S2E6 – SDoH & A Mission to End Hunger Together with Alexandra De Kesel Lofthus

Announcer [00:00:00] Welcome to RadioRev. Podcasting from the heart of healthcare in Minneapolis, Minnesota. This is the podcast for change makers looking to do more than just health engagement. It’s about getting people to take action and do things that actually improve their health. It’s a radical idea, right? So we’re talking with leaders, innovators, movers, and shakers who are bringing new ideas, inspiring others, and leading the way.

Jenn [00:00:26] Welcome to another episode of RadioRev. I’m your host, Jenn Dellwo. Thank you for joining us for episode six of season two. This series of episodes dives deep into social determinants of health, offering various viewpoints on the topic with a different industry expert each week with the hope that you take away new ideas, perspectives, and are inspired to look at SDoH in a new light from all angles. As a collective, the goal of these conversations is to inspire innovation and motivate the healthcare industry to work together to create meaningful solutions that help people live stronger, healthier lives. Today, we’re joined by Alexandra De Kesel Lofthus, Director of Health Care Partnerships at Second Harvest Heartland. Alexandra, welcome to the show. Thanks so much for being here.

Alexandra [00:01:06] Thank you for having me on. I’m super excited.

Jenn [00:01:08] We’re excited to have you here to talk about some of the awesome work that Second Harvest is doing. The way I like to start is with a little bit of music trivia. What’s your favorite ’80s song?

Alexandra [00:01:18] That’s a really hard question. So I grew up in two different countries through the ’80s, so I might take a little liberty to do one pre-me moving to the United States and post moving. So pre-moving to the United States I didn’t have a particular song. But we often listened to a band called Menudo, where Ricky Martin came from. And the reason I love it and can’t pick just one song is really because my neighbors and I would get together in the afternoons after school and listen to it and go dance outside and make up the routines. And it just reminds me of that joyful childhood play we used to have. It was like the real first boy band that I actually followed too, before I knew what a boy band actually was!

Alexandra [00:01:55] So anything Menudo at that time — it just always makes me happy because it’s just silly, goofy. And then after we moved to the United States I was still learning English, so I fell in love with movies. The movie soundtracks. I want to flip into Spanish now. So I fell in love with movie soundtracks because they were helping me with my English as well. And they were easy to understand, and you have dancing involved. So I followed a lot of movie soundtracks. And you’re going to kill me with this but there’s so much great ’80s music out there, but I’m going to say “Footloose!” It always makes me want dance. I hear it at parties, I hear it at weddings. Everybody starts dancing. Everybody’s got the routine down. It’s like “Thriller,” right? Everybody kind of knows a little of the routine. So, I’m gonna say “Footloose” just because it was during a great time during my transition to the United States. And it still continues with the dancing and just — I cannot help but dance to it. And so I’m gonna pick that even though there’s a ton of fantastic choices out there. {music plays}

Jenn [00:03:09] Love it, and no one has mentioned “Footloose” before. 

Jenn [00:03:15] So why don’t we start with you telling us a little bit about yourself, a bit about your background and your journey with Second Harvest Heartland.

Alexandra [00:03:21] Yeah, absolutely. So, like I said, I was born in Latin America. I was born in Caracas, Venezuela. And I moved to the United States in 1985, to California. Big transition to the Bay Area. I moved with my parents and my sister. The rest of my family actually lives in Belgium. So we’re a little bit of a full-time international family here. So that’s great. Moving to California was really different. So it was hard for me to just pick one song, like I said, but I took the liberty.

Alexandra [00:03:50] So I grew up there. I went to school at UC Davis, University of California, Davis, and got my Environmental and Resources Science degree. I’ve worked in nonprofits pretty much my entire life. I’ve worked in a research lab, I’ve worked at a healthcare center, all kinds of things. And then I moved to Minnesota in 1999, I think it was, for work. And I stayed here. It was hard to go from the Bay Area in California to Minnesota.

Jenn [00:04:15] I was going to ask you how that transition went for you.

