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.