Food Farmacy Grow, Gather, Prepare. Author: Deborah Dobson, Gretchen Gore and Faith Kinsinger

Transcription

1 Food Farmacy Grow, Gather, Prepare Author: Deborah Dobson, Gretchen Gore and Faith Kinsinger Date: 6/4/2018

2 Concept We intend to address food insecurity by providing healthy meals to the food insecure. The St. Mary s cohort will do this by providing the food insecure with a bag of healthy foods post discharge and follow up with a phone call to address SNAP benefits and other social needs. The St. Vincent s cohort will focus on education classes and food access offered with community partnerships. The Lutheran cohort will run a food farmacy program for food insecure diabetics that will focus on diet education, increasing access to community resources with the aid of a social worker, and providing a week s worth of healthy groceries every week for our participants over a 3 month span. Venture Definition: What we are working on: We are working on closing the gap on nutrition as a social determinant to health. The problems we are having: The problem we are having is the ability of at-risk patients to obtain the foods they need to support their health. Those eligible for SNAP benefits are not enrolled. (40% in Jefferson county! The highest in the state) Those with SNAP benefits not purchasing foods that would offer the most benefit. People being discharged home without access to the proper nutrition needed to aid their healing bodies. The impact to the SCL Health community if we don t find a solution to these problems: Food insecurity and healthcare costs will continue to rise. Patients will continue to have poor health outcomes and be medicine dependent.

3 Clear, Compelling Goal: Please frame in the form of a SMART Goal (Specific, Measurable, Achievable, Realistic, Timely). The goal of the program is to protect the health and well-being of patients and community members by providing access to healthy food while teaching ways to prepare nutritious meals on a limited income. Metrics: Provide the metrics you will use to determine whether your venture is successful. The metrics should support your clear, compelling goal. Indicator Cohort Site St Vincent St Mary Lutheran # of Meals Per Patient X X X Impact on Readmission Rates X X X # of Patients Served X X x HGBA1C X X Class Attendance X `x X SNAP Enrollments X X X Alignment with Strategic Priorities: Please provide an overview of which strategic priority this aligns to and how it will contribute. This project aligns with our strategic priority to improve clinical integration and be person focused. Our intent is to deliver safe, reliable, high-quality care that extends to closing gaps caused by social determinants of health. We desire to deliver a grow, gather, prepare Food Farmacy program that provides holistic care to the patients we serve through increased food access, diet education and support.

4 Scope: Items to consider when defining the scope of your venture include (but are not limited to) operational and technical resources, workflows, education/training, communications, technical build In Scope: Hgb A1C >9 Qualify as food insecure Willing to participate Discharging patients Utilizing community resources and partnerships Partnering with local farmers Out of Scope: New hires Building a new epic platform Anticipated Venture Start Date: July 1st Anticipated Venture End Date: 30th

5 Innovation Playbook (Please work with the System Innovation Team to work through this portion of the document) Type: It is the goal of the program to reinvent how we respond to the whole needs of the patient through a focus on nutritional wellbeing both in prevention as well as a broadened response to care planning. Shift: The primary focus of this venture is platform based Ambition: I would say this is radical. When people think of hospitals and health systems they think of prescriptions for medication, therapies, surgeries... How simple and effective to start prescribing food! Point Of View We met a group of women at a Senior Center who told us about a friend, Patricia, who had recently passed away from complications of diabetes. We learned that food access was definitely a problem for Patricia. We were surprised to find out a few other interesting facts as well. Patricia had health insurance but choose to only go to her chiropractor, as her friends believe she was getting some emotional need met there. We learned that her family support system was lacking and she would not let others in her home. We wondered if anxiety and depression played a role in food insecurity and if we needed to embrace a more holistic approach to our food farmacy program. We decided it would be game changing to create a food farmacy program that nurtured the physical, mental and emotional health of the patient. Alignment Assessment This aligns with our mission to support the poor and vulnerable by addressing the social determinants of health and finding a way to close the nutrition gap on the food insecure.