Alexandra [00:04:18] It was tough! I didn’t have a coat. I had a ski jacket, and that was pretty much it. But, you know, you learn to layer. And I really love the seasons, and I love how people are always outside enjoying it no matter what the seasons are. And different people, they love the seasons. I love the people. So I’ve been working in healthcare for about 20 years now, 20 or so years, in different capacities, never really in a clinical setting, but always on programs and things like that, operations. And I was working at the National Marrow Donor Program Be The Match before I came to Second Harvest Heartland. Yeah, a lot of people here know that organization, great organization. But my friend sent me the job description for Second Harvest Heartland and said “I think this might be a good fit for you. It’s got a little bit healthcare. It’s got people, it’s got projects. It’s innovative programing.” So I took a look at it and applied and got the job in 2016. So I transitioned over to Second Harvest Heartland, predominantly to lead the health and hunger work that we’re going to talk about today. So I’ve been there since — almost a four-year anniversary.

Jenn [00:05:16] Great. Thanks for that background. And so when it comes to Second Harvest Heartland, can you tell us a little bit about the work that the company does and what the mission of the organization is?

Alexandra [00:05:26] Sure. I’ll start with the mission. I think it really grounds us. It’s to end hunger together. There’s a new mission for us for this year, but it really does speak to the work that Second Harvest Heartland does with our community partners and our partners all over the state and nationally as well. So really to end hunger together.

Alexandra [00:05:42] So for those who don’t really know, Second Harvest Heartland is one of the largest, most efficient hunger relief organizations in the nation. We’re part of a group called Feeding America, which is a national umbrella group. We work in partnership with about a thousand different food shelves and other hunger relief programs where we help the one in 11 people or the one in eight kids that are hungry every day here in the state. So it’s a really great organization. I think a lot of people have probably volunteered there or donated to it. If you don’t know it, I suggest you go to www.2harvest.org to learn more about our organization and the great work we do. But on average, 77 percent of the food that our partner agencies distribute throughout the state comes from Second Harvest Heartland. So a good amount of food comes through us. And in 2019, we helped provide a record 97 million meals to about half a million people that we serve. So that’s quite a big number. The need continues to grow, unfortunately. But we’re there and our partners are there with us to ensure that we’re working toward ending hunger.

Jenn [00:06:46] So as we talk about social determinants of health, our theme for this entire season, terms like food scarcity and food deserts come up a lot. Can you talk more about what those terms mean specifically? What does it mean to live in a food desert? 

Alexandra [00:06:59] Sure. So simply put, a food desert is an area that has limited access to affordable, nutritious food. There’s quite a few of them. Roughly 235,000 Minnesotan residents live more than 10 miles away from a grocery store or supermarket, which means that they really rely on their gas stations or their dollar store or stores like that to provide their version of their food. And unfortunately, they don’t seem to have a lot of high produce quality, or a variety of the food that they serve is more processed. We are seeing a change in that, which is great. And I can go to gas stations now and buy more fruits than before. But still, it’s not quite there. So we know that they don’t traditionally have the healthiest food available. In our service area for Second Harvest Heartland, 37% of rural clients have five miles to walk to get to the closest food shelf. So even if we could provide a closer food shelf alternative, there are limitations to what we can do with the food shelves, including for some of the folks that live that far out, they have some mobility issues, so it’s hard for them to get to the food shelf or transportation, or hours of the food shelf. One of the stories I like to share is one of my healthcare colleagues at one of my partner systems that I work with, she always tells this story — it always resonates with me because it really defines what it looks like to live in a food desert. So she lives in a wonderful community, but it’s a small community. And their local store is a gas station, and it does have some produce, just kind of one little bit of the shelf. But you walk into the traditional grocery store versus the convenience stores, there’s a wall of water and juice and soda and maybe a tiny corner that has some fresh produce, right?

Alexandra [00:08:41] So they always do taco Tuesday nights, and she had forgotten to pick up the lettuce. And her husband had gone out to this convenience store to get the lettuce. They didn’t have any. So he had to go to the next town to find it. And he found it there, but it was $4, which is expensive for a head of lettuce, and the first three or four layers they had to discard because it wasn’t super good.

Alexandra [00:09:02] Now they’re very fortunate in the fact that they have transportation and have funding and have time to go buy groceries and go shop around. A lot of people don’t. But technically, even though it’s a wonderful community, she lives in a food desert. So she needs to go far to get groceries. She doesn’t have access to the nutritious food that she needs to serve her family. So that’s just an example of what it’s like to live in a food desert. 

