Progress 09/01/21 to 08/31/24
Outputs
Target Audience:The target audience for this project originally included Medicaid members of Aetna Better Health of Louisiana, ages 3-17, residing in St. Landry, Acadia, Lafayette, Washington, Tangipahoa or St. Helena parish. In October 2022, program eligibility expanded to include members of all Medicaid health plans, expanding the target audience to all Medicaid members, ages 3-17, residing in the six target parishes. Changes/Problems:The major change in our project approach includedpivoting our enrollment and recruitment efforts and establishing referral workflows where medical providers, clinic staff, and community partners could refer families to the program and families could self enroll. We also broadened eligibility to Medicaid members from any health plan. We learned that partnering with managed healthcare organizations has unique challenges and benefits compared to partners in other sectors. Managed healthcare organizations have high turnover rates in staff, unique systems and processes for approvals, challenges in sharing data related to claims and health outcomes, and are still learning how to incorporate social determinants of health into its electronic health record data coding, tracking, and measurements. We learned how critical word of mouth is in communicating the program to other partners such as community schools, school based health clinics, and other pediatrician offices. Word of mouth significantly increased awareness about the program which yielded more enrolled households. The pivots made throughout the program were in direct responseto the needs and feedback of the community and partners. This resulted in increased enrollment and engagement, however, created additional challenges in obtaining health data to support our initial evaluation goals. We were unable to establish a data sharing agreement with Aetna Better Health of Louisianain order to obtain claims data related to HFPRx participants. Additionally, the changes to the project design - including opening the enrollment to members of any Medicaid health plan, as well as creating options for self enrollment, also created challenges for obtaining health data from providers directly. As a result, we relied on self reported health data, qualitative evaluation and survey data to understand changes to participant health status, fruit and vegetable consumption and engagement with preventative care. What opportunities for training and professional development has the project provided?Program staff from Share Our Strength and partner organization, Aetna Better Health of Louisiana presented on lessons learned implementing a produce prescription program in rural communities in Louisiana at the RISE Social Determinants of Health Conference in April, 2024. The session was attended by other health and community organization staff and provided insights and best practices for program implementation. How have the results been disseminated to communities of interest?All participating partners were invited to a presentation on 12/11/24 providing a summary of the project and evaluation results and impact. The presentation was recorded and sent to all partners. A summary report is being finalized and will also be sent to all partners in the project and will be available for viewing by participants and the public on our organization website. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Goal 1: 1250 households participate in HFPRx. At the conclusion of this grant project, 1538 youth ages 3-17 and their households had been enrolled in the Healthy Families Produce Rx program. Of those, 1136 were enrolled in region 9 (Washington, Tangipahoa and St. Helena parishes) and 402 were enrolled in region 4 (St. Landry, Acadia, and Lafayette parishes). Upon gathering additional feedback from providers and clinics in the project, enrollment was expanded to settings beyond well child visits. This change made it more difficult to set weight management and nutrition counseling follow up appointments at the time of enrollment. However, expanding enrollment flexibility to include referrals from a provider, community health worker or community organization supported greater enrollment in these rural communities and ensured that eligible families could participate. Goal 2: HFPRx achieves a 90% incentive redemption rate.? At the conclusion of the grant project, the overall redemption rate for all participants was 62%, representing a total of $225,073 redeemed across both regions on fresh fruits and vegetables. While this lofty redemption goal was not achieved, our project team worked diligently to identify and address any barriers that families encountered in using their vouchers. This included extensive focus group and survey feedback gathering, and developing a participant engagement plan to include participants in ideating solutions to low redemption rates. The result of the participant engagement included exploration of other voucher solutions that could support participant choice in where vouchers could be redeemed, as well as additional reminders and customer service to ensure families knew how to use the vouchers from the outset of enrollment. This resulted in increases in redemption after the changes were made. Additionally, our program overall redemption rate of 62% aligns with the average GusNIP PPR redemption rates nationally. In Year 3 and Year 4 average redemption rates across all GunNIP PPR programs were 53.4% and 74.6% respectively. Goal 3: Fruit and vegetable consumption for participating households increases between program initiation and completion Goal 4: Participation in HFPRx increases utilization of preventative care by enrolled Aetna Medicaid members in catchment area. Goal 5: Children of participating households enrolled in weight management program achieve improved childhood overweight measures and better dietary health. Baseline and post surveys included questions on fruit and vegetable consumption. We did not see an increase in fruit and vegetable consumption. We believe we were unable to show an increase due to the following factors: The survey asked the participant to self report their consumption; the survey did not ask each household member's fruit and vegetable consumption. It's possible other adults or children in the household increased their fruit and vegetable consumption due to the incentive. Only 312 participants (20%) completed the baseline survey, and only 385 participants (25%) completed the post survey. Additionally, expansion of the target audience to include Medicaid members from all health plans, rather than just Aetna Better Health of