lisa marsh ryerson president the root cause coalition · food insecurity, and the social...

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Lisa Marsh Ryerson President

AARP Foundation and

Board Chair The Root Cause Coalition

A greater understanding of the size and scope of food insecurity, and the social determinants of health

New market-driven pathways to safe, affordable, nutritious food

Efficiencies in the health care system to improve health and reduce costs

Behavioral change through the use of incentives that reward healthy eating

Collective impact helps us achieve:

Mountain Plains Regional Summit: Diagnosis Hunger

Social Determinants of Health Defined

1 in 5 adults over 50 struggles with food insecurity


Focus

Creating a food-secure nation

Building strong social bonds

Advocating for older adults in the courts

Making homes affordable, livable and healthy

Empowering people to earn a living

Meeting the Essentials


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Barbara J. Petee Executive Director

The Root Cause Coalition and

Chief Advocacy and Government Relations Officer, ProMedica

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What do you think of this health system?

• 332 sites

• 4.7 million patient encounters system-wide

• 12 hospitals

• 334,000 lives covered by owned health plan

• 900+ employed physicians

• 2,300+ physicians with privileges

• Six ambulatory surgery centers

• 15,000+ employees

• 8,200 births

• 2,350+ licensed inpatient beds

• 90,000+ inpatient discharges

• 71,000+ surgeries

• 392,000+ ER visits

• 220,000+ home care visits

• 425,000+ rehabilitation therapy encounters

• $4.1 billion total assets

• $3.1 billion revenue

• Strong financial ratings

• Moody’s (Aa3); S & P (AA)

• Rated 99th out of 100 in Gallup Well-Being Index

• Nationally, fastest rate of poverty growth of a city of its size

• 70% of adults overweight

• 36% of low-income families concerned about having enough food

• Ranked 88th of 88 counties in state for infant mortality / low-birth-weight babies

• 28% of youth reported they felt sad or hopeless every day for 2 weeks or more in a row

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What do you think of this community?

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Now, what do you think of this health system?

• 332 sites

• 4.7 million patient encounters

system-wide

• 12 hospitals

• 334,000 lives covered by

owned health plan

• 900+ employed physicians

• $3.1 billion revenue

• Strong financial ratings

How do we make a distinct impact relative to our resources?

• Rated 99th out of 100 in Gallup Well-Being Index

• 70% of adults overweight

• 36% of low-income families concerned about having enough food

• Ranked 88th of 88 counties in state for infant mortality / low-birth-weight babies

• 28% of youth reported they felt sad or hopeless 2 weeks in row

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Essentials of well being

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Career well being

Social well being

Financial well being

Physical well being

Love of what we do everyday

Quality of our relationships

Security of finances

Vibrancy of our physical

health

What we have contributed

to our community Community

well being Source: Gallup, Well Being

• 16.6% of GDP today will be 19.3% in 2023

o People cannot afford basic care

o 1/3 of people skip care, prescriptions

due to cost

• Healthcare costs are a significant issue

with the general public

o It is the No. 1 cause of bankruptcy

o Lack of primary care/mental health

o No liquid assets to pay deductibles

o 70% have seen flat/falling incomes (05

to 14)

o Higher percent report material hardship

o Higher percent of chronic ill do not get

support they need

o Higher percent in poorer heath

o Inequities in care

• Medicare will grow from 49 to 79 million

• Medicaid will grow from 60 to 95 million

• Did ACA really change model?

o 20-25 Million insured under ACA

• 50,000 die: alcohol, opioid, other drug

overdose

• Future: Population Health = Social

Determinants

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Impact

Repeal of the ACA: • Lose coverage for 20M? • Destabilization of healthcare

industry? • Estimates of $1.1 trillion

increase in uncompensated care

• Replacement plan?

20 percent of health

and well being is related to

access to care and quality of services

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Going beyond our clinical walls…

Source: Institute for Clinical Systems Improvement; Going Beyond Clinical Walls: Solving Complex Problems, 2014

• 13% of U.S. households are food insecure • 19.5% of U.S. households with children are food

insecure • 30.3% of U.S. households – single moms with children • 31% of seniors cut or skip meals due to lack of resources • 24% undocumented workers • 91% people returning from prison • Almost 75% of SNAP recipients are seniors, disabled or

working parents. • SNAP benefits are often exhausted before the end of

the month

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Hunger in the U.S.