6 Venture Tribe Venture Sponsor: Innovation Partner: <From System Innovation Team> Venture Team Name Debbie Dobson Dr. Rudolph Beverly Paul Role St. Vincent lead Physician partner Diabetic educator Community outreach Gretchen Gore Cindy Jeanie Faith Kinsinger Melissa Goodwin Amy Danielle Kristen Dr. Shepirdigian Mary St. Mary s lead Logistics Food insecurity identifier Lutheran Lead Innovation support/logistics Social worker Registered dietician Nutrition Physician partner Diabetic Educator Risks Please outline the risks that this venture may incur. These could be related to compliance, technology, resources, adoption, etc. Food supply Non-compliance Transportation Device glitches or breaking Attendance Dependence on volunteers Short term fix Adequate space to store food

7 Technical Requirements Please provide an overview of what new pieces of technology or changes to existing technology would be needed to support this venture. HgbA1C reports run Epic turn on the 2 Food insecurity questions (ideal, but not mandatory) Social Media: Use existing channels to broadcast the cooking segments. Potentially expand to display segments in the clinics or lobby areas through the MarComm Popcorn or similar technology.

8 Innovation Challenge: Venture Milestones and Timing Venture Name Grow Gather Prepare Food Farmacy Date 6/4/2018 Venture Lead Deborah, Gretchen, Sabrina, Faith Location, St. Vincent, St. Mary and Lutheran Venture Timing: Lutheran: July Region Start Date July 1, 2018 Care Site/Department Lutheran Target Completion Date 30, 2018 Venture Milestones, Accountability & Schedule: Please identify milestones for 3 phases of work Phase 1: Setup and Prepare for Venture Launch Things to consider: Contract negotiations (if needed) Defining scope of work Identify stakeholders and decision makers Assess current state and gaps to address Develop goals and metrics Communication strategy Training strategy Define testing approach List the Key Milestones and Activities Responsible Lead Due Date If applicable, include IRB milestones, including target date for IRB approval Kristen 7/2/2018 Sysco/Sodexo contract updates Faith 7/12/18 Food partnerships with community partners Danielle 7/12/18 RD/intern roles create recipes, run shopping excursions, cooking class Mary 7/12/18 Diabetic educator main contact, run diabetes edu classes, follow up with participants Dwayne 8/17/18 Facilities: prep room and kitchen space, refrigeration Maricella, James 9/1/18 Lab: run initial and post HgbA1C labs Jeffco Dept. health and human services: SNAP signups Amy 7/12/18 Obtain food insecurity screen Faith 7/12/18 Stock shelves (hospital food drive) Cathie 8/24/18 MH and depression screen Amy 7/12/18 1

9 Innovation Challenge: Venture Milestones and Timing Dr. Sheperdigian 7/12/18 Physician role Phase 2: Launch and Testing Things to consider: Testing your solution Training those affected by the change Cutover from old to new processes or tools Measuring effectiveness of your change Go live support List the Key Milestones and Activities Responsible Lead Due Date Faith Sept Dec Eval weekly with team Mary Sept Dec Weekly diabetic class and shopping one day a week Run a cooking class RD Once a month Sept Dec Send home a healthy prepared meal Lab draws Weekly phone calls to patients RD Faith/Dr. Shep Mary Once a month Sept Dec Once in September and once in Sept Dec Amy Once in Anxiety and Depression Scale September and once in Enroll patients in SNAP Amy Ongoing thru pilot 2

10 Innovation Challenge: Venture Milestones and Timing Phase 3: Report Out Assemble performance metric data Summarize findings Define pivot and/or expansion plan List the Key Milestones and Activities Responsible Lead Due Date Faith/Dr. Shep 15 Summarize lab results Calculate the new SNAP enrollments Compare Health Knowledge evaluations Compare POQ3 depression and anxiety screen Amy 15 Mary 15 Amy 15 3

