Questions that Changed the Landscape for Human Services and - - PowerPoint PPT Presentation

Food Insecurity and Health: Two Questions that Changed the Landscape for Human Services and Evaluation

Shana Alford, BBA, MPP Director of Program Evaluation Feeding America’s Center for Research and Learning

Presentation and Discussion

I. Defining Food Insecurity II. Overview of Feeding America

• III. Current State of Hunger in America
• IV. Social Determinants of Health and A New Way of Business
• V. Screening for Food Insecurity in a Clinical Setting

A Case Example

• VI. Q&A/Audience Discussion

Social Determinants

• f Health

Chronic Disease Health Outcomes Poverty Food Security

The Intersections

Defining Food Insecurity

• Food security means that all people at all times have access to

enough food for an active, healthy life.

• Food Security
• High food security: no food access problems
• Marginal food security: one or two reported indications (anxiety over food

shortage but little or no indication of changes in diets or food intake)

• Food Insecurity
• Low food security: reports of reduced quality, variety or desirability of diet.

Little or no indication of reduced food intake.

• Very low food security: reports of multiple indications of disrupted eating

patters and reduced food intake.

Source: United States Department of Agriculture

How is Food Security Measured in the U.S.?

U.S. Household Food Security Survey Module: 18 item survey to capture the full range of severity of food insecurity among households. It is used annually in the U.S. Census Current Population Survey. Other Surveys:

• U.S. Adult Food Security Survey Module: 10 item survey
• U.S. Six Item Short Form Food Security Survey Module: 6 item survey
• Self-Administered Food Security Survey Module for Youth Ages 12 and

Older

Source: United States Department of Agriculture

Household Food Security has improved but an estimated 40+ million Americans are still food insecure.

US Economic Improvements

• 1. Overall, national poverty rate has declined.
• 2. Overall, median household income has increased.
• 3. More people with health insurance

Source: All Key Information found here https://www.hungernet.org/research/foodinsecpov/Pages/2016Incomepovertyrelease.aspx

36.9 36.4 37.2 39.8 43.5 46.1 46.2 46.4 45.3 46.6 43.1 46.5 46.9 45.6 46.3 50.6 49.9 48.6 47.9 42 33 29

10 20 30 40 50 60 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Number of people (millions) Year

Trends in Health Care Coverage and Poverty Rates

Individuals living in households with incomes below poverty threshold Individuals without health care coverage

US Economic Improvements

46.3 48.2 50.2 51.3 49.7 49.4 50.0 51.0 51.9 53.6 56.5

10 20 30 40 50 60 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Dollars (thousands) Year

Median Household Income 2005-2015

US Economic Improvements

Overview: Feeding America

The Nationwide Network

A More

Food-Secure Nation

How Feeding America Works

NATIONAL OFFICE

• National vision and plan to achieve clear goals
• The leading hunger research organization
• Highly efficient use of resources by measuring

program outcomes and impact

• National reach and grantmaking allow for

strategic market focus and community impact

• Unmatched cause-marketing, branding and

communications capacity

• Unmatched national advocacy capacity
• Ability to scale anti-hunger activities
• Developing approaches to ending hunger

FOOD BANK NETWORK

• Reaches into every county in the U.S.
• Regional and local authority on hunger relief
• Rooted in local communities, immediately

connected to the people we serve and donors

• Deep opportunities for community engagement
• Tailored, responsive programs for agencies,

food-insecure people, volunteers and donors

The Impact of the Feeding America Network

We serve

42 MILLION AMERICANS

annually, including 12 million children and 6 million seniors We provide

4 BILLION MEALS

each year to people in need We have

200 FOOD BANKS

in the Feeding America network We source and distribute

11 MEALS

for each $1 donated We source

1.25 BILLION POUNDS

• f fruits and vegetables

through the network

2 MILLION VOLUNTEERS

help carry out our vision for a hunger-free America

Overview: Hunger in America

Trade-Offs and Negative Im Impact on Health

Hunger’s Impact on Our Nation

A child’s ability to learn and focus in school A person’s social and behavioral response in stressful situations A person’s physical, emotional and social preparedness for the workforce A family’s health, as those who are food insecure are more likely to be hospitalized

• r experience health crises

A child’s cognitive and physical development at ages 0-3, a critical period of rapid growth

HUNGER IMPACTS

Making Tough Choices

The people Feeding America serves report that their household income is inadequate to cover their basic household expenses.

