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““2014 Community Benefit Report and Report on 2014-2016 Implementation Strategies,” Charleston Area Medical Center, accessed August 6, 2016, www.camc.org/documents/Community/2014/2014CAMCCommunityBenefitReportandReporton2014-2016ImplementationStrategies.pdf.)) Overview Charleston Area Medical Ce…”
Key strategies employed
- Connect procurement activities to identified community health needs
- Focus on growing the local agricultural sector
- Partner with existing distributors and contractors
- Engage non-traditional partners
- Charleston Area Medical Center
- Employees: 7,000
- Total spend: $634 million
Mission of Program
“Build the Base of Local Growers Providing Fresh Herbs, Fruits and Vegetables to Charleston Area Medical Center.”((“2014 Community Benefit Report and Report on 2014-2016 Implementation Strategies,” Charleston Area Medical Center, accessed August 6, 2016, www.camc.org/documents/Community/2014/2014CAMCCommunityBenefitReportandReporton2014-2016ImplementationStrategies.pdf.))
Charleston Area Medical Center (CAMC) is a nonprofit, regional referral and academic medical center based in Charleston, West Virginia, with a service area that includes nearly a third of West Virginia’s 1.8 million residents.((“Our Hospitals,” Charleston Area Medical Center, accessed August 6, 2016, camc.org/hospitals; Brenda Grant, “CAMC Value Chain Wealth Creation,” document provided to authors by Brenda Grant, January 2016. )) Participating as part of the Local Foods Value Chain project, CAMC encourages regional wealth creation by supporting the local agricultural economy while providing hospital patients and employees with healthier food. Originally funded by the Ford Foundation and the Greater Kanawha Valley Foundation, CAMC continued to prioritize this project even after the initial funding period was over. This was motivated by CAMC’s Community Health Needs Assessment, which identified unemployment and poverty and related illnesses connected to poor diets, such as coronary disease, as major community health needs.
The Local Foods Value Chain project was originally conceived as part of the Ford Foundation’s WealthWorks Value Chain program. The Value Chain framework focuses on leveraging demand for goods to catalyze inclusive and sustainable supply chains that build wealth at all levels. The approach “offer[s] a practical way to build your stocks of local capital, increase local ownership and control of that capital, and improve livelihoods and upward mobility for people, places and firms within a region.”((“Construct a WealthWorks Value Chain,” WealthWorks, accessed August 6, 2016, www.wealthworks.org/basics/construct-wealthworks-value-chain.))
In 2012, The Ford Foundation contacted the Charleston, West Virginia-based Greater Kanawha Valley Foundation about participating in the project, expressing particular interest in working with a hospital or health system. When approached with this opportunity by The Greater Kanawha Valley Foundation, Brenda Grant, the chief strategy officer at CAMC, immediately saw it as a “natural fit.”
CAMC has a history of innovatively advancing community engagement and the community health needs assessment process. In 1995, the Kanawha Community Coalition for Community Health Improvement was founded. The coalition, which includes other area hospitals and providers, the state and local health departments, the United Way, the local Chamber of Commerce, the local school system, and other community organizations, guides the Community Health Needs Assessment process. According to Grant, this assessment had been conducted for several years prior to the Affordable Care Act was passed, which led to federal assessment requirements.
“We identify the top three issues through a community forum and then address those issues through community workgroups,” she explained. Grant believes that key to the Coalition’s success is the composition of the Steering Committee and the independent role of the executive director. The executive director position is supported two-thirds by CAMC, and one-third by its smaller competitor, Thomas Health System. “We knew that if the position was seen as a CAMC position…it wouldn’t be effective.” Because of the work of this coalition, CAMC recognized the link between the strength of the local economy and community health and well-being, further solidifying interest in the value chain project.
The first part of the project focused on knowledge acquisition. As Grant reflected: “We spent the first year of the project learning about value chains. It was a different thought process for us.” The value chain process focused on identifying “win-win” opportunities for the hospital and community, a process which, according to Grant, diverged markedly from their traditional approach to community benefits: hosting health fairs, organizing support groups, and distributing funds to support community programs. Instead, the Ford Foundation provided support for a facilitator who helped convene stakeholders and identify possible value chains. After nearly a year of background research about the value chain approach, CAMC decided to prioritize working with local growers to increase the goods the hospital purchased locally.
