Innovate and partner for health equity

In March 2018, Tufts Health Plan joined forces with the Greater Boston Food Bank, Good Measures LLC, the Institute for Community Health and Cambridge Health Alliance. The result of this first-of-its-kind partnership was a free monthly mobile food market at Cambridge Health Alliance’s location in Revere, Mass. This is not the first mobile market in the region, but its comprehensive approach is unique.

Like all good ideas, it sprang from a need. “As the largest MassHealth Medicaid provider in the state, we focus on serving under-resourced communities,” said Duke Dufresne, medical director at Tufts Health Plan. “The concept of food as medicine is an important one, especially for underserved populations.”

But while the need was there and the idea had taken hold, not all good ideas get off the ground. This one did, thanks to Tufts Health Plan’s commitment to health equity and our innovative partnership.

“In keeping with our mission, we see access to healthy food as promoting wellness,” said Carl Paratore, Tufts Health Plan’s chief audit executive and Greater Boston Food Bank board of advisors member. “Where we can be an innovator to help drive positive change, we will.”

Support to sustain the program

At that first mobile food market, Paratore met a woman who said she always skips past the items on the perimeter of grocery stores, because they tend to be the most expensive and she knew her budget wouldn’t stretch that far.

It was a stark example of the need for fresh food in the community. It also validated the need for innovative partnerships to promote health equity. The mobile market gave the woman access to all the produce she could carry home – fresh from the Greater Boston Food Bank and at no cost.

“Fresh food needs to be distributed within days,” said Paratore, “so this is one way we can get it off a truck, out to the community and into people’s refrigerators within hours.”

That summer, the Revere mobile food market caught the attention of Massachusetts Attorney General Maura Healey, whose new Social Determinants Partnership Program was looking to award 13 $250,000 grants for innovation in health equity through cross-sector partnerships. In November 2018, the mobile food market received one of the grants.

This support provides resources needed to sustain the mobile market and a host of related services. In addition to providing free food, the market organizes health fairs which also give participants information on social services and help them with enrollment.

Tools to measure outcomes

Nutrition is another important element of the mobile food market – and often a complicated one.

“Food is medicine is a great concept but you can’t just introduce new foods. You have to also understand the needs of a diverse population,” said Dufresne.

That’s where Good Measures* comes in. With eight to 10 different produce offerings at each market, there’s plenty of variety. Good Measures registered dietitians help people understand how to prepare delicious and healthy dishes that reflect the diverse culinary traditions of the area. They also offer a free app that’s loaded with recipes and virtual access to registered dietitian nutritionists.

Good Measures takes it one step further with a proven way to measure the efficacy of a user’s diet; it’s called the Good Measures Index. Caroline Carney, Good Measures registered dietitian and vice president of business development, explains that the “Index looks for gaps in what people are eating and makes suggestions on how to fill those gaps so people can get the nutrients they need.”

“So if food is medicine,” said Dufresne, “how do we measure wellness? We measure it through improvement in chronic disease states, blood pressure, weight and how someone is controlling their diabetes, for example.”

To study the effects of a mobile food market on health outcomes and health care costs, the partnership is also charged with evaluating the impact of improving access to healthy produce on health and well-being.

“We want to measure health outcomes as well as the impact of the program,” Dufresne said.

Poised for growth

Judging from attendance, the program’s impact is undeniable. Starting with 50-80 households two years ago, the market now serves an average of 300 households and distributes 7,500 pounds of fresh produce to the community each month.

Many of Tufts Health Plan’s members are patients at the Revere Cambridge Health Alliance site, and they’ve become market regulars. “But we don’t limit distribution to members or patients,” said Dufresne. “We’re trying to serve the community at large.”

So what’s next for the mobile food market? “We’ve proved the concept and the next step is to see whether there’s an opportunity to scale it,” said Paratore.

Paratore also sees a learning opportunity for all of us. He believes the face of hunger needs to be redefined. “You never know who is struggling to access healthy food. It happens everywhere and requires everyone’s attention,” he said.

“Our goal, as our CEO says, is to do the right thing,” added Dufresne. “Yes, there are business aspects, but it’s what’s right – for our members and for the community overall. If you’re looking for that, you have license to be innovative.”

* Tufts Health Plan has a minority ownership interest in Good Measures.