Louisiana, created additional challenges in collecting data related to health outcomes and child overweight measures. To account for this, questions related to self reported health and use of prevenative care, including well child visits, were also added to the survey as noted in previous reports. While significant increases in fruit and vegetable consumption and preventative care engagement were not deteted in the pre and post surveys, qualitative evaluation of participants included the following themes: Participants strongly value the Healthy Families Produce Rx program and the impact it has on the health and wellness of the family Participants perceive their health plan, pediatrician and related medical staff as trustworthy and likely to apply to future produce rx programs if they promoted the program Participants underscored that the program increased the ability to include other family members in the shopping, cooking and meal preparation process. Parents and caregivers also acknowledged how the program had supported healthier eating habits for their children, including children eat more and greater variety of fruits and vegetables. Goal 6: HFPRx strengthens community efforts to reduce food insecurity and to improve dietary health. Fourteen healthcare sites participated in the project, which included identifying and referring children and their families to the program. Healthcare sites included: pediatric practices, family medicine practices, federally qualified health centers, and school-based health centers. Additional community partners involved included: Louisiana Department of Health, community health workers, healthy communities coalitions, Louisiana State University Ag Center, food banks and food pantries, farmer's markets, and Access Health Louisiana. These partners continue to remain engaged in the work and are connecting these efforts with complimentary projects such as "double up" SNAP nutrition incentive programs, a CDC High Obesity grant project to expand healthy food access, SNAP-Ed and EFNEP nutrition education programming and streamlined electronic referrals from healthcare providers to community health workers for navigation support to federal programs like SNAP, WIC and summer EBT.
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Progress 09/01/22 to 08/31/23
Outputs
Target Audience:Originally, the target audience was Medicaid members of Aetna Better Health of Louisiana in Regions 4 and 9. We expanded eligibility criteria to all Medicaid plans in Regions 4 and 9 of Louisiana making the target audience Medicaid members of any health plan. Changes/Problems:We pivoted our enrollment and recruitment efforts and established referral workflows where medical providers, clinic staff, and community partners would refer families to the program and families could self enroll. We also broaden eligibility to Medicaid members from any health plan. We learned partnering with managed healthcare organizations has unique challenges and benefits compared to partners in other sectors. Managed healthcare organizations have high turnover rates in staff, unique systems and processes for approvals, and are still learning how to incorporate social determinants of health into its electronic health record data coding, tracking, and measurements. We learned how critical word of mouth is in communicating the program to other partners such as community schools, school based health clinics, and other pediatrician offices. Word of mouth significantly increased awareness about the program which yielded more enrolled households. Our program uses Vouchers for Veggies for nutrition incentives to participants. Vouchers for Veggies has had great success in operating in major retailers in all 50 states. Since all Wal-Mart retail locations accept Vouchers for Veggies participants can redeem their nutrition incentives at any Wal-Mart. This resulted in receiving redemption data from an additional 15 retail locations in 6 states outside of Louisiana. To increase the response rate for the post surveys we began offering a $25 gift card to incentivize participants in completing the survey. What opportunities for training and professional development has the project provided?We hosted three 3 provider training sessions. How have the results been disseminated to communities of interest?Preliminary findings have been presented at two conferences. In October 2022, project staff presented "A Managed Care Opportunity to Address Food Insecurity: Lessons Learned from Healthy Families Produce Rx in Louisiana" at the Root Cause annual conference in Minneapolis, Minnesota. In June 2023, project staff presented "Launching and Adapting a PPR in Rural Louisiana" with a medical provider champion at the GusNIP Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information Center (NTAE) annual convening in Arlington, VA. What do you plan to do during the next reporting period to accomplish the goals?We plan to expand enrollment in region 4and develop additional provider and community partners in that region. We plan to reach our enrollment goal of 1,250 households and for all households to complete the 6 month HFPRx program. We will also increase participant communications and access to nutrition education resources in an effort to increase voucher redemption rates.
Impacts
What was accomplished under these goals?
-- 730 households have enrolled in HFPRx in Region 9. - 161 households have completed the 6 month HFPRx. -- Over $112,000 of nutrition incentives have been distributed to participants, and over $71,000 have been redeemed by participants. The redemption rate is 65%. -- The HFPRx program modified its original recruitment and enrollment plans to make the program more accessible to eligible participants. Eligible households were no longer required to enroll during a well-child visit or at a clinic. We increased the avenues to enrollment by permitting eligible households to self enroll at any location. This increased the speed of our enrollment and reduced the burden on medical providers and clinic administrative staff who had limited capacity to recruit and enroll participants. -- The HRPRx program is unable to collect electronic health record data to examine the impact of the program on health outcomes. - Three new Community Partners worked with Share Our Strength to recruit and enroll eligible households - Health providers at 4 health clinics across Regions 4 and 9 were trained on recruitment and enrollment protocols - Community Health Workers at 6 Health Unit offices across regions 4 and 9 were trained on recruitment and enrollment protocols
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