On the Road to Healthy Eating

Adapting Unique Technology to Tackle Food Insecurity

The Background

Food Insecurity

Food insecurity is defined by the U.S. Department of Agriculture as a “household-level economic and social condition of limited or uncertain access to adequate food” and a lack of “access by all people at all times to enough food for an active, healthy lifestyle.” Food insecurity is commonly measured by the U.S. Census Bureau’s Current Population Survey through questions regarding:

• • Anxiety that household budgets are sufficient to buy enough food
  • Inadequacy in quantity or quality of food eaten in the household
  • Instances of reduced food intake for adults and children

Food insecurity can be further divided into two categories¹:

Low food security — households report reduced quality, variety or desirability of diet; however, food intake is not reduced.

Very low food security — households report multiple indications of disrupted eating patterns and reduced food intake.

Food insecurity is an oft-recurring challenge for impacted households — as often as every three months or more for three-fourths of very low food security households and frequent or chronic for about a quarter of all food-insecure households.

• • An estimated 33.8 million Americans lived in food insecure households in 2021.
    • • This includes 12.5% of U.S. households with children.
  • 32.1% of households with incomes below the Federal poverty line were food insecure.²

Outcomes:

Access to nutritious food is considered a social determinant of health (SDOH) — one of the conditions in individuals’ day-to-day environments that affects a range of health, functioning, and quality-of-life outcomes.3 Because food insecurity often goes hand-in-hand with a nutrient-poor diet, both low and very low levels of food insecurity can contribute to a multitude of health issues, including obesity, heart disease, hypertension, diabetes and other chronic disease. It can also add stress and cause difficulties managing diet-related chronic conditions.

The stress that comes with food insecurity is also consequential. Over 90% of households facing very low food security report issues such as:

• • Worrying food would run out before they had money to buy more.
  • Reporting food they bought did not last, and did not have money to buy more.
  • Not being able to afford to eat balanced meals.
  • Cutting the size of or skipping meals.⁴

All told, addressing food insecurity is crucial in any attempt to improve long-term health outcomes for households facing difficulty accessing or affording nutritional food.

Payments Technology: Restricted-Spend

Restricted-spend technology allows for unique re-loadable prepaid cards to be issued, managed and loaded with funds that can only be spent on approved items. Defined, customizable catalogs track eligible items at the universal product code (UPC) level, which allows issuers to ensure that cardholders are only spending appropriated funds on approved items.

Purchases are approved or declined at the point of sale. Once a retailer is integrated within the network, determination of purchase eligibility is automatic — ineligible items will require payment from a separate source, while eligible items can be purchased with any funds available on the card. Approved purchases are completed with a simple swipe of the card.

Delivery of funds via the restricted-spend card allows for the ongoing management and reloading of funds without costly logistics involved in tracking spending, reimbursements, or misappropriation of funds.

How it Works:

The Challenge

Improving Outcomes

With a rural population often spread in small communities across the Appalachian Mountains and sector-specific challenges to economic opportunities, West Virginia has struggled with food security among segments of its population. The state, which has a population of over 1.79 million, reported higher food insecurity than the average U.S. state in 2019-2021. As recently as June 2022, a survey found that West Virginia had the highest rate of food insecurity in the nation, with more than 21% of West Virginians reporting food scarcity in their homes in 2022.⁵ This continued level of food insecurity negatively impacts statewide outcomes and cost of patient care, and most importantly, those individuals and families in need.

Through a grant from the Highmark West Virginia Charitable Fund for Health, the West Virginia Health Network has targeted neighborhood health with a community-minded approach to wellness. This granular approach is not as simple as throwing money at the problem, or even just delivering food; it requires a thoughtful plan for continuous and efficient disbursement of food or funds, establishment of healthier long-term eating habits, and replicable accessibility within neighborhoods. In order to make the most of the grant, the Health Network needed to ensure money was going towards nutritious foods while limiting overhead related to administration and management.

If done correctly, this approach could simultaneously provide food and instill better long-term dietary habits, reducing short-term and long-term health-related issues. However, the program needed an efficient way to both deliver funds and ensure the funds couldn’t be misused while limiting the costly tasks of monitoring spending and/or managing reimbursements.

