Archives for Affordable Care Act

Fresh Advantage featured at Yale Master’s Tea


On October 14, Fresh Advantage’s Managing Director Marydale DeBor, partner Chef Anne Gallagher, and Fresh Advantage affiliate nutritionist Francine Blinten enjoyed “Tea” (a longstanding Yale tradition) with the next crop of eager healthy-food champions on campus at Pierson College. This Fresh Advantage trio was delighted to be the first special guests in the Yale Sustainable Food Program’s 2015–16 speaker series “Women of Food.” The afternoon’s theme was “Women Addressing Food in Healthcare.”


Women in Healthcare

From left: Bella Napier, Professor Stephen Davis, Chef Anne Gallagher, Annie Harper, Marydale Debor, Francine Blinten, and Robert Cole.

Francine discussed the progress being made by the Fresh Advantage team in the “food transformation initiative” they now lead at the Connecticut Mental Health Center. Chef Anne (pictured below with several Yale students) prepared a delicious tea with food from the Yale Farm. Dishes included kale bruschetta topped with parmesan, scarlet turnip and squash pancake topped with sour cream and a hot pepper coulis, and roasted beet skewers with pecan-crusted goat cheese drizzled with balsamic reduction.

For those who couldn’t attend the event, an accompanying podcast interview with Marydale is available here. (Please see below the photos for additional information.)


Vegan roasted beets from the Yale Farm

Vegan roasted beets from the Yale Farm

Listening to Marydale’s interview won’t make up for missing the mouth-watering food, but you will hear details of our “hub and spoke” theory of change for hospital food systems. Hospital food service operations can serve as the healthy food “hub” for patient, staff, and visitor meals, and they can support a variety of activities from patient nutrition education, employee wellness, and programs that address food insecurity in the community at large (the “spokes”). In fact, food and nutrition programs that address community health needs, such as food insecurity and malnutrition among seniors, are a creative and effective way for non-profit hospitals to fulfill their community benefit responsibility, a condition of tax-exemption. You’ll also learn which two groups in any hospital are our closest partners in implementing change in hospital food systems. (They may not be your first guess.) Who are they? Marydale specified two groups: plant engineers (“the first people I talk to are the ones who make the building run”) and nurses (“nursing is the other critical piece—nursing is the backbone of the hospital”).

Tune in to learn other features of our Food is Primary Care® approach to ensuring food and nutrition are valued as a central part of health care practice.



Nonprofit hospitals could reap credit for improving the eating habits of their patients and communities.

Fresh Advantage® director, Marydale DeBor

Fresh Advantage® director, Marydale DeBor

As they strive to prove they are benefiting communities under the Affordable Care Act, nonprofit hospitals may become the latest battleground between fast-food purveyors and advocates of healthy—and preferably locally produced—cuisine.

“I am looking for opportunities for you to be the doctors to the world,” said Marydale DeBor, a former Connecticut hospital executive, at the convention for the National Farmers Union last month in Springfield, Mass.

Hospitals have long been a culinary joke, serving unappetizing food of questionable nutritional value to patients while selling fast food that is even more questionable in their cafeterias. Medical-school critics have chastised physicians for prescribing to patients costly drugs to deal with the effects of diseases that arise from bad diets and lack of exercise rather than feeding them healthy food and teaching them to eat better when they leave the hospital.

But a new generation of doctors and hospital administrators is changing that. DeBor, a lawyer, previously served as vice president of external relations at New Milford Hospital in Connecticut, where she oversaw the overhaul of the hospital’s food system, emphasizing the quality and origin of the food. DeBor now works through her New Haven-based consulting firm, Fresh Advantage, to tell farmers who produce healthier food that they should lead a movement toward more-nutritious hospital eating—and reap the benefits.

She also told the farmers that the changing requirements for hospitals under “Obamacare” will expand their opportunity to improve food quality in medical institutions. To maintain their nonprofit status, hospitals have long had to prove to the Internal Revenue Service that they provide community benefits, and they have often gotten credit for providing care to people who couldn’t pay. But with almost everyone required to have insurance under Obamacare, hospitals will be looking for new ways to provide community services. One way to do that is to provide healthier food to patients and to teach patients and the community at large to eat better, she said.

DeBor, who now serves on the board of the New England Farmers Union and was a delegate to the convention, urged the farmers to develop “direct relationships” with the officials in charge of community benefits at their local hospitals.

“Farmers really need to be advocates in a time of opportunity,” DeBor said. “Talk about hospitals and what they are doing right now. It is a time of new ideas.”