11 Innovation Challenge: Venture Milestones and Timing Venture Name Grow Gather Prepare Food Farmacy Date 6/4/2018 Venture Lead Deborah, Gretchen, Sabrina, Faith Location, St. Vincent, St. Mary and Lutheran Venture Timing: Lutheran: July Region Start Date July 1, 2018 Care Site/Department Lutheran, St. Mary s noted as SMGJ Target Completion Date 30, 2018 Venture Milestones, Accountability & Schedule: Please identify milestones for 3 phases of work Phase 1: Setup and Prepare for Venture Launch Things to consider: Contract negotiations (if needed) Defining scope of work Identify stakeholders and decision makers Assess current state and gaps to address Develop goals and metrics Communication strategy Training strategy Define testing approach List the Key Milestones and Activities Responsible Lead Due Date If applicable, include IRB milestones, including target date for IRB approval Kristen 7/2/2018 Sysco/Sodexo contract updates Faith 7/12/18 Food partnerships with community partners Gretchen (SMGJ) Danielle 7/12/18 RD/intern roles create recipes, run shopping excursions, cooking class Mary 7/12/18 Diabetic educator main contact, run diabetes edu classes, follow up with participants Dwayne 8/17/18 Facilities: prep room and kitchen space, refrigeration Gretchen/Nathan (SMGJ) Maricella, James 9/1/18 Lab: run initial and post HgbA1C labs Jeffco Dept. health and human services: SNAP signups Amy 7/12/18 Mesa County Public Health Department: SNAP signups Gretchen/Cindy (SMGJ) Obtain food insecurity screen Faith 7/12/18 Gretchen/Jeanie (SMGJ) Stock shelves (hospital food drive) Cathie 8/24/18 MH and depression screen Amy 7/12/18 1

12 Innovation Challenge: Venture Milestones and Timing Dr. Sheperdigian 7/12/18 Physician role Phase 2: Launch and Testing Things to consider: Testing your solution Training those affected by the change Cutover from old to new processes or tools Measuring effectiveness of your change Go live support List the Key Milestones and Activities Responsible Lead Due Date Faith Sept Dec Eval weekly with team Gretchen (SMGJ) Mary Sept Dec Weekly diabetic class and shopping one day a week Run a cooking class RD Once a month Sept Dec Send home a healthy prepared meal Lab draws Weekly phone calls to patients RD Faith/Dr. Shep Mary Once a month Sept Dec Once in September and once in Sept Dec Amy Once in Anxiety and Depression Scale September and once in Enroll patients in SNAP Amy Gretchen/Cindy (SMGJ) Ongoing thru pilot Volunteers interviewing patients at discharge for food insecurity Gretchen/Jeanie (SMGJ) Sept Dec Volunteers gathering food bag and dispensing topatients that score positive Gretchen/Jeanie (SMGJ) Sept Dec 2

13 Innovation Challenge: Venture Milestones and Timing Phase 3: Report Out Assemble performance metric data Summarize findings Define pivot and/or expansion plan List the Key Milestones and Activities Responsible Lead Due Date Summarize lab results Faith/Dr. Shep 15 Calculate the new SNAP enrollments Compare Health Knowledge evaluations Compare POQ3 depression and anxiety screen Total number of grocery bags dispensed Amy 15 Gretchen/Cindy (SMGJ) Mary 15 Amy 15 Gretchen (SMGJ) 15 3

14 Innovation Challenge: Venture Milestones and Timing Venture Name Grow Gather Prepare Food Farmacy Date 6/4/2018 Venture Lead Deborah, Gretchen, Sabrina, Faith Location, St. Vincent, St. Mary and Lutheran Venture Timing: St. Vincent: July Region Start Date July 1, 2018 Care Site/Department St. Vincent Target Completion Date 30, 2018 Venture Milestones, Accountability & Schedule: Please identify milestones for 3 phases of work Phase 1: Setup and Prepare for Venture Launch Things to consider: Contract negotiations (if needed) Defining scope of work Identify stakeholders and decision makers Assess current state and gaps to address Develop goals and metrics Communication strategy Training strategy Define testing approach List the Key Milestones and Activities If applicable, include IRB milestones, including target date for IRB approval Responsible Lead Due Date Sodexo contract updates Kristin 7/2/2018 Food partnerships with community partners Debbie 7/12/18 Secure Diabetic educator Beverly 7/12/18 Secure facilities space for food and classes (Riverstone, Family Svc) Debbie 8/17/18 Lab: run initial and post HgbA1C labs Maricella, James 9/1/18 Obtain food insecurity screen Debbie 7/12/18 1