69%

HA VE HAD TO CHOOSE BETWEEN PA YING FOR UTILITIES AND FOOD

57%

HA VE HAD TO CHOOSE BETWEEN PA YING FOR HOUSINGAND FOOD

67%

HA VE HAD TO CHOOSE BETWEEN PA YING FOR TRANSPORTA TION AND FOOD

66%

HA VE HAD TO CHOOSE BETWEEN PA YING FOR MEDICINE AND FOOD

The People We Serve Have High Rates of Nutrition-Related Illnesses

Hunger in America 2014 findings show that high blood pressure and diabetes are common in the households of the people we serve.

58%

OF HOUSEHOLDS HAVE AT LEAST ONE MEMBER WITH HIGH BLOOD PRESSURE

47%

OF HOUSEHOLDS WITH SENIORS HAVE AT LEAST ONE MEMBER WITH DIABETES

77%

OF HOUSEHOLDS WITH SENIORS HAVE AT LEAST ONE MEMBER WITH HIGH BLOOD PRESSURE

33%

OF HOUSEHOLDS HAVE AT LEAST ONE MEMBER WITH DIABETES

Eating Produce and Healthier Foods Improves Health

Clinical trials have shown the positive effects of eating produce

• n cardiovascular disease and high blood pressure:

More than half of the people Feeding America serves identify fresh fruit and vegetables as the most desired foods not received at their food bank.

Lower risk of heart attack and stroke Lower risk of coronary heart disease Reduced blood pressure

Multiple Sources

Community Health Initiatives at Feeding America

• FAITH-DM: Diabetes Trial and Intervention in Food Pantry Settings
• https://hungerandhealth.feedingamerica.org/resource/feeding-americas-

response-to-diabetes-and-food-insecurity/

• Health and Hunger Website: Food Banks, Nutrition and Health Professionals
• https://hungerandhealth.feedingamerica.org/understand-food-insecurity/
• Nudges in Food Pantries (Behavioral Economics)
• https://hungerandhealth.feedingamerica.org/resource/the-power-of-nudges-

making-the-healthy-choice-the-easy-choice-in-food-pantries/

• AmeriCares Partnership (New)
• Americares selected 3 free clinics that will partner with Feeding America

member food banks in a Diabetes Prevention Healthy Food Integration Project.

Social Determinants of Health and New Ways of Business

Progress= Advocacy + Policy+ Research + Funding

Social Determinants of Health

• The World Health Organization (WHO) defines the social

determinants of health as the conditions in which people are born, grow, live, work and age.

• These circumstances are shaped by the distribution of money, power and

resources at global, national and local levels.

• There has been growing interest in thinking more critically about

these determinants when improving health outcomes and lowering healthcare costs.

New Rules for Hospitals by IRS

• New Requirements for 501(c)(3) Hospitals Under the Affordable

Care Act

• The Affordable Care Act (ACA), enacted March 23, 2010, added

new requirements that hospital organizations must satisfy in

• rder to be described in section 501(c)(3), as well as new

reporting and excise taxes.

Source: Center for Medicare and Medicaid Services

New Rules for Hospitals by IRS

• 1. Written financial assistance and emergency medical care policies,
• 2. Limited amounts charged for emergency or other medically

necessary care to individuals eligible for assistance.

• 3. Make reasonable efforts to determine whether an individual is

eligible for assistance under the hospital’s financial assistance policy before debt collection actions.

• 4. Conduct a Community Health Needs Assessment and adopt

an implementation strategy at least once every three years.

Related to Patient Debt and Financial Assistance.

Food Banks and Pantry Agencies

Source: Center for Medicare and Medicaid

Policy and Federal Dollars Make A Difference

• Center for Medicaid and Medicare Services
• Accountable Health Communities Model
• “addresses a critical gap between clinical care and community services in

the current health care delivery system”

• testing if the health-related social needs of Medicare and Medicaid

beneficiaries’ through screening, referral, and community navigation services will impact health care costs and reduce health care utilization.”

• 32 Participants testing new payment and service delivery

models

Source: Center for Medicare and Medicaid Services: Innovations. CMS. GOV

Screen & Intervene

A Public Health, Pati tient-Centered Movement

Two Question Food Insecurity Screener

• 1. “ Within the past 12 months we worried whether our food would

run out before we got money to buy more.”