Jenn [00:09:24] That’s a great example. So if you live in a food desert and are impacted by food scarcity or simply just can’t afford diverse, nutrient-rich foods, what are the health implications of a poor diet?

Alexandra [00:09:37] Well, there’s quite a few of them, as you can imagine. And we know that hunger and health are strongly connected. I think most people are starting to become really aware of that. It’s not a new concept, but it’s coming to the forefront nowadays. Food is medicine. Again, not a new concept but you’re hearing that term being used a lot more now in a lot of different settings, which is great. But again, it’s rising, that acknowledgment of how important it is to not only eat, but eat healthy foods that will benefit your health and take care of you. Better nutrition leads to better health outcomes and quality of life. That’s not, again, not rocket science. But it’s worth reminding people of the connection. And poor diet is a major risk factor for numerous chronic diseases. And food-insecure populations, specifically, are 1.7 times more likely to have diabetes, 1.4 times more likely to have heart disease, and two times more likely to have a stroke. So by dealing with food insecurity, you’re also upping your risk of having these chronic diseases that are diet-related, which is really unfortunate. In addition, many people who experience hunger are making tough decisions between food and other necessities, including their medical care or the medicines. It is kind of the broader picture, social determinants of health. They’re always kind of having to make tough decisions as it is. So not only does it impact their physical health and their chronic disease and their nutritional health, but also think about how much stress it is to have to make these decisions every month. Every time you have to say, “Okay, am I going to buy food or take my medicine? Or do I go to my doctor, or do I pay my utilities bill?” In a lot of cases they’re dealing with more than one of them. So two or three at a time and over several months. It’s not like a one-time decision, it’s the wheel of the life that they’re living. So that, of course, impacts their health as well.

Jenn [00:11:18] This reminds me of a conversation I had on an earlier episode in the season where our guest, Craig Kennedy, was talking about how there’s not a one-size-fits all solution to social determinants of health. So even if you’re able to solve one problem, that doesn’t mean that a person isn’t struggling with multiple. So you can help people get the food that they need, but they might also have the transportation issue. So now they can’t get to the food that they need. So it’s a web that we need to address holistically rather than just pick out certain individual elements.

Alexandra [00:11:52] Absolutely. They’re connected. And some folks that have health issues may not have transportation issues, so it can vary. So though it’s great to have a larger approach to certain topics, you need to understand that the way that we work specifically is we work with targeted groups, populations. We’re not going to boil the ocean on this, because to really, truly get the outcomes that we’re looking for, to really have health impacts, you have to kind of identify the population and what their outcomes are that you’re looking to achieve. And that may be different for each one of our partners. It may be different within the institution that we’re working with. So that’s a really great point. It’s a big field out there and we do need to support each other. But there’s also areas where targeted interventions are more effective at times.

Jenn [00:12:35] Absolutely. So how does this affect individuals and the way they potentially interact or receive care within the healthcare system?

Alexandra [00:12:44] So food insecurity individuals in general may have not received traditional healthcare in the sense that they may not be accessing healthcare at all because it’s expensive or they don’t have insurance, or they have another barrier. Or they are accessing healthcare. We often see in the department that work with, their patients are showing up more in the E.R., or inpatient, or using community paramedics as their transportation to the clinic, for instance. So they may be engaging with healthcare, but just not necessarily in the most optimal ways that we would like them to engage with their healthcare provider. So there’s a lot of different complexities that go with the people that we serve and how they interact with healthcare. I find it really interesting in the patient population that you try and serve to see how you can impact them. Is it food insecurity and transportation or just one or the other or things like that.

Jenn [00:13:34] Right, a real personalized approach.