15 Innovation Challenge: Venture Milestones and Timing Stock shelves (hospital food drive) Paul 8/24/18 MH and depression screen Amy 7/12/18 Physician role Dr. Rudolph 7/12/18 Phase 2: Launch and Testing Things to consider: Testing your solution Training those affected by the change Cutover from old to new processes or tools Measuring effectiveness of your change Go live support List the Key Milestones and Activities Responsible Lead Due Date Eval weekly with team Weekly diabetic class and shopping one day a week Run a cooking class Send home a healthy prepared meal Lab draws Weekly phone calls to patients Anxiety and Depression Scale Faith Mary RD RD Faith/Dr. Shep Mary Amy Sept Dec Sept Dec Once a month Sept Dec Once a month Sept Dec Once in September and once in Sept Dec Once in September and once in Enroll patients in SNAP Amy Ongoing thru pilot 2

16 Phase 3: Report Out Assemble performance metric data Summarize findings Define pivot and/or expansion plan Innovation Challenge: Venture Milestones and Timing List the Key Milestones and Activities Responsible Lead Due Date Summarize lab results Faith/Dr. Shep 15 Calculate the new SNAP enrollments Compare Health Knowledge evaluations Compare POQ3 depression and anxiety screen Amy Mary Amy

17 Innovation Venture Metrics Venture Name Venture Grow Gather Prepapre Food Farmacy Date 6/4/2018 Location St. Mary s Medical Center Venture Timing Region Western Colorado Start Date July 1, 2018 Care Site/Department St. Mary s Medical Center Completion Date 30, 2018 Performance Metric Description Identify outcome and process measure results that address the health of the individual, the care provided and/or the reduction in cost of care. Identify the target, the quarter the target will be achieved and any baseline measurement currently available Metric Food Insecurity Survey Process (P) or Outcome (O) Measure Triple Aim Metrics Improve health (H) Improve care (C) Reduce costs (RC) Baseline Performance and Measurement Period P H, C, RC September Target Performance Identify need Frequency Measured Once per admisstion Goal Date for Achieving Target 31 st Number of Grocery bags provided O H, C, RC September 1 bag per patient Once per admission 31 st Snap enrollments P H September Once per admission 31 st 1

18 Innovation Venture Metrics Venture Name Venture Grow Gather Prepapre Food Farmacy Date 6/4/2018 Location Lutheran Venture Timing Region Start Date July 1, 2018 Care Site/Department Lutheran Completion Date 30, 2018 Performance Metric Description Identify outcome and process measure results that address the health of the individual, the care provided and/or the reduction in cost of care. Identify the target, the quarter the target will be achieved and any baseline measurement currently available Metric Example: 30 Day Readmission rate Example: 90 Day Readmission rate Process (P) or Outcome (O) Measure Triple Aim Metrics Improve health (H) Improve care (C) Reduce costs (RC) Baseline Performance and Measurement Period Hgb A1C O H, RC September And Target Performance A drop of 2 points in HgB A1C 2x Frequency Measured Goal Date for Achieving Target 15th Snap enrollments P H Throughout pilot once 15th Health knowledge survey Number of participants (direct and indirect) Number of meals provided O H September and Increase in health knowledge O H, RC Throughout pilot 6 direct participants plus their family members 2x once 15th 15th P H, C Throughout pilot 5 7meals/week weekly 15th POQ3 anxiety and depression scale O H, C September and Decrease in anxiety and depression 2x 15th 1

19 Innovation Venture Metrics Venture Name Growth Gather Prepare Food Pharmacy Date 6/4/2018 Venture Location St Vincent Venture Timing Region Start Date July 1, 2018 Care Site/Department St Vincent/Physician Clinics Completion Date 30, 2018 Performance Metric Description Identify outcome and process measure results that address the health of the individual, the care provided and/or the reduction in cost of care. Identify the target, the quarter the target will be achieved and any baseline measurement currently available Metric Process (P) or Outcome (O) Measure Triple Aim Metrics Improve health (H) Improve care (C) Reduce costs (RC) Baseline Performance and Measurement Period Target Performance Frequency Measured Goal Date for Achieving Target Hgb A1C (>9) O H, RC September And Adropof2 points in HgB A1C 2x 15th Attendance in education sessions P H Throughout pilot Min 3 classes attended pp Monthly 15th Health knowledge survey O H September and Increase in health knowledge 2x 15th Number of participants (direct and indirect) O H, RC Throughout pilot 6direct participants plus their family members once 15th Number of meals provided P H, C Throughout pilot 5 7meals/week weekly 15th POQ3 anxiety and depression scale O H, C September and Decrease in anxiety and depression 2x 15th 1

