“We’re trying to take care of people before they get sick,” says Josh Trautwein, co-founder and CEO of About Fresh, the parent organization of Fresh Truck and the relatively new Fresh Connect food prescription program. Facilitating access to food as medicine has been part of Trautwein’s vision since the first Fresh Truck took to the streets in 2013, in the form of a retrofitted school bus bringing fresh fruits, vegetables and whole grains to Boston neighborhoods where residents had the most difficulty accessing them. Now, building on relationships established over the years, and with $4 million of funding from Boston Medical Center and Mass General Brigham, Fresh Connect is available in the form of a prepaid VISA card. 

Locally, Fresh Connect is accepted at the Daily Table stores in Dorchester, Roxbury and Cambridge, all Stop & Shop stores and 16 farmers markets. And the list of retail partners is growing. People who meet the criteria for food insecurity and complex medical conditions likely to be helped by healthy foods—hypertension and diabetes, for example—are referred to the program by their healthcare providers. 

Michael Lantow joined About Fresh in January 2019 as Fresh Connect program director, “with the aim of figuring out how to develop a scalable, data-rich solution for making it possible for the healthcare sector to cover the cost of food for people and measure impact,” he says. “Fresh Connect is designed to be flexible, according to how our healthcare partners want to invest in food for their community of patients or members.” The cards are programmed to be used in any grocery store, restaurant, farmers market or ecommerce platform.

Says Trautwein, “Michael built something that’s really powerful in the sense that it integrates really easily and delivers a frictionless experience. A special feature of Fresh Connect is how we partner with retailers with low upfront cost and burden.” 

The Fresh Connect web application facilitates enrollment of healthcare providers, insurers and social service agencies. It also captures shopping-level transaction data, baseline health insights and shopper demographic information. “By collecting all that information we are then able to measure the impact of Fresh Connect on our cardholders over time,” Trautwein explains. 

When healthcare providers enroll qualified patients, they collect baseline health indicators through Fresh Connect’s HIPAA-compliant, system-integrated enrollment form. Members are asked food insecurity questions based on federal guidelines every three months throughout their  enrollment to measure whether Fresh Connect is making a positive impact.

Information retained by the Fresh Connect application also can connect shopper-level transaction data, such as individual and aggregate spending on approved foods, to electronic health records, “to measure deeper levels of impact on health and total cost of care,” Trautwein explains. “We are a built-in tool that is deeply integrated into how [healthcare providers] take care of patients.” 

Every time a new patient receives a card, a Fresh Connect team member contacts the person to welcome them into the program, explain how to use the card and give the locations closest to where the person lives. A multilingual cardholder support line lets patients check their card balances, ask questions and see where they can use their cards—an ever-expanding list. 

Fresh Connect’s first retail partner, Daily Table, began accepting the cards in October 2021. Signs in the store windows welcome Fresh Connect cardholders, and others strategically located throughout the store remind them that they can use their cards here. Michael Malmberg, chief operating officer of the three-store nonprofit grocery chain, says he had been talking to About Fresh about the program for about a year and a half before it went live. 

“Our missions are so aligned—to make healthy food affordable—that we were obviously the first place for Fresh Connect to launch,” he says. 

A huge plus, he continues, is that the program is seamless for customers and store employees. The card, which operates exactly like a credit card, is programmed to recognize only approved foods. At Daily Table, that means everything in the store, since it all meets requirements for healthy food. Fresh Connect shares monthly reports on members’ spending at the stores. 

“We hope Fresh Connect will help more and more people find out about Daily Table,” Malmberg says. “The more customers we have, the more we serve our mission.”  

Chuck Wilkins was an early farm stand partner, accepting Fresh Connect at his Gary’s Farmstand Too farmers markets in Roxbury Crossing and Brigham Circle. When About Fresh team members first visited Wilkins to introduce him to Fresh Connect, he says the program appealed to him immediately. “People really need some produce and some food and we can give it to them,” he says. 

At Stop & Shop, a more recent Fresh Connect retail partner, “We’re looking at ways to drive access to healthier foods,” says Jennifer Brogan, director of external communications and community relations. “We thought [Fresh Connect] was an innovative solution to get fresh fruits and vegetables into the hands of people who need it most.” 

Working with the Boston Public Health Commission to identify its store in the neighborhood with the greatest percentage of people facing food insecurity and highest rates of chronic conditions like heart disease and diabetes, Stop & Shop launched a Fresh Connect pilot program at its Grove Hall store in December 2021. In mid-January of this year the program was rolled out to 100 stores in eastern Massachusetts, and in April it was expanded to the business’s remaining 400 stores.