Alexandra [00:13:36] It’s worth digging into the data and working with organizations, seeing what data can you bring to help us identify the real barriers versus us making assumptions about the people that we’re trying to serve. And I think with our program and the program with our partners, whether they’re providers, or health systems, or community-based organizations, they understand the importance of addressing social determinants of health. And they come with their own strengths and values to the table, and also a real sense of partnership, of knowing what they want to address together and knowing that this is something that we should all work together on, finding strong connections and being able to leverage those. And we work very closely with our partners to design the program around food insecurity issues as well as chronic disease management. We have very robust programs, and we help folks; sadly it’s our area of expertise to work with lower-income people, that a lot of Second Harvest Heartland and our partners do, versus a health system that has a wide range of people that they’re serving. So we can kind of bring that lens as well. This is how we can engage with them, and there are common trends that we’re starting to see in this population that we’re trying to serve. So I think, again, being able to work with them on that level. And another thing I think is really important because it really benefits the individual, is that we work very closely with our healthcare partners, and we provide training with them because they are kind of all over the spectrum starting to engage in this work. We’ve been working with food insecurity for a really long time. So it’s kind of our area of expertise as well. So we work on that and help them when they’re thinking do I even start screening? How do I screen? Is it with paper? Is it electronic? How do I approach this conversation with the patient? So we’re really not ready. They’re just not comfortable with it yet. Some partners are absolutely comfortable, and they’re way ahead. So we come with a team, but we also bring the staff in and say, when you send us a referral, or when we engage with your patient, this is what’s going to happen with them. So they understand what happens when they refer a patient to us. So they’re not just giving it to anybody, and that builds the trust with the patient, with the healthcare provider, and the community-based organization because we’re doing it together and leveraging our strengths. And so I think that really helps the patient feel more confident about either accepting your resources or being more open with their partners. And then on the flip side of that, because we’re able to provide information back at the patient level to our healthcare providers, we’re closing that referral loop, as you would say. Anything that they want, what they use, they can take that information back the next time the care  coordinator meets with that patient. They say, hey, I saw that you connected with this app, hey, I saw that you connected to this resource. And so it kind of continues that dialog with them. So it’s not a one-time shot.

Jenn [00:16:09] Throughout this season, we’ve talked to several different people about the scope of SDoH. We touched on this already, a little bit about how there’s not a one-size-fits-all solution to address them. However, there is a lot of amazing work happening to address specific areas, an example being food insecurity. How is Second Harvest Heartland making an impact to address SDoH?

Alexandra [00:16:31] Great question. So Second Harvest Heartland, like I said earlier, has been really involved in the food space for a really long time. So we have some robust programs, really strong programs already in place. For instance, we know that children can’t focus and learn in school if they’re hungry. So we’ve got child hunger programs that we work with very closely. We know that workers have a hard time focusing when they’re at work if they haven’t eaten. And then that can lead to lost productivity as well as jobs. So we’ve tried making sure that we’re making an outreach to the whole population that could benefit. And then, of course, as you know, there’s been a huge increase and rise in obesity and heart disease and chronic diseases that are diet related, which is kind of where the healthcare sector is starting to come in with our partnership, with our FOODRx program. And so we offer a variety of services. And when you engage with the FOODRx program you also have all those resources behind us that Second Harvest Heartland brings to the table. So we may be the face of the healthcare programming, but we leverage everything that Second Harvest Heartland brings. Whether that is connecting to child programs or connecting to senior programs as well, which is a really great benefit all around, encompassing that work.

Jenn [00:17:38] So we’ve now mentioned FOODRx multiple times. Can you tell us a little bit more about the program?

Alexandra [00:17:44] Yeah, absolutely. Like I said, it’s the healthcare space that Second Harvest Heartland has invested in. It started in actuality about four years ago, spurred by research that was happening at Feeding America, a national organization I mentioned, as well as our partnering with Hennepin Healthcare. We’ve been working with them for over a decade as far as identifying folks that are food insecure and sending referrals over to Second Harvest Heartland. So it started with those two things really jumping off the base, knowing how important it is to intersect with health and hunger. So we strongly feel that by building truly meaningful connections between individuals, the healthcare partners, and the communities that we serve around food security solutions we’ve really embraced the concept of food as medicine, but with the goal of not only providing nutritious food, which is important, but also really what the health plans focus on. We want to improve the health outcomes. We want to improve the health of the population that we’re working with. We want to reduce the cost of care and the appropriate utilization of care, as well as really engaging patients in their care, whether it’s with their care coordinator or their health plan, but keeping them using less the E.R. and more really integrating the care that best serves them and supports them in their needs. This has been great. So, I mentioned that we started with two research studies, and I kind of wanted to call out our partners in that because they took the first step with us in this space. So it’s CentraCare Health up in St. Cloud, they were the first ones we did a study with. And the second one that we’re wrapping up right now is Hennepin Healthcare as well. So the core of the programs are kind of the same, just the execution was a little bit different. But really looking at those things, health outcomes. So it will see scores for our diabetic patients. Are we improving cost of care? Are we improving patient engagement with the system? What else are we learning from doing interventions like that? And unfortunately, I can’t go into very deep details because we’ve written our manuscripts and are looking to publish. Maybe I’ll come back.! Stay tuned, everyone, exciting news coming your way!