The overall goal of the program is to help build the capacity of local growers to meet the produce needs of CAMC. This involves working with CAMC’s supply chain partners—its wholesale produce vendor and food service company—to shift practices that enable participation from local farmers. This also includes growing the capacity of local food producers in the region. In essence, CAMC serves as the convening force: bringing together supply chain actors to identify the barriers for local farmers and gaps in the chain, and then work with partners to fill those gaps.
A critical element to program set-up and staffing is the leadership and participation of The Greater Kanawha Valley Foundation. Grant explained, “In healthcare, we’re busy. I have lots on my plate. The Greater Kanawha Valley Foundation provided needed support such as scheduling meetings, and providing the meeting location space. A lot of those things that are time consuming but critical to success.”
The Greater Kanawha Valley Foundation also played the role of convener, making sure the right stakeholders were at the table. “They hired a facilitator for our first year to help us clearly define the project and after the first year provided a value chain coordinator, Megan Simpson, who is a program officer at the foundation. It was that kind of support…that really helped found this.” On CAMC’s end, Brenda Grant, along with Steve Perry, associate administrator of the supply chain, and Mike Marinaro, health system director of food services, all participate in and support this effort.
Key strategies employed
Connect procurement activities to identified community health needs
One of the tenets of the value chain approach is that projects are driven by demand and established to address a real need for the participating institutions. CAMC did not just choose a product they already purchased, but rather one that would help them meet their mission to promote health and well-being. Specifically, CAMC chose to focus on fresh herbs as a means to make meals more flavorful without adding sodium and fat.
Heart disease is the leading cause of death in West Virginia, making cardiac care especially important. Brenda Grant explained that one of the first steps for cardiac patients at the hospital is a low-sodium, low-fat diet, but emphasized that this shift came with challenges: “Our patient satisfaction scores related to the food reflected dissatisfaction at having sodium and fat removed from meals.” The idea of purchasing local herbs and local vegetables to increase the quality and add flavor to food helped CAMC see the value chain initiative as a win-win, addressing patient concerns about food quality while supporting the local economy.
In addition to clinical health needs, the local food value chain is directly tied to CAMC’s larger Community Health Needs Assessment process. The initiative is framed as a means to promote regional health and well-being. Fostering local access to, and knowledge of, healthy food is an essential health intervention; and, growing the base of producers providing healthy food can help achieve this. But more importantly, the Community Health Needs Assessment process recognized unemployment and generational poverty as critical issues.
“Eighteen percent of people and 25 percent of children live in poverty with little improvement over of the past ten years,” reads the Community Benefit Implementation plan. Historically, coal mines were one of the area’s major employers. Over the last fifty years many of the mines have closed, leading to high levels of unemployment. Grant explained this influence: “[Community members] tend not to want to leave their county, their community, and don’t have a lot of opportunities [to train for new jobs]…As a state, we’re struggling with how we shore up the entire economic viability of southern West Virginia.”
Thus, an explicit goal of the local food value chain project is to address this employment gap and actually grow the local foods sector in West Virginia. The Community Benefit Implementation Plan itself states “the wealth creation approach intends to improve the livelihoods of poor people by creating wealth that is owned, controlled, and reinvested in places.”((“2014 Community Benefit Report and Report on 2014-2016 Implementation Strategies,” Charleston Area Medical Center, p. 27, accessed August 6, 2016, www.camc.org/documents/Community/2014/2014CAMCCommunityBenefitReportandReporton2014-2016ImplementationStrategies.pdf.)) This plan also outlines the specific goals of CAMC, which are to: address obstacles and barriers, implement a locally grown food value chain, and increase the number of jobs for people in the community. The connection to the Community Health Needs Assessment process and the implementation plan ensures that CAMC is measuring impact. The metrics CAMC tracks include: the number of growers providing food to CAMC, the amount of produce purchased by CAMC, and the cost to CAMC.