“We are the first major chain retail partner,” Brogan says. “We’re making it really easy for folks to shop for fresh fruits and vegetables that are paid for by their healthcare providers when they’re doing regular shopping at Stop & Shop. We’re really pleasantly surprised with the results and usage out of the gate, especially at Grove Hall.” Unlike at Daily Table, cardholders can only buy items sold in the stores’ produce section. Fresh Connect signage is posted in areas with the heaviest numbers of users. A Stop & Shop landing page dedicated to Fresh Connect members highlights the resources available to them. “Fresh Connect has a great customer care line,” Brogan adds. “We direct customers to their line.” 

Stop & Shop also hired a dietitian, Christine Sinclair, who works at the Grove Hall location and maintains regular communication with Fresh Connect. Because many Fresh Connect cardholders also have other benefits, like SNAP, Sinclair says, “We want to help them maximize their benefits.” She is developing webinars and other programs that can help educate people about which cards to use when. “Some of our nutrition programs—such as webinars, classes—focus on diabetes, heart-healthy eating, healthy eating on a budget, issues Fresh Connect users have,” she says. 

Largely due to its reach and accessibility, the Stop & Shop relationship was a key factor that led some local healthcare systems to partner with Fresh Connect. The program currently has five such partnerships and is developing others that should launch later in 2022. Community Care Cooperative (C3), an accountable care organization that works with healthcare centers across the state, began talking to About Fresh in 2019, but it wasn’t until Stop & Shop began accepting cards that “it made sense,” says Kim Prendergast, senior director of social health. “We wanted members to be able to get to a location easily. Our Fresh Connect partnership is part of a bigger program we run aimed at addressing food insecurity for our members with complex health issues.” 

C3 started the Fresh Connect partnership as a pilot with one healthcare center in late February. It got off to a strong start, with 150 members in Greater Boston in the first month. “The ability to add Fresh Connect cards to what we’re supporting—families, especially families with young children—was very appealing to us because it allows us to incentivize getting fruits and vegetables into those families’ homes,” Prendergast says. 

Community health workers at C3-affiliated community health centers refer members for Fresh Connect Cards. In order to be eligible, a member must have a complex medical condition—for example, children with autism, asthma or overweight; adults with diabetes or hypertension—and food insecurity. “So they are getting not only access to food but access to the right kinds of healthy food that will support their health condition,” Prendergast says. Cards come with $100 and are reloaded every month, up to the full $100 based on what the member spent the previous month. “There’s no downside to spending all of it,” Prendergast notes. 

Fresh Connect is new enough that C3 does not have enormous amounts of usage data yet, but early response from recipients has been overwhelmingly positive. Anecdotally, C3’s healthcare members have said they appreciate the ability to reach more patients. And patients have emailed that the additional funds have reduced their stress levels and that access to healthier food is making them feel better physically. 

“What’s great about the team at About Fresh is that they understand that we really want to think about how we can get healthier food onto the tables of people to prevent disease, to help them manage disease and that people want to have a lot of options for how they shop,” Prendergast enthuses. “They want to be able to shop at grocery stores and they want to be able to use their money at farmers markets.” 

Cambridge Health Alliance (CHA), another accountable care organization, also launched its program in February, with plans to offer Fresh Connect cards for one-year periods. “It is an intervention,” explains Wilfred McCalla, senior director for ACO network development and performance. “Our goal is to serve as many patients as possible who are food insecure.” In addition to food insecurity and certain chronic, behavioral or functional health conditions, CHA members who utilized hospital emergency departments two or more times in the previous year and women with high-risk pregnancy are considered eligible for Fresh Connect. Healthcare workers from 18 groups within the organization, from complex care managers to patient resource coordinators to social workers can refer patients to the program. 

CHA, which serves 40 communities in Cambridge, Somerville and metro-north, began discussions with About Fresh in 2021 and followed the progress as Fresh Connect developed. “When they expanded to Stop & Shop, I thought it was ready for what we needed to do,” McCalla says. “It was important to get into a major food chain,” to make it as easy as possible for patients to get to a market. (CHA offers transportation to stores for those who need it, roughly one-third of users.) Cards come with up to $100 per month per user. “We thought about what people could spend on fresh foods,” McCalla says. Like the C3 program, the cards are replenished monthly based on what the user spent the previous month. 

CHA had planned for 500 users in its first year; 300 enrolled in the first two months. So they are trying to expand the program’s reach. “We’re applying it as broadly as possible,” says McCalla. So far, he adds, “Patients are grateful for the funds to supplement their food budget and focus on healthy foods.” 

From new mothers to elders struggling with mobility constraints to the range of chronic conditions affected by diet, “the profile of folks we hope to support and reach is limitless,” says Trautwein. “Despite the fact that we’ve built a tech program, it is a technology platform that is grounded in all our original values.”

aboutfresh.org

This story appeared in the Summer 2022 issue.