Alexandra [00:19:38] But really, the outcomes that we’re seeing are, yes, we’re reducing A1C scores. Yes, we’re reducing cost of care. Now, I’m not going to claim that our program is the only one reducing all of the total cost of care. But we are seeing that trend, and we’re also seeing the fact that if we’re not reducing the cost care, we’re below the trend line of folks that are not enrolling in our program. And again, I’m not saying that it’s all because of our program, but we are seeing that across all our programs, which means that we do have some impact in that space. We’ve just shown some return back to the healthcare providers that we work with, which is great news. So then in 2018, great news, we started actually contracting directly with our healthcare and health plans. And this was really important for us for a couple different reasons. We started with very generous philanthropic funding, and that allowed us to set up the program, to set up a patient data warehouse, to become HIPAA compliant, well, following the guidelines and all that critical infrastructure that you need to establish a new program. But unfortunately with philanthropic funding, oftentimes when the grant runs out, you have to pull out, it’s the end of the program. Well, what now? I don’t want to enroll again, or I’m a family member who wants to enroll. We always intend to have more of a business model where we work directly with partners in healthcare and can be a partner at the table where we get paid for the services that we provide because we’re able to provide a lot of different services for our partners with the intent that it would allow us to stay with the community. So really sustainable models and then also scalable models. So we started with some pilots. Great — prove the concept, prove the ROI, prove that it worked. But now we really want to scale it. We can ensure that we are impacting a larger group of patients that could benefit. It kind of goes with the health equity, right? We have great healthcare in the state as far as healthcare goes. But our health equity could use a little more work, I would say. So this allows us to expand and sustain the program in a much more robust fashion. So that was really exciting in 2018 when we started with those contracts. And today we have eight contracts, but we represent over 15 clinics in Minnesota and western Wisconsin. 

Alexandra [00:21:39] So this is really great because we offer a portfolio of services, but we also partner with all the other food banks in the state of Minnesota and western Wisconsin and North Dakota, east North Dakota, to say instead of everybody creating their own healthcare program with the food bank, they all opted to use the FOODRx program. So we work in partnership with them. So we’re able to see patients and help individuals all across the state and in western Wisconsin and North Dakota, because we have those relationships. It also makes it a lot easier for our partners that they only have to contract with one of us versus six of us. And they also know that their patients are going to get the same program no matter where they live in the state of Minnesota. We’re in western Wisconsin, which is really great. And we have a really robust portfolio of services coming through FOODRx, because, again, like I mentioned, our partners are all over the place. Some are just starting out, acknowledging that we want to talk about food insecurity, and some are really ingrained in it. And we’re doing chronic disease management around this program specifically. So I’m going to kind of quickly walk through some of the services that we offer if that’s okay.

Jenn [00:22:39] That’d be great. 

Alexandra [00:22:40] Awesome. So the first one is very similar to the initial work we did with Hennepin Healthcare, where we can help with food insecurity screening, whether it’s being done by a partner or being done by us. We’ll screen for food insecurity. We’ll connect those folks with food resources and/or SNAP application assistance. Not everybody qualifies for SNAP or is even interested in SNAP. So we want to ensure that for those that aren’t, they’re still getting the food resources in the community that they need. So that’s the first intervention, right? That’s the first touchpoint that we can have with them, with a partner. And then once they connect with us that way, they are able to stay with us. They’re in our system. I’m using air quotes here, you know. But they know that they can always call us back. So we help with recertification for SNAP, things like that. So it’s not like we just call once and that’s it. We can build up a solid relationship with them, and we walk through the applications with them. So we don’t just mail them the information, we walk them through, we follow up in a very hands-on, high-touch way. We’re also a multicultural staff, knowing that not everybody is fluent in English. I know how hard it was to fill out my documents when I moved to the United States. And I speak, I would say fairly good English. And I have a master’s degree, and I still have difficulty applying for some of the government things, like for my citizenship. So we’re very conscious of that, especially as some populations are starting to shift and change, right? 