20 Innovation Venture: Pilot Risks Venture Name Grow, Gather, Prepare Date 6/4/18 Location St. Mary s Medical Center Venture Timing Region Western Colorado Start Date July 1, 2018 Care Site/Departmen t St. Mary s Medical Center Target Completion Date 30, 2018 Risks Describe Risk Need is greater than what we can provide Providing one bag of groceries is not a long term solution Space for Food Pantry at Hospital Volunteer capacity What Would Be the Potential Impact on the Project & SCL Health if the risk became an issue? Program would not be sustainable Readmission rates would not change Would not be able to launch pilot Higher cost to program in having to use associates Probability of Happening (Low, Med, High) Medium Medium Low Low Mitigation Strategies Collaborate with other community food partners to meet need. Connect patients with other resources (Food Banks, Cooking Matters Classes, Food For Life Classes, SNAP/WIC) Creative solutions to space issue Reaching out to RSVP, Meals on Wheels, Senior Companion Volunteers to help during launch. 1

21 Innovation Venture: Pilot Risks Venture Name Grow, Gather, Prepare Date 6/4/18 Location Lutheran Venture Timing Region Start Date July 1, 2018 Care Site/Departmen t Lutheran Target Completion Date 30, 2018 Risks Describe Risk Not having enough food supply Non compliant participants Education classes not conducive to patients schedule Transportation Selling food for other purchases What Would Be the Potential Impact on the Project & SCL Health if the risk became an issue? Failed venture, dissatisfied patients Low Probability of Happening (Low, Med, High) Mitigation Strategies Coordinating with Sysco during the pilot phase, as well as doing an adopt a shelf drive thru Wellness, and gardens at West Pines Lower N. Medium Interview pt. s prior to enrolling in the program to determine feasibility Lower N Medium Interview pt. s prior to enrolling in the program to determine feasibility Lower N. Disruption of class and shopping if pt. s show up late Medium Utilize hospital lyft contract Inaccurate results. low Education alongside free food. 1

22 Venture Name Grow, Gather, Prepare Innovation Venture: Pilot Risks Date 6/4/18 Location St. Vincent Venture Timing Region Start Date July 1, 2018 Care Site/Departmen t St. Vincent Target Completion Date 30, 2018 Risks Describe Risk What Would Be the Potential Impact on the Project & SCL Health if the risk became an issue? Probability of Happening (Low, Med, High) Mitigation Strategies Not having enough food supply Failed venture, dissatisfied patients Low Coordinating with Sysco during the pilot phase, as well as doing an adopt ashelf drive thru Wellness Non compliant participants Education classes not conducive to patients schedule Lower N. Medium Interview pt. s prior to enrolling in the program to determine feasibility Lower N Medium Interview pt. s prior to enrolling in the program to determine feasibility Transportation Lower N. Disruption of class and shopping if pt. s show up late Medium Utilize hospital lyft contract Selling food for other purchases Inaccurate results. low Education alongside free food. Glitch with continuous monitoring device Inaccurate results Low Insure back up device available. Lab draw 1

