Recipient Organization
FISH
804 ELMVIEW RD
ELLENSBURG,WA 989269339
Performing Department
(N/A)
Non Technical Summary
The prevalence of diet-related health conditions and associated healthcare utilization and costs continues to rise in the Medicaid population. Increasing consumption of fruit and vegetables improves these conditions and reduces utilization and costs. But the Medicaid population, especially in rural areas, has a high rate of food insecurity, thus a low rate of fruit and vegetable consumption. Downer et al. (2020) state that "policy makers are experimenting with... allow[ing] public insurance money to be spent on food is medicine interventions" like produce prescription programs. Research that addresses how to increase fruit and vegetable consumption, improve food security, and reduce diet-related healthcare utilization and costs for rural Medicaid populations will inform policymaking.A federally qualified health center, food bank, food hub, public health department, and university will participate in the project. Partners will adapt the evidence-based Community Supported Agriculture (CSA) Partnerships for Health model, a subsidized CSA program. The federally qualified health center will verify and target Medicaid patients with, or at risk for, diabetes, hypertension, and/or overweight/obesity and "prescribe" CSA shares to them. A food hub will drop off CSA shares at the food bank, which will deliver CSA shares to patients. The food bank will provide weekly newsletters, monthly skill sheets, quarterly cooking demonstrations, monthly tastings of fruit and vegetables, and weekly text messages. The public health department will conduct key informant interviews with patients, and Behavioral Health Consultants and Care Coordinators from the federally qualified health center will provide motivational support and address barriers to participation. The university will analyze data and developevaluation reports. The food bank will disseminate findings tocommunitypartners, state agencies, and Medicaid managed care organizations; and the university will publish findings in peer-reviewed journals.The ultimate goals of the project are to improve health outcomes andreduce healthcare utilization and costs of rural Medicaid patients with diet-related health conditions. If these goals are met, project partners expect the general impact to be a reduction in blood sugar, blood pressure, and body mass index in rural Medicaid patients with, or at risk for, diabetes, hypertension, and overweight/obesity, respectively; and a reduction in diet-related emergency department visits, hospitalizations, readmissions, and costs for rural Medicaid patients. Societal benefits would include a reduction in theprevalence of diet-related health conditions and associated healthcare utilization and costs.Using a validated microsimulation model, Lee et al. (2019) found that a 30% subsidy onfruits and vegetables for the 82 million adults 35 to 80 years of age on Medicare and/or Medicaidwas estimated to prevent 1.93 million cardiovascular disease events, gain 4.64 million quality-adjustedlife years, and save $39.7 billion in formal healthcare costs.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
The major goals of the project are to improve health outcomes for Medicaid patients with diet-related health conditionsin Kittitas County, Washington;reduce healthcare utilization and costs of Medicaid patients with diet-related health conditionsin Kittitas County, Washington;improve the nutrition self-efficacy of Medicaid patients with diet-related health conditionsin Kittitas County, Washington;and sustain subsidized Community Supported Agriculture (CSA) shares forMedicaid patients withdiet-related health conditionsin Kittitas County, Washington?. The objectives are:1. For each budget period, increase from baseline fruit and vegetable (FV) consumption in 115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year;2. For each budget period, improve from baselinefood security in115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year;3. For each budget period, improve from baseline general health in 115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year;4. For each budget period, decrease from baseline no-shows to clinic appointments in 115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year;5. For each budget period, decrease from baseline total associated costs ofno-shows to clinic appointmentsin 115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year;6. For each budget period, increase from baseline knowledge of FVs in 115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year;7. For each budget period, improve from baseline attitudes about FVs for 115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year;8. For each budget period, demonstrate the effectiveness of subsidized CSA shares for 115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year;9. By September 29, 2025, increase distribution of FVs for CSA shares; and10. By September 29, 2025, secure funding for CSA shares for 115patients with, or at risk for,diabetes, hypertension, and/or overweight/obesityper year.
Project Methods
FISH and community partners will achieve objectives and proposed outcomes by adapting the evidence-based CSA Partnerships for Health model (Partnerships), asubsidizedCSA program.FISH will hire a Project Manager and Van Driver, facilitate monthly partner meetings, order CSA shares from a food hub for 115federally qualified health center (FQHC) patients each year, contract withthe FQHC, university, public health department, and a Grants Management Consultant for reporting, evaluation, engagement, and grants management services, and collaborate with the Nutrition Incentive Hub to develop a program brochure. The FQHC will verify and target Medicaid patientswith, or at risk for, diabetes, hypertension, and/or overweight/obesity; "prescribe" CSA shares to them; and collect healthcare utilization and cost data. FISH will schedule weekly CSA share deliveries with patients and distribution sites.The food hub will drop off CSA shares at FISH.FISH will travel to three distribution sites in Kittitas County each week,collect NTAEParticipant Surveydata and NCIFood Attitudes and Behaviors Surveydata,and deliver CSA shares to patients. FISH will provide weekly newsletters in CSA shares with lists and photographs of food, information about lesser-known vegetables, recipes, and stories from the food hub. In addition, FISH willprovide monthly skill sheets in CSA shares (e.g., written and pictorial instructions for preparing vegetables; skill sheets developed by Partnerships); quarterly cooking demonstrations; monthly tastings of FVs; and weekly text messages (e.g., "Eat a rainbow! To keep eyes & skin healthy, eat deep yellow/orange fruits & veggies 3x/week - like butternut squash, mango, oranges & corn!"; text messages developed by Rhode Island SNAP-Ed). The public health departmentwill conduct key informant interviews with patients, and Behavioral Health Consultants and Care Coordinators from the federally qualified health centerwill provide motivational support and address barriers to participation for patients who don't pick up CSA shares. FISH will provide NTAE and NCI data to the university, the federally qualified health centerwill provide healthcare utilization and cost data to the university, and the university will analyze data and developevaluation reports. FISH will disseminate findings tocommunitypartners, state agencies, and Medicaid managed care organizations; and the university will publish findings in peer-reviewed journals. To sustain subsidized CSA shares, FISH willdistribute FV from farm donations, farm gleaning, farmers market gleaning, and a small-scale farm for CSA shares; and secure community benefit funds and Medicaid reimbursement for CSA shares.FISH intends to share information and core data with the NTAE. For the outcome evaluation, FISH and community partners will collect data from the NTAEParticipant Survey, NCIFood Attitudes and Behaviors Survey, the federally qualified health centerpractice management system, andmonthlyproject reports. They will collect baseline and follow-up data, and the university will use a pretest-posttest design, to evaluate outcome measures 1-7. FISH will collect follow-up data, and will use a posttest design, to evaluate outcome measures 8-13.For the process evaluation, FISH and community partners will collect data from theNTAEParticipant Survey, NTAEInstitutional-Level Data Set, and monthly project reports. The Project Manager will compare data to the Implementation Plan each month to evaluate output measures.