Jenn [00:23:54] Yes, and that can be considered a social determinant as well.

Alexandra [00:23:57] Absolutely. The other thing that we provide is a stabilization box. It’s 12 pounds of shelf-stable food. It comes in a box. It comes with three recipes, because we really want to encourage them to eat that nutritious food. We know we’ve heard from providers that say I’m okay with asking the question, but then what? I sent them a referral, but I want to do something right then and there on the spot, right? So this is something that they can give to a patient right then and there, you know, if the patient is in need and then they can take it home. It’s also used when patients are discharged. When they go home, we don’t know if they have food at home. They can take this box of food with them as well. Or it also helps with medication adherence, because if they need to take their medication with food and they don’t have food, they’re not going to have the efficacy of the medication. So there’s a lot of different uses for that stability box.

Alexandra [00:24:44] And then we have our big program I’ve mentioned a couple times, and it’s a chronic disease management program. The two research studies are based on that program. It’s 30 pounds of shelf-stable food that’s disease specific. We have a diabetes and a heart disease box right now. It’s also culturally specific. So we know that to encourage folks to eat the healthy food that’s available that may not be their normal diet. To encourage that, the food we have is traditional, standard American, Hispanic, and Somali. And the food reflects those cultures, as do the recipes that are in the boxes. And it’s also translated. And so they can get this box once a month, and they can do it for six months, nine months, or twelve months. And then the great thing is that because the program is adaptable to what our healthcare partners want, in some cases, the patients come to the clinic to pick it up. In some cases it’s delivered by community paramedic. In some cases they can go to one of our agency partners to pick it up. So there’s a variety of ways that we can work with the patients, knowing that, as you say, with social determinants of health involved, there can be multiple barriers. So if transportation is a barrier, if they can go to the food shop and pick up other things and produce or other items and get their food box, that’s one way to kind of reduce those barriers. We’re always kind of mindful of what makes it the easiest for the patients, but also working very closely to integrate with the clinic staff and not create a new process, but maybe enhance a process that they already have around this. With different models, like I mentioned, we either integrate directly with the clinic or we’re working with the clinic staff. We integrate with care coordination. In some cases there’s a health provider that is really actively managing that patient. And in that case, we just deliver the box. We’re just responsible for that component. But again, we’re all over the spectrum in the sense of what we can do for our partners, which is really great, because, we want to be sure we’re meeting them where they are, so we can meet the patients, where they’re at.

Jenn [00:26:34] I just love this so much because it is such a high level of personalization, because if you want to get someone to do something — this is something that Icario thinks about all the time — there’s not a one-size-fits-all. I feel like I’ve said this multiple times, but there’s not a one-size-fits-all solution. Not everyone is going to respond to messages in the same way, and having the different recipes available to people — it’s just so smart and makes so much sense, because that’s what personalization is. If you want people to do something specific, you need to meet them where they are with things that you know that they like in order to be adherent.

Alexandra [00:27:09] I think it’s also important to know that we can be involved throughout the process. We also do end-to-end partner management, so we can create patient registries and manage them from outreach to the patient, to recruitment to the program, to enrollment, to offboarding them, to getting them back to the clinic. We can be that comprehensive with our partners, knowing some of them are under-resourced right now as well. It doesn’t always have to fall on the healthcare partner that we work with. And like I mentioned earlier, it’s something that’s unique, again, that we have a data warehouse and we exchange information with our partners at different levels for a couple different reasons. A) We want to be able to make it personalized. So identifying what are the barriers that clinic is encountering. What solutions can we come up with? So the community paramedic was that — knowing that we were seeing a higher drop-out rate. The number one reason was I can’t get to the clinic. So then the community paramedic stepped in and said, okay, for those that have that barrier, why don’t we enroll them with us and we will home deliver with them, which is fantastic. But we didn’t know that. We weren’t sharing our data back and forth around the program. And it also allows us to bring in information specifically for the patients that we served, around their health outcomes. They’re able to see scores, their hospital utilization, things like that. And then for some that can, we can also bring claims data. So we can really provide a holistic picture of what the intervention is, its effect on the patient, and what the impact may be in conjunction with the work that our healthcare partners are doing. And we’re really pushing that data sharing just because it helps us understand where you are at and where your patients are out throughout the whole process of it, not just at the end when you’re making the final measurements.