23 Lost continuous monitoring device Innovation Venture: Pilot Risks $700 per device low Device covered by insurance 2

24 BUDGET TEMPLATE FOR INNOVATION CHALLENGE Food Farmacy Debbie Dobson St. Vincent 6/4/2018 Detailed Funding Sources and Budget Identify a detailed budget indicating how funds will be spent each quarter for the grant period. Total funding requested by innovation venture Phase 1 Secure Materials Phase 2 Live Pilot Phase 3 Wrap Up and Report September October November January February Total INNOVATION CHALLENGE Operating Expenses Wages and Benefits $3,200 $3,200 $3,200 $3,200 $3,200 $1,600 $1,600 $19,200 Office Supplies $100 $250 $250 $250 $250 $250 $100 $1,450 Office Expenses $0 Medical Supplies $600 $600 $600 $600 $600 $600 $3,600 Training, Training Materials $100 $250 $250 $250 $250 $250 $1,350 Contract Labor $0 Food $2,000 $2,400 $4,800 $4,800 $4,800 $18,800 Operating Expense Subtotal $44,400 $1,200 Capital Expenses Equipment $4,800 $4,800 Hardware $0 Labor (ex: IT) $0 Software $0 Capital Expense Subtotal $0 $4,800 Total Funding $49,200 Manager wage $40/hr.25 FTE RD wage $40/hr.25FTE Food; $50/bag with room to expand cohort based on results Office Supplies: paper survey ($100 month) and grocery bags $150 month) Equipment: CMD for cohort ($800 per device) 1

25 BUDGET TEMPLATE FOR INNOVATION CHALLENGE Food Farmacy Gretchen Gore St. Mary's Medical Center 6/4/2018 Detailed Funding Sources and Budget Identify a detailed budget indicating how funds will be spent each quarter for the grant period. Total funding requested by innovation venture Phase 1 Secure Materials Phase 2 Live Pilot Phase 3 Wrap Up and Report Oct Nov Dec Jan Feb March Total INNOVATION CHALLENGE Operating Expenses Wages and Benefits $1,600 $1,600 $1,600 $1,600 $1,600 $1,600 $1,600 $11,200 Office Supplies $100 $250 $250 $250 $250 $250 $100 $1,450 Office Expenses $0 Medical Supplies $0 Training, Training Materials $0 Contract Labor $0 Food $7,000 $7,000 $7,000 $7,000 $7,000 $35,000 Operating Expense Subtotal $47,650 Capital Expenses Equipment $2,000 $2,000

26 BUDGET TEMPLATE FOR INNOVATION CHALLENGE Food Farmacy Faith Kinsinger at Lutheran Medical Center 6/4/2018 Detailed Funding Sources and Budget Identify a detailed budget indicating how funds will be spent each quarter for the grant period. Total funding requested by innovation venture Phase 1 Secure Materials Phase 2 Live Pilot Phase 3 Wrap Up and Report Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Total INNOVATION CHALLENGE Operating Expenses Wages and Benefits $1,760 $960 $1,120 $1,440 $1,440 $1,440 $800 $8,960 Office Supplies $1,000 $400 $100 $100 $100 $100 $200 $2,000 Office Expenses $0 $0 $0 $0 $0 $0 $0 $0 Medical Supplies $0 $0 $0 $2,500 $0 $0 $2,500 $5,000 Training, Training Materials $0 $0 $0 $125 $125 $125 $125 $500 Contract Labor $0 $0 $5,000 $0 $0 $0 $0 $5,000 Food $0 $0 $0 $3,600 $3,600 $3,600 $3,600 $14,400 Operating Expense Subtotal $2,760 $1,360 $6,220 $7,765 $5,265 $0 $0 $35,860 Capital Expenses Equipment $10,000 $0 $0 $0 $0 $0 $0 $10,000

27 Innovation Challenge Semi Finalists Submission Please fill out this submission form and return to Peter Kung by end of day on April 7th, Submissions received after the deadline will not be considered and will not move forward in the challenge. Innovation Venture Lead(s): Faith Kinsinger, Deborah Dobson, Gretchen Gore, Sabrina Suazo Team Member Names: Cindy Ortiz SMGJ Location (SMGJ, LMC, SVH): Phone Number: Innovation Venture Title: Food Pharmacy: Grow, Gather, Prepare Program Innovation Intent: This is a concise articulation of your venture s goal. Consider these two questions as you frame your intent: 1. How is this innovation different? Assess what others have already focused on and use this to identify types of innovation to focus on those things that are distinctive and create a shift in the patient journey. 2. How ambitious is this venture? How much will you be able to move the needle on your goal? The grow-gather-prepare program helps close the gap on nutrition as a social determinant to health. The goal of the program is to protect the health and well-being of patients and community members by providing access to healthy food while teaching ways to prepare nutritious meals on a limited income. Food is a major player of health and wellness. Healthcare has always placed a high value on diet-from food pyramids in public health to specific diet plans at hospital discharge. This innovation attempts to meld these two; public health in an acute care setting. The patients and community members who are touched by the Grow-Gather- Prepare Program have the capability to make life long changes to their health. Not only will their lives be changed, but evidence shows those with increased food access improve the lives of those in their home and community. This innovation can not only move the needle, but with a long game view, the impact will have exponential growth. Innovation Shift: What is the primary focus of the change you want to create with your venture? Choose from one of the following three options and provide a short narrative of how your venture fits that option: Business Model: configuring assets, capabilities, and other elements of the value chain to serve our customers and generate revenue differently

