Mountain Comprehensive Health Corporation (MCHC), a federally qualified health center, with eight clinics in the Eastern Kentucky counties of Letcher, Perry, Owsley, Bell, and Harlan and thirteen school-based clinics in the school districts of Letcher County, Jenkins Independent, and Perry County has partnered with the City of Whitesburg/Letcher County Farmer’s Market, Owsley County Farmer’s Market, Community Farm Alliance, and Grow Appalachia to provide increased access to locally grown fruits and vegetables through an innovative nutrition program known as FARMACY.  This program began in 2015, and we have seen growth…

 

How FARMACY Works

 

Eligibility

 

       There are two ways for MCHC patients to be eligible for the FARMACY program.

 

       1.   Pregnant women and Type 1 diabetics

             qualify regardless of income.

        2.  Patients diagnosed with Type 2 diabetes,

             obesity, and/or hypertension qualify IF

             their incomes fall below 100% of the Federal

             Poverty Guidelines as established annually by

             the Department of Health and Human Services

             (HHS).  (SNAP participation required for USDA FINI)

 

 

In order for eligibility to be established, the MCHC clinical provider prescribes a written prescription that states “OK FARMACY”.  The patient takes the script to a certified pharmacy technician that serves as an eligibility assistance counselor.  Once eligibility is determined, the patient receives a voucher (see picture at top of page) that allocates $2 per day for the patient and $1 per day for each additional household member for a week to redeem for locally grown fresh fruits and vegetables.  For example, a household of four would receive $35 per week. Only one member of the household has to have a qualifying diagnoses for the entire household to benefit from the FARMACY program.  The eligibility assistance counselor also takes initial measures such as body mass index (BMI), weight, blood pressure, and blood sugar levels to monitor during the course of the FARMACY program to see what impact the FARMACY program may have on the patient’s health and well-being.

 

Redemption

 

In order for a MCHC patient to redeem the value of the FARMACY voucher, the voucher recipient or designated household member must take the voucher to the market manager or a market assistant at a participating Farmer’s Market, to receive wooden coins with values of $1 and $5.  The patient then takes the wooden coins to each booth to purchase locally grown fresh fruits and vegetables.  At the end of the market day, the local farmers cash in the wooden coins with the market manager to receive payment. In order to receive a voucher for the next week, the patient just comes back into their MCHC Clinic to see the eligibility assistance counselor.  There is no need for the patient to see the MCHC clinical provider again just for the FARMACY program.

 

                                               MCHC also sponsors blender bikes to promote physical activity and healthy eating at the

                                               City of Whitesburg/Letcher County Farmer’s Market and Owsley County Farmer’s

                                               Market. The blender bikes are stationary bikes that make smoothies out of fresh fruits and

                                               vegetables as the riders pedal the bikes.

 

                                                Results

 

                                                The demand for the FARMACY program has been astounding.  As of the end of the

                                                market season, 162 households had received FARMACY vouchers with an 83%

                                                redemption rate, or 132 households that have taken advantage and benefited from the

                                                FARMACY program. Of the 132 households, 50% redeemed 100% of the vouchers, and

                                                95% redeemed 50% or more of the vouchers.

 

 

The data we gathered on the health benefits to the patient during the initial project period are as follows: Of the 132 patients, we were able to obtain the health benefits of this program for 90 of the participants.

The recorded weight loss is a cumulative 105.60 pounds, glucose cumulative is a 267 point

decrease, and the BMI is a 7.94 point decrease.  Improvement was seen in 26% of patients

in terms of blood pressure. 85 participants completed the post-market survey on the

FARMACY program, and of those:

 

         89% reported that they noticed an improvement in their overall health and well-being,

 

         99% of those said that the program assisted their families financially in meeting their

        nutritional needs, and

 

         64% reported that they actually canned healthy food for the winter.

 

In 2016, MCHC sought funding from the USDA NIFA Food Insecurity and Nutrition Incentive program to expand the existing FARMACY program in Letcher County and extend the FARMACY program to Owsley County through collaboration with the Owsley County Farmer’s Market.  The Owsley County Farmer’s Market is coordinated by the Owsley County Public Schools, University of Kentucky Agricultural Extension Office, and Kentucky Farm Bureau.  MCHC was awarded the USDA NIFA FINI grant in the amount of $72,360.  MCHC had also secured additional internal resources and external funding from partners such as Wellcare, Passport, Humana, University of Kentucky, LabCorp, Delta Dental, and BB&T for total funding of $142,500.  This has allowed us to do a version in Pineville as well, since they do not have a farmers’ market. MCHC was able to help 322 MCHC patients and their families to gain access to healthy, locally grown fruits and vegetables to improve quality of life and health outcomes. With family members included, MCHC assisted 784 people in 2016. The recorded weight loss is a cumulative 212 pounds, glucose cumulative is a 2,776 point decrease, and the BMI is a 34.87 point decrease.  Improvement was seen in 50% of patients in terms of blood pressure.  A new measure for 2016, waist circumference decreased 103 inches.  In 2016, MCHC worked with the University of Kentucky Department of Dietetics and Human Nutrition to facilitate validating the data.

 

The 2016 survey results showed the following:

 

         95.6% ate a lot more or a little more fruits and vegetables as a result of FARMACY

 

         76.7% stated they will buy more fruits and vegetables as part of the grocery shopping

 

         94.1% were motivated by the FARMACY program to eat a healthier diet

 

         53.8% decreased the amount of money they typically spend on healthcare

 

         69.9% froze or canned the fruits and vegetables bought through the FARMACY program

 

In 2017, MCHC plans to continue the FARMACY program with the City of Whitesburg/Letcher County Farmer’s Market, Owsley County Farmer’s Market, UK Bell County Extension Office (modified program) and expand the FARMACY program to the newly established Harlan County Farmer’s Market.  MCHC has partnered with BitSource to customize software for better utilization of the data obtained through the FARMACY program.  The FARMACY program software will allow data to be manipulated more easily to better understand the economic and health impact.

 

The FARMACY program has been a “win-win-win” as stated by MCHC Chief Executive Officer, L.M. (Mike) Caudill.  The patients win because they have access to locally grown fresh fruits and vegetables at no cost to them, and the hope is that patients’ health outcomes will improve, and that their culture of eating will shift and improve to healthier choices of preparation and choice. The community and farmers win because of the additional funding stream to the participating Farmer’s Markets and the local farmers which creates even more economic activity in the community.  The FARMACY program added an additional $18,305 to the farmers’ market sales in the 2015 season, and $117,556 in 2016.  MCHC wins because it potentially results in better health for our patients and spotlights the patient-centered mentality of MCHC in the dawn of the era of pay for performance health care.  MCHC plans to sustain and eventually expand the FARMACY program to the other local farmers’ markets in the counties served by MCHC as resources permit.   The payers win because if patients’ health improve, then the cost of providing care should decrease.

 

If you would like additional information about MCHC or the MCHC FARMACY program, please visit us on the web and like us on Facebook at www.facebook.com/mchcky.

 

 

© MCHC 2017 “MCHC is a FTCA covered entity and its employees are covered individuals under 42 USC 233.”

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