Focus on growing the local agricultural sector
The Greater Kanawha Valley Foundation writes that, “This project seeks to demonstrate that an agrarian culture can impact the economic transition of our region while providing access to and knowledge of healthy food to a population uniquely in need of such access and knowledge.”(()) This broader vision of regional transformation, tied to community health goals, expands the reach and impact of the project. While the project will help CAMC meet their immediate goal of sourcing more fresh herbs and vegetables, over the long run they will also help to grow the local economy as a whole. This broader approach focused on the agricultural economy allows CAMC to address systemic barriers that local vendors face.
One of the major barriers for local vendors, which CAMC learned about through their initial research process, is not having food safety certification. In order to comply with food safety regulations, vendors must have Good Agricultural Practices (GAP) certification, which is issued by the United States Department of Agriculture. With CAMC providing guaranteed markets to vendors, the investment in certification is worthwhile. However, the certification process can be cumbersome and costly for new vendors. Thus, a key part of the program is helping local growers develop Food Safety Plans and earn certification. Along with offering a Food Safety Plan workshop, CAMC and its value chain partners worked with the West Virginia Department of Agriculture to improve the certification process and with The Greater Kanawha Valley Foundation to implement a small grants program to cover certification costs.
Partner with existing distributors and contractors
CAMC recognized that a critical piece of implementing a supply chain strategy would involve their existing food distributors and contractors. CAMC had an existing contract with Morrison’s, a food contracting service, but Morrison’s was open to working with local vendors. Perhaps most important, CAMC’s local produce distributor, Corey Brothers, was also on board. “These folks were around the table from the beginning as we looked at the hand-offs—what will be required for this to happen, what kind of liability insurance is needed, all these kinds of things. We built from the ground up, and continued to get buy-in as we worked through this,” noted Grant. The partnership ensures that CAMC has the distribution infrastructure, and also necessary food safety expertise around GAP certification.
Working with their larger distributor also helps CAMC guarantee markets to local growers. The hospital recognizes that the current food demand far exceeds existing local supply. In essence, CAMC has committed to purchasing whatever is produced locally. They can promise a stable price, and then delegate to Corey Brothers the distribution logistics. In addition, Corey Brothers’ larger distribution network provides local vendors with access to other markets for surplus produce. This also creates added security for the hospital, should local growers have any trouble meeting demand. Grant explained that in the first year of the program, two large growers lost their crops due to flooding. Corey Brothers averted the potential hospital food supply shortfall with produce from outside the state.
- In 2015, 23% of the food budget was spent with local producers
Engage non-traditional partners
CAMC recognized early on that connecting with local growers would require partnerships within the agricultural community, especially since food safety and GAP certification were critical to success. These partnerships included: the West Virginia Commissioner of Agriculture, the West Virginia Extension office, the Department of Agriculture staff overseeing certification processes, as well as the growers themselves. “When we invited those folks to the table, I honestly did not think anybody would come…[but] we had twenty-five to thirty people at that meeting,” Grant remembers. “There was a lot of interest and when I asked them, ‘Why did you come?’ they shared that they appreciated the fact that a large institution was willing to invest the time, energy and effort in this project.”
These partnerships proved critical to the success of the program. During early partnership meetings, local farmers shared that the classes required for GAP certification were not held often enough, or were offered at inconvenient times. CAMC then worked with the Department of Agriculture to increase the number of classes provided. Another bottleneck identified was the inspection process. One person was in charge of certifying farms in the state, and the fees to growers were sometimes a barrier. As CAMC and the planning team became more knowledgeable about the process, improvements were made, both to the process as a whole and to the methods for communicating with growers. For example, to decrease the transportation costs associated with the certification process, the Department of Agriculture would bring the person in charge of certification to Charleston, so the growers would only have to pay for the travel from Charleston. “We’ve worked really hard to make that more convenient for the farmers,” detailed Grant.
A third challenge was the absence of an aggregator to process produce. Herbs, the catalyst for the project, require significant processing. There was not an existing facility to wash and process herbs and vegetables, so growers without their own processing facilities had difficulty providing these goods to the hospital. However, the county extension agent in a neighboring county opened a processing plant, where growers could rent space. In addition, due to the demand established through the CAMC program, another local processing facility and aggregator is now available through the Kanawha Institute for Social Research & Action.
Chief Strategy Officer
Charleston Area Medical Center
Brenda Grant, interview by David Zuckerman and Katie Parker, January 25, 2016.