In 2012, Nemours, an integrated pediatric health system, implemented a dynamic approach to managing pediatric asthma in children throughout Delaware’s major cities and on behalf of the 42,000 children in surrounding zip codes. The model of care addresses broader system issues by using an integrator function—convening multisector partners in support of a shared goal, led by community health worker leadership, a patient-centered medical home, and optimal technology to treat pediatric asthma in the state. Key partners include: state-based chapters of the American Lung Association; state/local housing and public health departments and stakeholders; the U.S. Department of Housing and Urban Development; leadership councils; as well as other coalitions and community-based partners. Between 2012 and 2013, early findings from the Nemours’ self-monitoring plan indicate that emergency department visits to the Nemours Alfred I. DuPont Hospital for Children for asthma registry patients decreased by more than 40 percent. Nemours is funded by a Center for Medicare & Medicaid Innovation’s Health Care Innovation Award. To read more about this innovative program, see this brief summary [link].
State Category: Delaware
Nemours Children’s Health System
Nemours is an integrated pediatric health system committed to improving the health of children. Established in Delaware in 2004, Nemours Health & Prevention Services were first created to help children grow up healthy by integrating treatment and prevention of illness. They work with community partners to influence policies and practices to improve children’s health. Through family-centered care in children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania, and Florida, as well as world-changing research, education, population health, and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter the doors. The work is financed by Nemours operating budget and with limited external grants. To read more about this innovative program, see this brief two-page summary [link].
Campaign to Make Delaware’s Children the Healthiest in the Nation
Since 2006, Nemours, an integrated pediatric health system, has worked to address childhood (ages 2–17) overweight and obesity in Delaware with multisector partners including: the Governor’s Office; Cabinet secretaries and other government officials; pediatric providers; child care centers; schools; principals and superintendents; and other community-based organizations. Activities include systems-level and practice interventions, such as working with state-level partners to promote healthy eating and physical activity through child care licensing, as well as creating a learning collaborative to facilitate policy and practice change. Preliminary results show a flattening of the overweight and obesity curve for Delaware children between 2006 and 2008. This successful initiative is funded by a number of sources including: Nemours Health and Preventive Services; the Robert Wood Johnson Foundation; U.S. Department of Education; U.S. Department of Agriculture; Centers for Disease Control and Prevention; General Mills Foundation; and American Heart Association. To read more about this innovative program, see this brief summary [link].
Improving the Health of Communities by Increasing Access to Affordable, Locally Grown Foods
BY MICHEL NISCHAN, CEO and Founder, Wholesome Wave
When my son was diagnosed with type 1 diabetes, I became painfully aware of the direct connection between food and health. As a chef, this realization caused me to transform the way I fed my family and customers. Fresh, nutrient-dense, locally grown foods became the foundation for the type of diet that would give my son and restaurant guests the best long-term health.
Quickly, though, I recognized that not every family can afford to purchase healthy foods. As a result, I founded Wholesome Wave in 2007.
Wholesome Wave is a 501(c)(3) nonprofit dedicated to making healthy, locally and regionally grown food affordable to everyone, regardless of income. We work collaboratively with underserved communities, nonprofits, farmers, farmers’ markets, healthcare providers, and government entities to form networks that improve health, increase fruit and vegetable consumption and generate revenue for small and mid-sized farms.
Double Value Coupon Program
In 2008, we launched the Double Value Coupon Program (DVCP), a network of more than 50 nutrition incentive programs operated at 305 farmers markets in 24 states and DC. The program provides customers with a monetary incentive when they spend their federal nutrition benefits at participating farmers markets. The incentive matches the amount spent and can be used to purchase healthy, fresh, locally grown fruits and vegetables.
Farmers and farmers’ markets benefit from this approach, and have been key allies as we work towards federal and local policy change. In 2013, federal nutrition benefits and DVCP incentives accounted for $2.45 million in sales at farmers’ markets.
Communities also see an increase in economic activity. The $2.45 million spent at local farmers’ markets creates a significant ripple effect. In addition to the dollars spent at markets, almost one-third of DVCP consumers said they planned to spend an average of nearly $30 at nearby businesses on market day, resulting in more than $1 million spent at local businesses. We also see that the demographics of market participants are more diverse – our approach breaks down social barriers and allows consumers who receive federal benefits to be seen as critical participants in local economies.
Equally as important, people are eating healthier. Our 2011 Diet and Behavior Shopping Study indicated 90 percent of DVCP consumers increased or greatly increased their consumption of fresh fruit and vegetables – a behavior change that continues well after market season ends.
Today, the program reaches more than 35,800 participants and their families and impacts more than 3,500 farmers. Combined with the new Food Insecurity Nutrition Incentives Program in the latest Farm Bill, this approach is now being scaled up with $100 million allocated for nutrition incentives over five years.
Fruit and Vegetable Prescription Program
We developed the Fruit and Vegetable Prescription Program (FVRx) to measure health outcomes linked to fruit and vegetable consumption. The four to six month program is designed to provide assistance to overweight and obese children who are affected by diet-related diseases such as type 2 diabetes. In 2013, the program impacted 1,288 children and adults in 5 states and DC. Nearly two-thirds of the participants are enrolled in SNAP and roughly a quarter receive WIC benefits.
The model works within the normal doctor-patient relationship. During the visit, the doctor writes a prescription for produce that the patient’s family can redeem at participating farmers’ markets. The prescription includes at least one serving of produce per day for each patient and each family member – i.e., a family of four would receive $28 per week to spend on produce. In addition to the prescription, there are follow-up monthly meetings with the practitioner and a nutritionist to provide guidance and support for healthy eating, and to measure fruit and vegetable consumption. Other medical follow-ups are performed, including tracking body mass index (BMI).
FVRx improves the health of participants. Forty-two percent of child participants saw a decrease in their BMI and 55 percent of participants increased their fruit and vegetable consumption by an average of two cups. In addition, families reported a significant increase in household food security.
Each dollar invested in the program provides healthier foods for participants, boosts income for small and mid-sized farms and supports the overall health of the community. As with the DVCP, there are benefits for producers and communities. In 2012 alone, FVRx brought in $120,000 in additional revenue for the 26 participating markets.
In less than seven years, Wholesome Wave has extended its reach to 25 states and DC and is working with more than 60 community-based organizations, community healthcare centers in six states, two hospital systems, and many others. Our work proves that increasing access to affordable healthy food is a powerful social equalizer, health improver, economic driver and community builder.
Wholesome Wave is working to change the world we eat in. As the number of on-the-ground partners increases, we get closer to a more equitable food system for everyone. This means healthier citizens and communities, and a more vibrant economy nationwide.