In this era of soaring medical and insurance costs, almost anything that can make a measurable change in worker health is likely to make an employer sit up and take notice. Especially if the investment is minimal.
When University of Kentucky agriculture marketing professor Tim Woods brought such a program to UK Health and Wellness last year, they were intrigued. For $200 each, UK could give some employees a chance to eat fresh, local produce, which could have an impact on everything from how much they spent at the pharmacy to how much they ate out.
And Woods had data to back it up. In 2015, Woods had done a small experiment: If people were offered a voucher to buy a share in a local CSA — community supported agriculture program — would they do it? And would it make any difference in their health?
Woods knew people would like the idea and he suspected it would get them eating healthier. For a decade, a similar program in Madison, Wis., called the FairShare CSA Coalition, had offered vouchers, funded through insurance companies. The perk was so popular that it has grown from 96 shares in 2005 to about 9,000-10,000 vouchers for shares in recent years from more than 50 local farms.
He got a USDA marketing service grant to look at what the health benefits might be, something that hadn’t been studied before.
“We were thinking if we want to really make a solid case to our employers at the University of Kentucky, Baptist Health, Urban County Government, all these other entities in the Lexington area, we have to be able to have some really solid research-based, carefully measured metrics to be able to state our case,” Woods said.
From the farm perspective, Woods knew that a guaranteed income stream like that would be monumental. When CSAs first began about 15 or 20 years ago, they were mostly small-scale, often with people working on the farm for their share of the produce.
Today, CSA has become a popular way for people to get fresh, local fruits, vegetables, eggs and meat in weekly shares. But participation typically costs $600 to $750 per season, and the participant has to pay up front.
If workplaces offered a $200 voucher toward a CSA, that would be a sizable incentive for employees to sign up. Woods signed up 95 people who had never participated in a CSA before and then surveyed them on specific lifestyle changes.
Participants reported that they ate breakfast and dinner in restaurants less, ate less often in their car, ate fewer processed snack foods and fewer processed foods for meals. They were more likely to eat salads, buy organic food and locally grown food and fix dinner at home, not surprising since they had boxes of fresh produce to use every week.
They increased their average daily fruit and vegetables servings and said they felt healthier. They talked about nutrition and healthy food with colleagues and friends, too, creating a spillover effect.
And, most importantly, their monthly expenditure at the pharmacy dropped from an average of $33.84 to $17.23, almost a 50 percent decrease, and the number of visits to the doctor went from almost 7 1/2 times to only about twice during the six-month program.
Those results surprised even Woods, who published them earlier this year in the International Journal of Agricultural Sustainability.
“It was just across the board,” he said. “In working with CSAs, I kind of had a hunch that’s what it was like.”
When Woods showed this to UK Health and Wellness, they said “we can pick this program up,” he said, which is important because an employer-funded investment is more likely to be long-lasting rather than just for a year or two.
“The results were quite favorable,” said Jody Ensman, UK Health and Wellness manager. She recommended a pilot program at UK for 200 shares. Appalachian Regional Healthcare in Hazard joined in and offered employees 50 shares. Hospice of the Bluegrass heard about the program and asked to participate, too.
Liz Fowler, president and CEO of Hospice of the Bluegrass, said that they had a wellness initiative at work already when she heard about the CSA voucher program earlier this year.
“We decided to begin as a pilot, because we hadn’t budgeted for it and we didn’t know the extent of the interest or the benefit,” she said. “We opened it up to all and said tell us why you’d like to participate. We decided to cap it at 30, and we had right at 29 or 30 who said they wanted to do it.”
Danita Ross, vice president of human resources at Hospice of the Bluegrass, used her voucher to sign up for a CSA share with Elmwood Stock Farm of Georgetown.
“There’s items we get I never would have bought, like beets. But I did chop it up and put it in my Vitamix and add pineapple to make a smoothie, and it doesn’t taste bad at all,” Ross said. “I’d never tried Swiss chard, but it came in the box and I found a recipe and it’s really good. And even my husband likes it.”
Now she looks forward to getting an email every Monday afternoon from Elmwood on what will be in the box the next morning. And it has made a difference in her health, Ross said.
“I think I feel better … and I think I can tell a difference with my allergies and my sinuses, too.”
A lot of the benefits have been intangible, Fowler said. Employees swapping vegetables and recipes, for instance. One employee with teenaged sons who refuse to eat healthy have succumbed to her eggplant pizza.
“It has encouraged a lot of employees to eat better ... it’s like Christmas when these boxes come in each week. ... It’s helping with our culture. We’re bonding around something besides work.”
Other benefits have been more concrete. One employee who had been on the brink of going on medication for pre-diabetes managed, through diet and exercise and increased fruit and vegetable consumption, to reverse course, Fowler said.
“When she went back to her physician, she was told now she does not have to be on medication,” Fowler said. “We are a self-insured plan so the cost of keeping someone off medication is certainly paying for the cost of her food box.”
Based on this year’s success, Fowler said they have already decided to do it again next year and are surveying employees to see how many might want to join in.
Ensman said that UK likely will continue the program, too, based on employee feedback, which has been all good. UK coupled the benefit with workshops by dietician Vanessa Oliver on what to do with specific vegetables as they come in waves.
Whether the program expands will depend in part on her budget, Ensman said.
“I think it’s been a really positive experience for everyone involved,” Ensman said.
Community Ventures of Kentucky, which specializes in innovative economic development programs, was brought in to create Bluegrass Harvest, administer the program and find farms to sell organic CSA shares and find employers willing to offer vouchers to employees.
Sandy Canon, president of Bluegrass Harvest, said that for next year they hope to expand to about 1,500 shares. She is targeting the 108 self-insured employers in Kentucky first.
“The opportunity is there, if we can grow our supply,” Canon said.
She is working with the Organic Association of Kentucky to find farmers who are experienced in growing for CSA and ready to take on more shares.
This year’s program resulted in about $100,000 in new sales for local farms, Canon said. “If we get to 1,500 we’ll be adding $1.3 million. ... It’s incredibly advantageous to our small farms.”
About 20 farms have approached her about joining the five, including the University of Kentucky’s South Farm, already in the program, she said. One goal: find more farmers in Eastern Kentucky who can participate.
The potential for growth as a farm revenue stream is strong: In Wisconsin, CSA sales through the vouchers program have grown by $6 million annually, Woods said.
“The farmers are a little bit nervous just for how big it could get,” he said. Existing production could handle about 2,000 to 3,000 CSA shares, but beyond that will require major growth, he said. The challenge is to build a model that can be sustainable for everybody.
Ann Bell Stone of Elmwood Stock Farm said the program has been great. This year it added about 60 shares to their CSA total of about 400, where they have been for five or six years.
“It introduced CSA to people who maybe hadn’t heard of it before, or who couldn’t attend a farmers market. It allows them to be aware of what’s grown in Kentucky and once you get the vegetables in your house you’re going to do something with them,” she said. The data from the study should go a long way, she said, to convince employers that “when people eat better and have good nutrition, life is better on many levels.”
Woods doesn’t think they will have much trouble making that case.
“The nice thing about a CSA share is it’s not only helping the employee directly, but the employee household, if they’ve got a spouse or kids. There’s a lot of sharing that goes on,” Woods said. “And improvements in these various health measures actually get better over multiple seasons. You see some movement after the first year, but after folks come back over the second year they are increasing fruit and vegetable consumption more. And the biggest advances are taking place amongst folks starting at the poorest places of health. That’s a really strong selling point to these self-insured organizations.”