Delivering Benefits

Similar programs for distributing health benefits exist today, but they’re often limited by administrative costs and/or inefficiencies due to an inability to restrict spending. For example, some current distribution models include cash handouts, which incur greater risks in handling/transferring and no oversight into spending. Other models included distributed gift cards or debit cards; these often come with no restrictions beyond eligible retailers.

Even when programs do employ spending restrictions, they typically encompass all food
items limiting their ability to guide households toward healthier dietary habits by enabling the purchase of unhealthy snacks and sugary treats. Solutions such as reimbursements and vouchers come with a significant time cost and can require additional personnel to manage approvals or recurring physical distribution.

Since these programs have finite resources, any inefficiencies can lead to fewer resources for those in need — or even challenge the long-term success of the program.

The Solution

Adapting the Tech

The West Virginia Health Network tapped InComm Payments, a leading global payments technology company, to develop a custom solution for delivering funds to local families most at-risk of food insecurity. InComm Payments’ technology allows for the delivery of physical restricted-spend cards that can be both a) managed digitally, including the loading and reloading funds, and b) restricted so that funds can only be spent on approved items or catalogs of items. Utilizing this technology, a card can be delivered to an eligible individual and then reloaded on a recurring or as-needed basis. Spending of funds on said card could then be automatically restricted based on a pre-configured catalog, limiting the potential for waste and misuse.

These cards can also be custom-branded to health plans or charitable organizations — in this case, they’ll bear the branding of the Health Neighborhood Program.

Partners With a Purpose

The pilot program in West Virginia, in partnership with the West Virginia Health Network and major dollar discount retailer, will provide these restricted-spend cards to individuals with a qualifying need through two health system clinics that function within the West Virginia Health Network. The program will initially launch in specific zip codes, with applicants screened for food insecurity to determine eligibility for the program.

Through the program, a total of 350 cards will be provided to the health centers, who will in turn distribute the cards to qualified individuals. These cards will be capable of monthly top-up, meaning the Fund can load the cards with up to $175 each month. Ultimately, the amount will be determined by need and total members for each family. Load amounts can be made in $75, $100, $125, $150, and $175 denominations. In addition to the cards and subsequent funds, participants will also receive individual support through the program, including assistance procuring a primary care physician and support for chronic health conditions, if applicable.

The cards will be accepted solely at participating locations, and the funds can only be redeemed on items in the retailer’s healthy foods section, which has been curated by a registered dietician. This means the program not only excludes extraneous purchases such as alcohol and tobacco, it further limits eligible products to those screened for excess added sugars, sodium, and saturated and trans fats, supporting proper nutrition while still giving individuals a wide range of options.

Since the retailer is already a part of InComm Payments’ national retail network, minimal IT efforts will be needed to support the launch of the program. With numerous retail locations already established in the pilot communities, no new infrastructure is required. And though it is currently operating exclusively with one national retail chain, any retailer within InComm Payments network can be similarly included should the program seek to expand.

By converting funds to physical cards that are connected to digital accounts, the West Virginia Health Network has reduced the cost of administrative oversight compared to other options, such as review and physical management of receipts for reimbursements or the monthly mailing of new physical materials for fund management, as well as potential loss and misuse of funds from delivery of unrestricted funds.

¹ Source: U.S.D.A. Economic Research Service. “Definitions of Food Security.” Available: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/

² Source: U.S. Department of Agriculture Economic Research Service. “Key Statistics and Graphics.” Available: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics

³ Source: Healthy People 2030. “Social Determinants of Health.” Available: https://health.gov/healthypeople/priority-areas/social-determinants-health

⁴ Source: U.S.D.A. Economic Research Service. “Definitions of Food Security.” Available: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/

⁵ Source: The Center Square. “Report: WV had the highest food insecurity in nation through first half of June.” Available: https://www.thecentersquare.com/west_virginia/report-wv-had-highest-food-insecurity-in-nation-through-first-half-of-june/article_78b49780-fe19-11ec-a370-1f2b94c9f900.html