique patients reached ? Patient surveys reporting impacts on produce purchasing and consumption ? Number or value of produce items sold at corner stores ? Number of vendors/farmers at farmers markets ? Corner store sales receipts from customer purchases where incentive is redeemed (for quality assurance) Since activities towards this grant are commencing in September 2022, TFT will report on the GusCRR objectives in the Year 2 progress report.
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