That message had a natural appeal to small-scale farmers, particularly those who live near large urban centers, but DeBor told the Midwestern-dominated Farmers Union that the most important part of the message is that hospital food should be healthy. Farmers in low-population states need not fear the movement, because farms near urban areas can’t possibly supply all the food for big cities and suburbs. Nebraska Farmers Union President John Hansen, who was in the audience of DeBor’s speech, said farmers in rural states should also become active in the “buy local” movement, because he has learned that restaurants and institutions in Nebraska often buy steaks and other meats from “five or six states away.”

The movement is not without complications, however. At New Milford, the hospital’s food vendor refused to go along with the new ideas on purchasing and food preparation and had to be replaced.

Another issue is affordability of the fruits, vegetables, and other high-quality foods that many doctors and nutritionists now recommend when people leave hospitals. Wholesome Wave, a Connecticut-based group, raises money from foundations, government agencies, corporations, and hospitals to help low-income people in 28 states and the District of Columbia buy fruits and vegetables from farmers markets and local producers, but its organizers acknowledge the need is great.

Scott McFarland, the Cleveland Clinic’s former president of wellness, had a mandate to make wellness part of the clinic’s brand. He said in an interview that he got pushback when he limited fat and sodium in hospital menus, removed all drinks with high-fructose corn syrup from the vending machines, pulled deep-fryers out of the kitchen, and banned “all the bad items” that people should not be tempted by “when they are in the bubble of the Cleveland Clinic.”

Food-safety requirements make it difficult for small farmers to sell to hospitals, noted McFarland, who now lives on the Hawaiian island of Kauai, where he and his partner run an athletic club and have a 16-acre farm that grows avocados, figs, citrus, and bananas that they sell to local restaurants and hotels. McFarland said that institutional buying requirements are so strict in Hawaii that he has not been able to sell to hospitals there, but he believes farm groups and the food-hub system established by Agriculture Deputy Secretary Kathleen Merrigan to help small farmers meet the food-safety requirements of institutions will help.

McFarland grew up on an Indiana corn and beef farm and was once a lawyer for the National Corn Growers Association. Today, he is the vice president of the Hawaii Farm Bureau, and said the combination of younger doctors’ views and government pressure on doctors and hospitals to “keep patients out of the hospital rather than put heads in the beds” make it a smart move for farmers to grow what the hospitals want to buy.

“Over the next decade,” he said, “you are going to see Americans eat healthier, and that is going to have an impact for farmers.”

[box style=”grey rounded” ]Contributing Editor Jerry Hagstrom is the founder and executive director of The Hagstrom Report, which may be found at  This article appeared in the Thursday, April 4, 2013 edition of National Journal Daily.[/box]

Food is Primary Care™ and the National Farmers Union Convention

Nat Farmers 2013For the first time in its 111 year history the National Farmers Union will hold its convention in New England and Fresh Advantage’s Marydale DeBor is pleased attend as a member of the New England Farmers Union board of directors and delegate to the national convention.

Marydale will present at a breakout session called “Scaling up to Meet Demand” which will look at how farmers can grow to meet the demand for local foods by expanding and by working with fellow family farmers through cooperatives and other organizations.

Marydale DeBor, spreads the message of “Food is Primary Care™” “Health care institutions can become powerful change agents in promoting public health and reversing the trends of obesity and chronic disease,” Debor said. “And they can do this while they also build sustainable local and regional food systems.” She will discuss models that exist and new possibilities created by the Patient Protection and Affordable Care Act of 2010.

Marydale Speaking

“With the addition of a New England chapter in 2009, the National Farmers Union recognizes the role that farmers and fisherman operating in rural, urban and peri-urban locations play in our nation’s agricultural economy,” said Marydale DeBor. “The support that farm programs offer to agriculture and fisheries in all geographic environments enhance the diversity and strength of our food system and promote its sustainability,” she said.

2013 National Farmers Union Convention, March 2-5, 2013, Springfield, Mass. — Mass Mutual Center
New England Farmers Union, a member-driven organization, is committed to enhancing the quality of life for family farmers, fishermen, nurserymen, and their customers through educational opportunities, co-operative endeavors and civic engagement. For more information, see

Opportunities and Challenges of the Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA) will compel hospitals to promote population health in the communities they serve. Practicing prevention and keeping the general population served healthy will be a necessity as new payment models are adopted by third-party payers and pressure increases to control per capita costs. In addition, specific mandates tied to reimbursement include reducing patient re-admissions within 30 days of discharge.

Doctor_PrescriptionPPACA also affects health-care sector employers: incentives exist within the new law for wellness programs that can keep an institution’s workforce healthier and more productive while reducing costs.

Fresh Advantage can help with these challenges by strategically expanding your organization’s capacity for public health practice through well-coordinated community and employee benefit practices.

Fresh Advantage understands how to integrate nutrition, meal planning, and methods for assuring a patient’s access to food into hospital discharge planning. The FA team also helps your staff coordinate with caregivers and community health care resources to maximize patients’ wellness and reduce the chance of relapse necessitating readmission.