Heart smarts at corner stores

Heart Buck ticket
In underserved communities that lack supermarkets, families often depend on corner stores—also known as mom-and-pop shops or bodegas—for food purchases. Unfortunately, most of these stores sell packaged foods and offer few, if any, nutritious options.

In response, The Food Trust developed a range of strategies for increasing the availability and accessibility of healthy food in communities that need it most, from bringing new supermarkets to underserved communities to working with small store owners to increase healthy offerings. Heart Smarts is a new model that builds upon this work, bringing coordinated public health and social services into the store environment.

“This program has influenced me to take better care of myself, and I feel like being able to get my blood pressure done at the corner store that I shop at regularly gives me accountability.” – Heart Smarts participant

Heart Smarts, originally designed for implementation in corner stores and other small food retailers, combines increased access to healthy, affordable food with community engagement, education and incentives to encourage healthy choices. The Food Trust’s educators provide participants with in-store nutrition education lessons, healthy food tastings and healthy food incentive coupons (known as Heart Bucks). In addition, starting in 2015, Lankenau’s health educators began providing free regularly occurring health screenings where shoppers can stop in to check their blood pressure and weight; receive healthy lifestyle counseling; and take home referrals and resources, including information on smoking cessation.

“Customers are always so excited to come monthly to get their blood pressure checked and purchase healthy options with their Heart Bucks coupons.” – Corner store owner, West Philadelphia

Heart Smarts creates community hubs where underserved individuals are empowered to improve their health and reduce their risk of diet-related disease in a supportive store environment. By reaching people where they live and shop, Heart Smarts provides neighborhood residents with the information they need to make healthy decisions and addresses social determinants of health by helping participants access needed community health and social services.

By the numbers - Health screenings (2017): 345 screenings conducted; 42.9%* repeat participants; and 36.4% participants had lost weight on a subsequent visit (*repeat visitor (2015–17) with at least one visit during 2017)
Lankenau currently provides free screening services at two corner stores in West Philadelphia on a monthly basis alongside Food Trust programming. With this community facing high rates of heart disease, diabetes and obesity—health conditions exacerbated by both poverty and the lack of healthy food resources—there is much opportunity for this program’s continued growth and innovation.

Heart smarts and medical student advocates

Healthy Corner Store Initiative worker handing heart bucks to participant
The Medical Student Advocate (MSA) program is an innovative collaboration between Lankenau Medical Center and Philadelphia College of Osteopathic Medicine, created with the intention of improving health outcomes for vulnerable patients. Second-year medical students act as advocates for patients, working to recognize and address non-medical needs and barriers to care. The MSA program has demonstrated that medical students have a place in identifying and addressing social needs, which can benefit both patients and providers. The program is part of Lankenau’s Patient Centered Medical Home, where Lankenau Medical Associates, an internal medicine and subspecialty practice, and City Line Family Practice, a family practice, function as a medical home by using systematic, patient-centered and coordinated care management processes.

Lankenau recently expanded their MSA program to include a community rotation, and is now using MSAs to identify and address social determinants of health alongside its Heart Smarts health screenings. These trained medical students conduct a survey as part of the screening to identify a variety of potential social needs such as those related to food insecurity, childcare, employment, transportation and access to primary care. The students can then follow up with participants with referrals to local resources and social services, helping to address the social determinants of health, and track the number of needs identified and the number of referrals and connections made.

Philly Food Bucks at farmers markets

Lankenau Food Bucks ticket
Many Pennsylvanians struggle to provide their families with fresh fruits and vegetables, even with efforts over the years to increase availability and access. More than 580,000 households in Pennsylvania receive Supplemental Nutrition Assistance Program (SNAP) benefits, which can be used at many types of food retailers.

Since 2010, The Food Trust has administered Philly Food Bucks, a SNAP incentive program that encourages SNAP users to purchase fresh, local foods at participating farmers markets. For every $5 spent using SNAP at participating markets, customers receive a $2 Philly Food Bucks coupon for fresh fruits and vegetables, increasing the purchasing power of lower-income farmers market shoppers by 40 percent.

“[On-site screenings] let me know if I should be going to the doctor sooner instead of later!” – Farmers Market customer

Since the launch of the program, The Food Trust has partnered with Lankenau to reach even more community members by creating a food buck distribution system through Lankenau Medical Associates, a Lankenau-based primary care practice bordering West Philadelphia. In-clinic patients screened for food insecurity receive $10 in Philly Food Bucks, which can be redeemed at any of The Food Trust’s 20 farmers markets and other partner farm stands in Philadelphia to purchase locally grown fruits and vegetables. Patients that use their first packet of “bucks” are then eligible for a free “refill” of another $10 worth of vouchers. These food bucks are purchased by Lankenau from The Food Trust through the innovative use of community benefit dollars. Lankenau was the first hospital to leverage community benefit dollars to purchase Philly Food Bucks.

“It’s great that they come out. The elderly really need their blood pressure checked in this community. Knowing where their health stands really encourages them to shop healthy at the market.” – Alkebu-Lan Marcus, Mill Creek Farm, West Philadelphia

By tracking long-term health outcomes through the electronic medical records at the time of Food Buck distribution and through The Food Trust’s Food Buck redemption tracking, Lankenau Medical Associates staff can support ongoing conversations with their patients about nutrition, food security and healthy food access.

Main Line Health screen team member performing health screening (finger prick) on participant
In addition to the integration of Food Buck distribution with primary care locations in West Philadelphia, Lankenau is also able to reach community members where they shop by providing health screenings and nutrition education at five West Philadelphia farmers markets. While shopping for fruits and vegetables, customers can also receive free nutrition resources, seasonal recipes, on-site health screenings and family-oriented wellness activities. Blood pressure screenings help educators identify at-risk individuals and provide them with health information and connections for follow-up care.

Meeting people where they shop presents a unique opportunity: Instead of speaking with a doctor and then shopping many days later, we can directly link patients to fresh, nutritious food while their health is fresh in their mind.

Accomplishments - Philly Food Bucks distribution and redemption (2017 season): 325 patients received Philly Food Bucks; 1,528 participants reached at market; 667 participants received health screenings and 20 farmers impacted across five markets