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Economic Impacts of Hunger

• The cost of hunger to our nation is at least

$167.5 billion. • Healthcare costs alone related to hunger

nationwide are $130.5 billion annually.

• The annual cost of hunger to every U.S. citizen

is on pace to amount to roughly $42,400

per citizen over a lifetime.

An average food insecure family of 4 may forgo up to 100 meals a

month.

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ProMedica’s Anchor Institution Model: Healthy Individuals : Healthy Communities

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• Through our community partnerships, the link between

obesity and hunger became apparent. • Many overweight/obese individuals lack access to high-

quality, nutritious foods at affordable prices

• Hunger induces irregular eating patterns which can lead

to overweight and obesity.

• Likewise, a strong link between hunger and health

exists across the age, economic and social spectrum.

• Pulled toward the other social determinants.

Identifying the Problem


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• Food reclamation

o More than 315,000 pounds of

food collected since inception,

o Equals 275,000 meals

• Employee and community food

drives

• Employee Food Assistance

Community-based Solutions


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Community-based Solutions

• Support for USDA child nutrition

programs

o ProMedica Toledo Children’s

Hospital—2016 summer meal

sponsor, only Hospital in Ohio

o Served more than 550 meals

• 5K Walk/Run benefitting local hunger

relief organizations

• Food insecurity screening questions

added to community health needs

assessment


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Clinical Solutions

• ProMedica hospitals are screening in-patients using

validated screening questions (The Hunger Vital Sign).

“ Within the past 12 months we worried whether our

food would run out before we got money to buy more.”

“Within the past 12 months the food we bought just

didn’t last and we didn’t have money to get more.”


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Clinical Solutions

• Food insecure patients are provided with an

emergency care package and community

resources upon discharge.

• To date screened more than 54,000 patients

• Screening questions now built into Epic

foundational IT system.

Hunger screening in primary care

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Food Pharmacies

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• Primary care physicians are screening for

food insecurity.

• Food insecure patients receive a referral to

the food pharmacy.

• Food pharmacy provides patients with

healthy food for themselves and their family.

• Patients return to the Food Pharmacy once a

month for up to 6 months before needing a

new physician referral.

• More than 2,000 unique households have

been assisted since opening in April 2015,

with more than 4,200 visits.

Food Pharmacies

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Preliminary Data Analysis

• Referred patients are predominantly female,

African American, between ages 40-65 and

receive Medicaid.

• Chronic conditions observed most often

included nutrition related diagnoses (obesity,

hypertension, hyperlipidemia, diabetes,

kidney disease).

• Average number of visits, 3 per household.

• Primary care services increased for this

population and a decline was observed in the

number of avoidable admissions, number of

visits to emergency department and all-cause

readmission rate.

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GOING BEYOND

Ebeid Institute

• Teaching kitchen – 2nd Floor

• New Call Center – 3rd Floor

• Job training/career skills

• Financial literacy classes

• GED classes

• Diabetes education

• Block by block community

empowerment/improvement

Financial Opportunity Center

• Annie E. Casey Foundation Center for Working Families Model

• FREE financial coaching & education

• Debt management, Credit building

• Employment readiness training

• Housing

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• 208 served, 40 ProMedica Employees

• 52% has seen coach 5 times or more

• 48% increase in net income

• 15% increase in credit score

• $88,190.00- Approved Income Supports

• $340,00 + in Federal Tax returns

• 9 opened savings or checking account

• 10 purchased a new car, 3 with cash and 7 approved loans

• 21 approved for credit card (to build credit)

• Settled student loan & major medical debt

• New 501(c)3, formed October 2015

• Founding members: ProMedica and AARP Foundation

• Goals: Research, Advocacy, Education

• 35+ Members

• 2nd Annual National Summit – Louisville, KY October 9-10, 2017

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The Root Cause Coalition

We need to pay as much attention to the social

determinants of health as we do to achieving

clinical excellence.