Jenn [00:28:37] That’s so important.

Alexandra [00:28:38] Exactly. And then also some of our partners are now providing information after the patient has completed the program so we can truly measure if this interaction is helping to sustain changes, sustain behavioral change, especially around the chronic disease management. It’s great when you’re in the program, but it takes time to change your behavior. It’s a stimulus to changes. Are you seeing those outcomes carry over three months after the program’s ended, six months after the program has ended. So now we’re trying to get that level of data back. And that’s really important for us to make sure that these are impactful changes that are long lasting for the patients.

Jenn [00:29:12] Right. And not just being able to meet the patient where they are, but be your partners where they are to understand the barriers that the clinics are facing. I haven’t heard of anyone else taking that extra step and doing that. So to hear you say that you’re doing that is really innovative.

Alexandra [00:29:28] Thank you. Yeah, it’s critical to the success of the program. You know, we want to make sure that you aren’t creating more work for your partners, that you’re working with your partners. And we co-design our programs together with them from the very beginning. What do you already have existing? What can we tap into? What can we bring that you don’t already have? You know, really, really co-creating a program, which is really, really important if you’re going to get the outcomes that you’re looking for.

Jenn [00:29:52] A true partnership. Speaking of scale, could you see this being rolled out on a national level?

Alexandra [00:29:59] I think so. I think it really depends. Right now we’re really focused in this area. Like I said, we just started in 2018. So, it’s just been barely two years, which is great. There’s still a lot of need out in the state of Minnesota where we really like to focus our efforts. That’s our home turf. So in western Wisconsin — Second Harvest Heartland does cover territories in western Wisconsin too — once we’ve kind of done our work here and really proved it out we’re more than happy to scale it to a national level. I already work with a lot of the food banks and kind of provide ‘hey, this is how we work it. This is the situation in the state of Minnesota. Feel free to take away the learnings from me and apply to your state as well.’ Or if the opportunity arises, and it’s a good fit, we think we can do it. I’m proud of our program.

Jenn [00:30:41] Yeah. I would be too. So shifting gears a little bit to member experience. How have you seen the FOODRx program impact individuals? Are there any success stories you can share?

Alexandra [00:30:52] Yeah, absolutely. And it’s really great because we do survey our participants, especially around the chronic disease program throughout their time in there. And then we learn from them what is working, and what isn’t. Are you using the recipes? Are you eating the food? Would you like to see something else in the food that we didn’t think of. And all the recipes are developed by a registered dietitian in the community. So we’re always asking for additional feedback. Just because it was good two years ago doesn’t mean it’s the right thing right now. So we get our feedback that way, which is fantastic. But they’re also able to share comments or stories with us, which is the best part of the job when you get to read those. You sit there, and it’s like, oh yes! This worked for them and this made them happy. Sometimes you get a comment that makes the program better, that is more of a critique, which is also very important. But I want to read just two of the quotes that we had. There’s also some more on our website at 2harvest.org/foodrx if you want some more. But I could spend hours talking about our patients — they’re amazing. The two quotes are: “The program is highly beneficial to help support my household and to teach proper eating habits.” Again, that was really great to hear because it talked about the sustainability of their health post-program, building the skills necessary to do that, which was really nice to hear the patient say versus our assumption. So that was very good for validation. And we got a lot of comments that are in that genre of feedback. So we feel like we’re getting some good validation on the program. The other quote is, “This program is such a blessing because I need the food. But I also know I need to start eating healthy.” And when they’re getting the food as part of their treatment, kind of like a prescription, this kind of reemphasizes the need to eat healthy, but also it’s free for them. It’s all free for the patients. So it encourages them to try the food that’s in the box because it’s not a cost to them. So one of the things we joke about is the whole grain pasta. It’s come a long, long way. But for some people, it still has that stigma that we’re like, oh, I don’t know about that whole grain. But again, it’s part of their box. So why not give it a try? And it turns out that people really like it because it has come a long way, and we’ve tested all the recipes ourselves as well. We had community members test it as well as the staff.

