Update April 26 at 4:41 PM
U.S. Department of Veterans Affairs and The Rockefeller Foundation have released specifics regarding the structure of demonstration projects to be conducted in conjunction with "food is medicine" startup About Fresh.
Two produce prescription pilot projects and associated research pilot programs at VA healthcare systems in Salt Lake City, Utah and Houston, Texas will focus on improving quality of life for veterans with or at risk of developing diet-related health conditions. Eligible veterans can enroll in About Fresh's Fresh Connect program to receive $100 per month for fresh products. Enrollees will also receive nutrition education and ongoing coaching from VA registered dietitian nutritionists.
“We know good food is the foundation of good health, and study after study has found food is medicine interventions make people healthier even as they cut health care costs,” Rajiv Shah, president of The Rockefeller Foundation, said in a press release. “I am proud the foundation will be collaborating with the VA to help make American veterans’ lives healthier and more food secure. This program will also help to accelerate our understanding and use of these programs as an integral part of health care delivery to the benefit of millions of other Americans.”
Over a quarter of Afghanistan and Iraq war veterans experience food insecurity, more than double the general population. In 2014, the VA found that 78% of veterans were overweight or obese. The same population has a 5% higher rate of diabetes.
VA tops the list as the largest integrated healthcare system in the country with 1,200 healthcare facilities serving nine million veterans. The new pilot projects were designed in collaboration with VA clinicians and the administration's office of food security.
Researchers at the University of Utah will evaluate the effects of the projects on enrollee health, accrued healthcare costs, utilization and patient satisfaction. Ultimately, insights gained will inform future food and health policies and programs across the VA healthcare system.
About Fresh, with support from the Rockefeller Foundation’s Food is Medicine Research Initiative, is partnering with the Veterans Health Administration (VHA) to create a large-scale demonstration project aimed at using healthy food to improve veterans' health.
About Fresh, a startup focused on integrating healthy food into the healthcare system began bringing fresh produce to Boston food deserts in converted school buses. But Josh Trautwein founded About Fresh with no attachment to the means, but rather the ends: food is medicine overall, not necessarily food trucks as a way to get there.
Today, the Boston-based startup nonprofit is mapping out the nearly million-dollar demonstration project with the VHA to prove that the "food is medicine" movement has a future in healthcare.
“This project is almost more important than expanding our program because we want to contribute to the system's change in healthcare,” Trautwein told Fierce Healthcare. “That's going to create the context for healthcare investment in 'food as medicine'.”
The move to embrace "food as medicine" shifted from a widely dismissed corner of healthcare to a topic of conversation at the highest levels when, in September 2022, the White House held its conference on hunger, nutrition and health. It was the first time the conference had been convened in half a century.
In the U.S., 34 million people are food insecure, with 100% of U.S. counties exhibiting food insecurity. Diet-related illnesses like heart disease and diabetes are some of the leading causes of death, disproportionately affecting under-resourced communities.
At the White House conference, more than 100 private and public sector contributors, like Kaiser Permanente and Google, committed $8 billion to initiatives fueling the movement.
In collaboration with the American Heart Association and Kroger, the Rockefeller Foundation announced the mobilization of $250 million to build its research initiative. By the end of November, Rockefeller announced that it would be using $4.6 million to scale "food is medicine" initiatives, including its partnership with About Fresh.
Despite the increasing need for healthy food programs, debate of how food fits into healthcare has been contentious. Before any buy-in takes place, healthcare organizations want to know the same things they would for any medicine: disease, dosage and duration, experts say.
“There is a need for more robust research and data, and we're hearing from healthcare that, from their perspective, there has to be a strong business case,” Diana Johnson, Rockefeller Foundation food initiative program officer, told Fierce Healthcare. “And it gets to those things like how programs should be designed for specific populations and specific disease categories.”
About Fresh will use its digital Fresh Connect program to source the “better data” Rockefeller and healthcare organizations are looking for, Trautwein said.
"It's funny when people see just our programs right next to each other. They'll ask how we've built fintech alongside this like scrappy school bus," he said. "The tech was built on top of our square point-of-sale system with a native gift card feature. We built a very basic app that can facilitate card loading and create a profile for the person that was receiving the card and rolled that out through community-based organizations and health centers."
Fresh Connect integrates its HIPAA-compliant platform into provider workflows including electronic health records and third-party referral platforms. Through integration with FIS, an IT service management company, prepaid debit cards can be used at Walmart, Kroger stores and Albertsons across the country.
Executives involved in the VHA-Rockefeller Foundation demonstration project were not able to share exact details of the initiative, but Johnson said that Fresh Connect's technology was an important reason for the company's selection as a project partner.
“About Fresh has served the community for years and so they have a very unique understanding of how these issues impact households, and what it really looks like to deliver a quality program to folks in need,” Johnson said. “So developing the Fresh Connect technology seems like a natural evolution in their growth as an organization and it makes sense that they would continue building solutions for complex problems like inequitable food access.”
Through the data acquired with the VHA, "food is medicine" organizations can learn how to design solutions for niche populations, Johnson said, like prescription programs for fresh produce to serve patients with diabetes in Kansas, as one example.
She sees the point of care as a unique moment to create long-term behavior changes that could extend lives, an impetus for healthy diet adoption that is not integrated into existing government food programs like food stamps.
Thea James, M.D., vice president of mission for Boston Medical Center, spoke at the White House conference about the health system’s prescriptive food program including a rooftop farm that distributes over a million pounds of food annually. Boston Medical partnered with About Fresh in 2019 to bring Fresh Connect to their patients. The duo began a two-year randomized control trial in 2020 to examine the impact of the program on health outcomes and total cost of care.
James said it was a snowy day when she first stepped on an About Fresh bus. She was impressed by the program’s ability to step out of the box and onto the bus and then into Fresh Connect’s data analytics platform.
“[About Fresh] was meeting the people where they are and when you do things like that, you give yourself an opportunity to establish trust and rapport in the community,” James told Fierce Healthcare. “I don't think hospitals realize how much distrust there was of them until the COVID vaccine.”
James saw promise in the data analytics system giving primary care doctors insights into what their patients were eating and results for health metrics like patients' A1C levels.
The resulting partnership let Boston Medical meet the regulations for new Medicaid reimbursement models, and About Fresh took advantage of new waivers to get contracts with healthcare systems. Patients got healthy food and the cost of caring for patients went down, James said.
Now, when the health system has small pockets of money to invest in the community, they look to About Fresh, James said.
“I think About Fresh can help the government understand how it is complicit in the very thing it’s trying to help just because it is lazy in its mindset,” James said. “It doesn't know how to make connections between health and nutrition or money and nutrition. The government can decrease the things that cost a lot of money, which is diseases, with the level of data.”
As Trautwein begins structuring the demonstration project, he says About Fresh is staying open to what new solutions may present themselves, asking the same question the company always has: "How do we scale to make this a permanent feature of healthcare?"