Changes on the menu

Restaurants across the U.S. might serve Wild Alaskan salmon with a side of wheat berries, but at Fletcher Allen Health Care, an academic medical center in Burlington, Vt., the meal is locally sourced and costs only $5.25.

The 419-bed hospital is considered a leader in providing organic, local and sustainable food options to its patients, employees and the wider community it serves. It buys 80% of its beef from farms in Vermont that do not use therapeutic antibiotics. The majority of the eggs it purchases are organic. It works with 70 local farmers and producers. Three years ago, it opened a rooftop garden that grows vegetables for food served in patient rooms, the cafeteria and cafés.

Fletcher Allen isn't the only hospital system or food-service contractor that is starting to address the role of healthy food options at its facilities. Interest in providing healthier has taken off with hundreds of hospitals and one large food-service provider pledging participation in healthy food programs during the past year.

As a result, food service companies and hospitals say the move toward incorporating healthier food options into hospital menus and cafeterias is shaping purchasing practices, food service contracts and business strategies for healthcare providers.

“There's more and more attention being paid to the obesity epidemic, the epidemic of chronic disease and this kind of knowledge that the healthcare sector should be playing a leadership role in this area,” says Michelle Gottlieb, co-coordinator of Health Care Without Harm's healthy food in healthcare program.

Annual spending on food does not make up a large percentage of a typical hospital's total expenses. For example, Fletcher Allen spent about $4.2 million on food in fiscal 2012, compared with the roughly $956 million in total expenses the hospital reported that year.

However, food prices are generally rising about 3% to 5% each year, putting ongoing pressure on budget-conscious hospitals to develop strategies that offset rising costs.

And as reimbursement cuts weigh on financial decisions, some hospitals are re-evaluating whether to outsource food service as they address patient-satisfaction scores, the health of the communities they serve and growing food costs.

Officials at hospitals that buy larger percentages of local, organic or sustainable foods say that it's possible to continue to make these purchases without seeing higher food costs. Concern about the costs of incorporating healthier foods into menus has traditionally been a barrier for some providers that are considering participating in healthy food programs or providing healthier meals in their facilities.

“Many hospitals are deeply engaged and busy with changes in healthcare regulations, and it can be daunting to be thinking about doing new initiatives that mean forging new relationships and patterns,” Gottlieb says.

Fletcher Allen's initiatives are unique in many ways, especially when compared to the broader spectrum of the nation's hospitals, many of which continue to serve fried foods and burgers even as they grapple with how best to treat and prevent high rates of obesity and other chronic diseases in other areas of their operations.

“I do think it's a fallacy to say healthier food always costs more,” says Diane Imrie, Fletcher Allen's director of nutrition services. “It takes a lot of work for it not to cost more, but it can certainly be done.”

Fletcher Allen will often substitute certain meats or other products if the prices on those foods rise significantly.

Other hospitals have changed their cafeteria pricing structures to make less-healthy food slightly more expensive. Reducing meat purchases, one of the more costly food items for hospitals to buy, have helped control costs, Gottlieb says.

Hospital Sisters Health System, a 13-hospital system based in Springfield, Ill., also has focused on purchasing local and sustainable food products including bread, milk and cheese.

Unlike Fletcher Allen, which self-operates its food service—Imrie notes that it would be a challenge for food service to become part of the Fletcher Allen brand if the system didn't self-operate—Hospital Sisters contracts with Sodexho, one of the largest food-service contractors in the U.S.

As part of the contract, signed in July 2011, a quarter of the system's food must come from local sources, says Rick Beckler, director of food, nutrition and environmental services at Hospital Sisters. The system spent about $9.5 million on food last year.

“It's a real difficult time right now in healthcare,” Beckler says. “Also, when you take the food service world, and I look at the changes that we've gone through as far as access to food, the cost of food continues to go up every year.”

In 2011, about 75% of food purchasing in the healthcare sector was done by healthcare facilities that self-operated their food service, according to a report released that year by Technomic, a food industry data firm. Data from FoodService Director, a trade magazine for the food-service sector, reported that the number of self-operated healthcare facilities has risen since 2009, when less than 60% of healthcare facilities self-operated their food service businesses.