Alexandra [00:33:03] And then another great thing besides the patient stories that I think are, for me, really empowering, really important because it’s the voice of the patient. And then our goal is to then follow up with some focus groups to continue to learn about the process. It’s like I was saying earlier, we are seeing trends in reducing A1C scores for those that are diabetic. Lifestyle changes are made to their diet and related to their activity levels. You know, the feedback we’re getting from them is yep, I am eating more vegetables, I am eating more fruit, I’m eating more in line with what I need to do for my disease management. And then, of course, because we’re Second Harvest Heartland, it’s important for us to see improvement in food security. And we are seeing that. And that’s interesting because we also had a program that we did. It wasn’t a requirement to be food insecure, but they were Medicaid patients. There was just an understanding that because you’re Medicaid, you could benefit from something like that. So we asked the question, but it was not a requirement. And at the end, we asked the same set of questions for both populations, for food secure, food insecure. The food secure said they felt more food secure after the program. So something to keep in mind is that just because somebody says they’re food secure, that doesn’t necessarily mean they’re fully food secure, and it doesn’t necessarily mean that they’re getting the right food for their disease management.

Alexandra [00:34:16] So food security can change at any given time. You know, someone could have a car accident and all of a sudden they have medical bills or things like that. So it was really interesting to be able to offer a program not based on food security, but see you can also have positive impacts, especially coming from a food bank. That’s what we hope to do, end hunger. Oh, and I’m going to add some quick stats for our program. Just because I’m really touched by the fact that in our fiscal year 2019 we served over 4,500 patients across all the services that we provide, and we’re adding new partners constantly. That allows us to reach even more patients. That’s a lot of patients that have benefited from our services. And I can’t thank our partners out there enough for trusting us with their patients and engaging with us in this effort, because it’s super important. And we just hope that number continues to go up. And then we can, as a community, really work to impact the health. But we’re really proud of that number.

Jenn [00:35:15] Yeah. That’s amazing. You should be proud of that number. So overall, what has the impact of the FOODRx program been at the health plan or provider level?

Alexandra [00:35:25] So I’ve talked a little bit about some of the outcomes, the A1C, the reduced cost of care. Things like that. I also want to point out the patient engagement with their provider and the patient engagement with their health plan. We have a higher contact rate for this particular population than most average methods provided by healthcare providers. That was something we didn’t know before, which we know now. So our staff is trained in ways to contact this patient population and to talk with them. So that was really impressive. We were like, oh wow, we didn’t know that about us. Look at that. So they’re trusting us more and more with that patient population, to do the initial outreach for them as well. Also, like I said, the reduction of claims and the lower trend, improved engagement, or here are more patients, they’re now more engaged with their care coordination on a routine basis, which is really important.

Alexandra [00:36:16] We want them to be able to go to their care coordinator or the health coaches. Let’s keep them out of the E.R. Let’s keep them out of inpatient units if we can, so we want to continue to see that trend. They know that their healthcare providers are there for them, and they know Second Harvest Heartland is there for them as well. And that we’re there for them together. It’s really important. And of course, I have to say this because, you know, it’s healthcare. There are a lot of really great results that I cannot talk about because I have nondisclosure agreements with our partners, and it’s a competitive market out there. But like I said, we do tailor our programing based on the measures and outcomes that the healthcare partners are looking to achieve. It’s unfortunate we have to keep some of that information a little bit close to heart, I’m sorry to say. But that’s the way of the world. It’s just how it works, so just know that we also keep information confidential even with our partners. That’s part of our trust building as well.

Jenn [00:37:08] Makes sense. So shifting gears away from all of the amazing work that Second Harvest is doing, I want to talk about you a little bit. What’s the coolest thing that you’ve done lately?

Alexandra [00:37:19] This podcast! I was so excited! I’ve never done a podcast, and I have stage fright with public speaking, so this is a great opportunity. I’m trying to say yes to things that are good for me, that will grow me. And so I really appreciate this opportunity. This has been a super fun thing to be a part of.

Jenn [00:37:37] We’ve loved having you be a part of it and sharing the story of everything that you guys are doing at Second Harvest. It’s amazing work, and we really appreciate it. Thank you so much.

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