28 Platform: Focus on reinventing, recombining, or finding fresh connections across capabilities and offerings to create new value for customers. Customer Experience: Connects, serves, and engages customers in distinctive ways, influencing their interactions with SCL health and our offerings. The primary focus of this venture is platform based. It is the goal of the program to reinvent how we respond to the whole needs of the patient through a focus on nutritional wellbeing both in prevention as well as a broadened response to care planning. Background: Identify if and how a similar solution has been tested or implemented before in either another healthcare organization or another industry. If so, identify when, where and the results that were achieved. Salem Health in Oregon implemented The Food Farmacy in According to Sharon Heuer, Director of Community Health Improvement it works like this: When a Dietitian recognizes that a patient is nutritionally compromised and has few resources to purchase food, they can now refer them to the Food Farmacy for help. Like many food banks, the Food Farmacy is run by hospital Volunteers and the project is funded by the Salem Health Foundation. The generous donations of hospital employees and community members ensure that their shelves are well stocked for their patients in need. When patients are referred to the Food Farmacy, a Volunteer visits with them before they go home. The volunteer helps the patient select groceries and delivers the selections to their room before hospital discharge. RN Discharge callers touch base with patients a few days after they go home to make sure that they have on going access to healthy food. The nurses often help patients connect with food pantries in their area and meals on wheels programs. The Food Farmacy ensures that patients in need have healthy food when they go home. Arkansas Children s Hospital (ACH) began screening for food insecurity in the summer of 2015, and has reported that about 20% of families describe problems with food or access to food. In response, ACH has partnered with the USDA and a local food pantry to serve free meals to children identified as being in urgent need during hospital and clinic visits throughout the year. The hospital also fights food insecurity through their Cooking Matters program, which provides tours of grocery stores to help teach how to purchase healthy foods on a budget, and coordinates a course on preparing nutritious meals. Assistance in applying for federal nutrition programs is also available to patients and their families. They serve anywhere from 1,250 to 1,500 meals per week on average. The San Francisco General Hospital Therapeutic Food Pantry is a clinically based prescription food program implemented to increase access to healthy food, promote healthy eating, provide unique nutrition education, and address food insecurity. It began in light of research done directly at the hospital, suggesting a clear relationship between food insecurity and disease. Physicians are able to write a prescription for healthy food items to patients who are food insecure, and they can pick the food up that same day at the pantry. It is staffed by a dietitian that helps patients decide what foods to eat or avoid for certain conditions, and it also offers classes for