Beckler says that the relationships the hospital system has maintained with “big-box” food-service contractors and distributors has allowed the system to continue to buy local and sustainable foods, in part because those companies can help source local foods and ensure that the food producers are meeting standards of safe practice.

“This isn't about getting rid of the big-box trucks,” he says. “They have a very important piece in our food-service business. They have some great relationships and have done a great job buying local in regional markets.”

Morrison, the healthcare subsidiary of the Compass Group, an international food service provider based in the U.K., is the only food service contractor to enroll in the Partnership for a Healthier America's healthy hospital food program, which was launched last fall. PHA is closely aligned with Michelle Obama's “Let's Move” campaign.

At least 60% of the 550 hospitals and health systems that contract with Atlanta-based Morrison will take similar pledges that another 155 hospitals and systems have taken as part of the PHA program.

“As we look at the trends in the healthcare food service industry and we look at our environment, we really identified that the timing is now more than ever to support doing this as an organization,” says Lisa Roberson, Morrison's corporate director of wellness. “It makes sense for us as an organization to make these changes throughout all of our healthcare institutions.”

The Partnership for a Healthier America was formed in 2010 by Kaiser Permanente, the Nemours children's health system and three other foundations. Last October, it announced a program targeting the food that hospitals serve patients, visitors and employees. Participating hospitals have committed to a set of phased requirements that include removing fryers, increasing fruit and vegetable purchases, and offering a healthy option at each meal that meets certain nutrition standards.

Morrison launched its own wellness platform in November before announcing plans to join the PHA initiative in March. The company's platform is similar in some ways to the PHA program.

PHA and Health Care Without Harm have developed voluntary programs that encourage healthy food options in hospitals. The Health Care Without Harm program has enrolled about 439 hospitals in its healthy food program.

“It's going to become more common for hospitals around the country to be engaging in these programs,” Gottlieb says. “There are going to be many hospitals that are going to start by taking baby steps and then there are going to be areas where this really becomes embedded into the DNA of the communities in which they sit.”

There are some regional efforts underway, as well, including an initiative among the 32 hospitals operated by the New York City Department of Health and Mental Hygiene.

HHA Services, a healthcare food service contractor owned by ABM, has also developed what it refers to as a “well-being” program. One element of the program is a meal option that includes an entrée and two side dishes that have less than 550 calories and 15 grams of fat, and at least 2 to 3 grams of fiber. The company also encourages its 25 hospital and retirement community clients to take the Health Care Without Harm pledge, which it has also signed.

Rick Abele, HHA Services' vice president of food and nutrition, says some hospitals are now re-evaluating their food service management options. In some cases, the company can provide capital to renovate a hospital's kitchen or retail food area.

“Some hospitals that have been self-managed for a long time are looking for different options,” Abele says. “A lot of times we can bring capital to the table as part of our relationship and bring them some investment money that they might not be able to get.”

Those hospitals also might be interested in working with food service contractors to improve customer and patient satisfaction. Patients and visitors are increasingly interested in information about calorie counts and the quality of the food they order in a hospital, as well as the feel of the overall experience.

Sodexo, for example, partnered with MyFitnessPal to incorporate its menus into a free mobile app that allows visitors and employees at its client hospitals, as well as other member organizations, such as universities and other workplaces, to track calories. Sodexo provides food services at 863 hospitals.

“That's what we're starting to see people want more of,” Hospital Sisters' Beckler says.

In addition, many hospitals adopted a call-center room-service model over the past decade that allows patients to call at nearly any hour to order a meal from a restaurant-style menu. However, the model is labor-intensive and can require staffers to be available for, in some cases, a 14-hour day, says Kimmi Campagna, director of partnership development at Cura Hospitality.

Cura, which works with eight hospitals in the Mid-Atlantic region, has developed a personalized room-service model that it says can improve a patient's perception of the hospital. Campagna says the model sends staff into patient rooms to take food orders.

“We had a large technology push for many years, and technology is absolutely necessary and has its place,” she says. “At the same time, you have to evaluate what your program is and where the personal touch can really affect patient satisfaction at a higher level.”

TAKEAWAY: Hospitals and food service providers are serving up healthier choices that don't necessarily mean higher overall costs.

Follow Jaimy Lee on Twitter: @MHjlee