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Transforming health care

“The difference between a good life and a great life is …

the community.” - Well Being

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Improving Food Security by: Connecting Clinic and Community

and Changing Policies and Practices

Source: US Dept. of Agriculture

CHC

•

••

St Joseph’s Clinics Cherise Callighan M.B.A.

The History: GME Community Clinics at SJH serve urban underserved patient populations Hypothesis: Unrecognized food insecurity was a barrier to providing patient-centered care. First clinic implemented a single question screening and referral protocol beginning in April 2016. “In the past 12 months, did you worry whether your food would run out before you had money to buy more?”

Positive screenings were contacted by our care managers, who would assess for urgent needs and refer the patient for both immediate and long-term food resources.

Early learnings:

Partnership created with Hunger Free Colorado and Metro Caring for urgent and non-urgent food insecurity needs. Care Managers do not have enough capacity Development of Care Coordinator position that only does food insecurity. Expansion into two additional SJH Community Clinics in December 2016 & January 2017

The data: Key dates: 11/16 – added care coordinator 12/16 – added second clinic 1/17 – added third clinic

0

20

40

60

80

100

120

140

160

180

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Hunger Free Colorado GME Referrals

Numberofreferralssent

Next Steps: Begin to review data of what services our patients are receiving Share with individual providers throughout GME his/her percentage of food insecurity patients Review data for specific population needs Create evaluation plan and need for increased screening in other locations

WIC Modernization

Presented by:

Erin Ulric, MPH – Colorado WIC Director, Colorado

Department of Public Health and Environment

Program

Strategies

Increasing Program

Participation

Improving Program

Quality

Growing Demand for,

and ease of access to,

healthy foods

Enhanced Collaboration

with Organizational

Stakeholders

Major Accomplishments 2016-2017

Baseline Research

• Implemented statewide research “Informing Outreach and Increasing Awareness of

Nutrition Programs: Research Report and Communication Recommendations”

• Data sharing with US Census Bureau to better identify potentially eligible populations

Customer facing initiatives (local agencies and participants)

• eWIC

• Statewide texting pilot and evaluation, subsequent statewide rollout

• Data Central – a reporting portal for local agencies

• Integration of a WIC referral system into PEAK – an online application tool for

Medicaid, SNAP, TANF and a number of other programs

• Nutrition Education Choice rollout – providing options on nutrition ed.

• Enhanced foods list with additional options such as yogurt

• WICShopper mobile app to help participants shop

Internal

• Organizational assessment and realignment

• Performance Improvement concepts better embedded into the culture

• Mastery goals for each staff to improve staff engagement

• Strategic plan for local agency communications

• Move from a bi-monthly newsletter to a weekly digest for local agencies

• Local WIC Impact pilot group was formed

Future Plans

• (Continuing to) Increase engagement with

participants through technology

• Implement workforce development strategies

as defined in conjunction with local agency

staff

• Increase marketing and outreach efforts

Hunger Free Colorado

Programs and Policies to Eliminate Hunger Kathy Underhill CEO

Resources

• Nutrition Obesity Prevention Research and Evaluation www.nopren.org

• Hunger Free Colorado

www.hungerfreecolorado.org

Food Research and Action Committee

www.frac.org

Children's HealthWatch

www.children’shealthwatch.org

Root Cause Coalition

www.rootcausecoalition.org

http://www.nopren.org/

http://www.hungerfreecolorado.org/

http://www.frac.org/

http://www.children’shealthwatch.org/

http://www.rootcausecoalition.org/

Get Involved!

• State hunger linkages committee (Academy of Pediatrics, Colorado Prevention Alliance, Kaiser Permanente, Hunger Free Co and WIC)

[email protected]

• Social Determinants Learning Collaborative

[email protected]

mailto:[email protected]


Getting Started Jessica Kejr

Harvesters—The Community Food Network

• Mission

We feed hungry people today and work to end hunger tomorrow.

• Vision

That everyone in our community will have access to enough nutritious food to maintain a healthy lifestyle.