29 healthy cooking techniques and strategies for shopping on a budget. Patients will also receive referrals to local food resources. To test the impact of the pantry, they will be tracking health changes in pregnant women with diabetes and obese children using a quarterly survey and data from their medical records. In January of 2017 it had completed its pilot phase and planned to expand on an ongoing basis to 5 clinic sites throughout the city. Community gardens have been implemented at other hospital sites and shown to provide educational opportunities and provide local fresh produce for hospital meals. Homestead hospital in Florida created a community garden in 2014 and has already hosted over 750 students for educational purposes with plans to expand its student reach this year. health news/grow2heal homestead hospitals communitygarden/ The food pharmacy is an idea that has been implemented in Pennsylvania at Geisinger Health Systems in The pilot proved to be successful in diabetic patients, with an average HbgA1C drop of 2 points. The Geisinger food pharmacy project now serves over 250 patients and their families. Geisinger interview NPR article Cooking Matters, a program that teaches how to shop and prepare nutritionally balanced meals on low income budgets found that families were cooking more often and more confident that they would be able to afford enough food. Over a six month period, families were eating more vegetables, including non fried options and green salad. Before the program, families sometimes worried that food might run out each month; six months post attending a cooking matters course, they rarely worried about this. Benefits: Identify potential patient experience, health, or financial benefits associated with the solution. Include the benefits to the patients, care givers and providers within and outside our four walls. How can those benefits be measured? Are you already measuring those benefits? What do we want to propose from here? Are there any other ways to measure the benefits we should capture? Initial participants can be selected from our CPC+ patient community with opportunity to expand the program to community partners. Not only will this program provide 360 degrees of Caring, it will be a natural opportunity to leverage and strengthen the SCL Health brand through earned media. Additional value will come from increased compliance and clinical outcomes associated with eating a healthier diet. Participants will complete pre and post program surveys and testing (lab panels) to measure the program's effectiveness. Comparison of the costs to treat an acute health issue, like low blood sugar, with medical attention ($19,345) versus addressing it with long-term nutrition ($657). (Hilary Seligman) Hospital-level examples demonstrate the success of healthy food programs to decrease the need for medical care. Geisinger Health System in Central Pennsylvania recently opened the Fresh Food Pharmacy which

30 offers food insecure, diabetic patients a prescription for free foods that will help them manage their diabetes. The fresh food is accompanied by education on nutrition and meal preparation, along with one-on-one meetings with health providers like registered dietitians. The annual cost per patient is $1,000 and preliminary data shows that participants in the Fresh Food Pharmacy improve their hemoglobin A1C (indicating improved management of diabetes) by an average of three points or the equivalent of a $24,000 reduction in medical expenses. Measuring the benefits of these programs can simply be done by documenting the number of people involved in these programs. (Grow) The gardens benefits can be measured by the number of community members owning a plot and by the weight of food grown and donated to the hospital or local food banks. (Gather)The food pharmacy benefits can be measured by the amount of people given food bags upon discharge. Follow up calls to these patients could also provide valuable information as to how the program has impacted their health. We will also measure the number of patients with chronic disease and food insecurity who are a part of the food pharmacy program that entails free shopping with a registered dietician. (Prepare)The food pharmacy preparation will be measured by the number of people we do one-onone food prep with and the number of community members who are educated on food prep using SNAP dollars. The initial goal will be to conduct cooking preparation classes by 12/31/2018 Technology: Describe the technology that will be needed to implement the solution. Identify if the technology already exists or needs to be created. If the technology already exists describe what will be tested that is unique to this solution. Explain how the new technology will enable providers or patients to create or enhance services. Ideal Epic: Turn on the option to identify Social Determinants of Health to more easily identify patients who should be triggered into the program. Epic: Create reporting capabilities to measure expected outcomes Social Media: Use existing channels to broadcast the cooking segments. Potentially expand to display segments in the clinics or lobby areas through the MarComm Popcorn or similar technology. Funding/Resources: 1. Describe the time required to secure resources and launch the venture. 2. Describe the investment needed for this solution (people, roles, technology). 3. Lastly, guessimate and circle budget needed (the innovation project funding will not exceed a 6 month period pilot). A) $10,000 $25,000

31 B) $25,000 $50,000 C) $50,000 $75,000 D) $75,000 $100,000 E) $100,000 $150,000 Lead time to secure resources and launch the venture Grow: 8 weeks Gather: 8 weeks Prepare: 4-6 weeks Resources needed a. Grow-containers, raised beds, soil, seeds, plants, water access, gravel, gardening tools, hoses. People that would need to be involved include: community garden lead, nutrition services, dieticians, and community partners. b. Gather-food pantry space, healthy food to stock the shelves, reusable grocery bags, screening tool to identify eligible discharging patients for food prescription. Involvement for the gather piece of this project includes epic technology to assist in identification of those at risk for food insecurity and volunteers to prepare food bags for the identified patients. c. Prepare-kitchen access, kitchen tools, technology to stream cooking class, guest chefs. People needed to support this project include epic technology, guest chefs, registered dieticians and nutrition services.