• 2. “ Within the past 12 months the food we bought just didn’t last and

we didn’t have money to get more.” Hunger Vital Sign Tool

Source: Children’s HealthWatch

Screen & Intervene: Focusing on the Intervention

• Asking the questions is only the starting point
• Food Banks and anti-hunger organizations have the expertise

that health care partners need to address food insecurity:

• Referrals to existing programs
• Considerations for expanding food distribution options at the health

care site

• Connection with long-term benefits

Addressing Food Insecurity: Expanding Food Distribution for Immediate and/or Long Term Access

Hospital or clinic emergency bags Hospital or clinic food pantry Mobile pantry at a hospital or clinic Mobile produce distributions Frozen meals distributed at discharge

Addressing Food Insecurity: Referrals to Existing Agencies & Food Distribution Programs in the Community

Level 1 : Patient Directed

• Phone number or website for a

central hotline, 2-1-1, or food bank referral

• Resource list with specific local

programs and agencies

Level 2: Patient Centered

• “Voucher” referrals to specific

agencies and programs with targeted types of food & health education

• Involve case management

approach for patient follow-up to improve likelihood the patient gets food

HIPAA Considerations for Non-Health Organizations

• Health Insurance Portability and Accountability Act (HIPAA)
• Requires Health Care Providers “Covered Entities” to protect patient data
• Sharing of names, contact information, health information invokes HIPAA

rules

• Release of information
• Business Associate Agreements
• Security considerations for Storage and transmission of information to & from

partners

A Case Example: Clinic-To- Community Integration

Screen, In Interv rvene and th then Eva valuate Kaiser Permanente and Hunger Free Colorado

Source: Health Affairs Blog, July 13, 2015, Stenmark, Soloman, Allen-Davis, Brozena

Video: Screening for FI in Clinical Setting

https://youtu.be/QnWhTNv2nbc

Source: Health Affairs Blog, July 13, 2015, Stenmark, Soloman, Allen-Davis, Brozena

Colorado Hunger Screening

In 2011, Kaiser Permanente of Colorado, an integrated delivery system covering more than 600,000 members, began partnering with Hunger Free Colorado, a statewide hunger advocacy and outreach organization, to implement a comprehensive hunger-screening program.

Source: Health Affairs Blog, July 13, 2015, Stenmark, Soloman, Allen-Davis, Brozena

• The program was first piloted in two pediatric clinics and has

since expanded to 10 departments and over 10 medical

• ffices.
• Since 2012,
• Kaiser Permanente has referred 1,839 members to Hunger Free

Colorado,

• 78 percent of whom received successful outreach from the
• rganization.

Colorado Hunger Screening

Source: Health Affairs Blog, July 13, 2015, Stenmark, Soloman, Allen-Davis, Brozena

Learning Curve

• A critical first step in securing providers’ buy-in to the

program was demonstrating that food insecurity is prevalent and is associated with poorer health outcomes among the populations they serve.

• Many providers were not aware of the extent to which food

insecurity is a real problem among their low- and middle- income patients.

Source: Health Affairs Blog, July 13, 2015, Stenmark, Soloman, Allen-Davis, Brozena

Evaluating Services: What happened?

• Evaluation efforts showed that fewer than 5 percent of Kaiser

Permanente referrals were calling the hotline.

• Response

Program staff developed a referral form in the electronic medical record: patients could sign to authorize Hunger Free Colorado to contact them. The time frame of inquiry about food insecurity was shortened to 3 months (not 12) helping staff identify patients with more current needs.

Source: Health Affairs Blog, July 13, 2015, Stenmark, Soloman, Allen-Davis, Brozena

RESPONSE TO EVALUATION: THE EFFECT

5%

78%

This percentage increase represents the proportion of referred patients receiving resources.

Evaluating Services: New Staff

In early 2014, the referral process changed again:

• Newly hired Kaiser Permanente community specialists whose

role was to connect patients with resources, not just for food insecurity, but for:

• housing,
• dental care,
• loss of health insurance, and
• financial assistance.

Source: Health Affairs Blog, July 13, 2015, Stenmark, Soloman, Allen-Davis, Brozena

Evaluating Services: Recent Status

Since the referral process for food insecurity has been formalized, the number of patients enrolled and referred to services grew substantially.

Source: Health Affairs Blog, July 13, 2015, Stenmark, Soloman, Allen-Davis, Brozena This includes Women, Infants and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) enrollment and Food Pantry Referrals

RESPONSE TO EVALUATION: THE EFFECT

60

1,547

+2,478% increase in number of patient referrals to Hunger Free Colorado increased from 2012 to 2014.

Thank you! Q&A and Discussion

Shana Alford, Feeding America salford@feedingamerica.org