• Distribute food through a network of 620 agency partners in 26 counties

• Last year, 50 million pounds, including 17 million pounds of produce

The Need

• 1 in 7 in our region is food insecure

• Network serves 141,500 people each month

Harvesters’ Response • Equipping and strengthening

robust network of agencies

• Multiple programs and models

• Offering more produce to all agencies

• Increased internal infrastructure to support overall work

Harvesters’ Response • Kids Café

• Afterschool and summer meals

• BackSnack • Weekend pack

Harvesters’ Response

• SNAP Outreach

• USDA programs • CSFP

• TEFAP

• Milk 2 My Plate

Harvesters’ Response

• Nutrition Services: • Supporting existing pantries

to increase pantry access and client dignity

• Nutrition “Nudges”

• Healthy Pantry Partnerships

• Recipe Distribution

• Project STRENGTH and Kids in the Kitchen classes

Hunger in America 2014

www.feedingamerica.org

http://www.feedingamerica.org/

Hunger in America 2014 Health Findings

62% O F H O U S E H O L D S H A V E

A M E M B E R W I T H

H I G H B L O O D P R E S S U R E

37% O F H O U S E H O L D S H A V E

A MEMBER WITH D I A B E T E S

Hunger in America 2014 Coping Mechanisms

78% PURCHASE

INEXPENSIVE, UNHEALTHY

FOOD

57% RECEIVE

HELP FROM

FRIENDS OR FAMILY

34% WATER DOWN

FOOD OR DRINKS

36% SELL OR

PAWN PERSONAL PROPERTY

29% GROW FOOD

IN A HOME OR COMMUNITY

GARDEN

Healthcare Settings

The opposite of hungry is not full. The opposite of hungry is healthy!

Interventions in Healthcare Settings

Is this healthcare for my clients, or food assistance for yours?

• Similar populations….same people

• Remove a barrier while increasing access to healthy food

• Provide consistent access

• Increase compliance with doctors instructions and medication

• Prescriptive pantries – various models (pantry, mobile, bus, physician screenings at intake)

Interventions in Healthcare Settings

• Pilot: Diabetes intervention

• Clinical case study

• Track A1C

• Food box (2x per month)

• Access to produce

• Physical activity component

• Community garden

• Intervention happens in clinical setting

Interventions in Healthcare Settings • Kids Café – serving meals for

children at clinics

• Current model….and growing!

• Reimbursable meals

• Brown bag lunches

• Mobile meals

• Pilot this summer!

Health Interventions in Pantry Setting

• Heart healthy pantries • Training program – in

development

• Biometric screenings

• Research and evaluation component

• Intervention happens at pantry setting

Nutrition Education • Support each effort

• Nudges at pantries

• Resources for training and awareness

Nutrition Education

• Support each effort • Recipe demos and

distribution

• Produce tips and demos

Ongoing Efforts at Harvesters

• Strategic Plan

• Build on general community awareness

• Food4Thought – Food as Medicine conversation

• Agency workshops – Intersections of Hunger and Health

• Community workgroups, including Hunger-Free Healthcare efforts

• Healthy food drives

• Paper Plate Campaigns

Lessons Learned • Invest time in building quality partnerships

• Pursue strategic long-term opportunities, but be flexible, nimble and responsive when new ideas pop up

• Identify mutually-beneficial goals and priorities among partners

• Know your role and expertise

• Find your champions

• The best way to do it….is to do it!

Opportunities to Consider • Identify and engage key stakeholders

• Work is happening…..

• Community Health Needs Assessments

• Incorporate in Community Health Improvement Plans

• Programmatic approaches along with policy advocacy

• Engage your local food banks

• Clinical interns are looking for community-based experiences

• Hospital social workers and care coordinators • Discharge plans; SNAP

Resources

• Feeding America • www.hungerandhealth.org

• Collaborating for Clients framework

• Nutrition Nudges reports and ideas

• Case studies and examples

• Addressing Food Insecurity: A Toolkit for Pediatricians • FRAC and AAP report

• Community collaborations and supporting groups

http://www.hungerandhealth.org/

Contact Information

Jessica Kejr


Director of Program Services

[email protected]

816-929-3045

www.harvesters.org


http://www.harvesters.org/

lisa marsh ryerson president the root cause coalition · food insecurity, and the social...

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