Nutrible

Problem Scale and Number of People Impacted

According to the USDA, approximately 19 million people in the US live in food deserts, with over half of those individuals living in low-income areas. Black and Latino Americans are more likely to live in food deserts than any other racial or ethnic group, with 17% of Black Americans and 14% of Latino Americans living in a food desert, compared to 8% of white Americans. Black and Latino children are more likely to experience food insecurity than any other racial or ethnic group, with 1 in 3 Black children and 1 in 4 Latino children living in households that are food insecure.

Additionally, Black and Latino Americans are more likely to live in poverty, which exacerbates food insecurity. The USDA reports that in 2019, the food insecurity rate was 21.7% for Black households and 15.6% for Latino households, compared to 7.9% for white households. According to the American Heart Association, Black and Latino Americans are more likely to have high blood pressure and diabetes than white Americans. In fact, Black Americans are twice as likely as white Americans to have diabetes, and the mortality rate from diabetes is 27% higher for Black Americans. 

According to a study published in the Journal of General Internal Medicine, patients who were food insecure had a higher risk of hospital readmissions within 30 days of discharge. Black and Latino Americans are more likely to be readmitted to hospitals due to complications from chronic conditions, with rates of readmission being 20-30% higher than those of white Americans. The lack of access to affordable and healthy food in Black and Latino communities is a key contributor to the higher rates of chronic conditions and hospital readmissions. 

Problems Related To Solution

Health systems, payers, and governments are working to reduce inequities in many chronic conditions. One way this is being done is by private health plans and 10+ state Medicaid plans have begun to cover medically-tailored meals and groceries for patients who suffer from chronic conditions. However, according to a report by the Food Research and Action Center, only about 1% of people who need medically tailored meals in the United States receive them.

 1) This happens because the ordering process is too cumbersome for providers to add to their work flows as every payer has different requirements and order processes. 

2) Additionally, most current vendor options are mail order, and have limited options that are familiar to Black and Latino patients. 

3) As mail order companies, they only service patients while they are being paid by health plans. As such, when health plans stop paying, patients who live in food deserts return to the unhealthy options that are available in their communities. 

 1) This happens because the ordering process is too cumbersome for providers to add to their work flows as every payer has different requirements and order processes. 

Solution - A one-stop-shop that simplifies the process so providers can easily generate orders regardless of the patient’s health insurance.

2) Additionally, most current vendor options are mail order, and have limited options that are familiar to Black and Latino patients. 

Solution - We offer options from more than 70,000 vendors including mail-order-vendors for patients who live in rural areas. 

3) As mail order companies, they only service patients while they are being paid by health plans. As such, when health plans stop paying, patients who live in food deserts return to the unhealthy options that are available in their communities. 

Solution - Nutrible breaks the cycle that currently leaves patients abandoned once insurance stops authorizing meals. We do this by offering meals from stores, restaurants, and even gas stations that are located in their own communities. This ensures that patients know how to navigate to healthy options in their communities. 

Economic impact - Currently, health plans pay $7B per year to mail-order-meal companies that don’t serve local communities. Our process redirects that revenue into local communities, and acts as a significant incentive for local businesses to offer healthier options. 

Target Population - 84M Americans with multiple chronic conditions.

According to a report by the Centers for Disease Control and Prevention (CDC) in 2021, approximately 60% of adults in the United States have at least one chronic condition, and 25% have two or more chronic conditions. This means that about 84 million Americans have multiple chronic conditions. The most common chronic conditions include hypertension, arthritis, diabetes, heart disease, and obesity. 

However, Black and Latino adults are disproportionately impacted by these chronic conditions compared to White adults. For instance, the prevalence of hypertension among Black adults is 44%, which is the highest of any racial or ethnic group in the United States. Similarly, the prevalence of diabetes is 16.7% among Latino adults, which is higher than the overall national average of 10.5%. These disparities highlight the urgent need for targeted interventions to improve health outcomes for Black and Latino individuals with chronic conditions.

What ways are they currently underserved?

Black and Latino communities are disproportionately affected by food insecurity and multiple chronic conditions, which further exacerbates health disparities in these communities. Food insecurity is a critical issue affecting many low-income households, particularly Black and Latino households, in the United States. Food insecurity is defined as limited or uncertain access to sufficient, safe, and nutritious food to meet one's dietary needs. The lack of access to adequate and healthy food can have serious health consequences, including an increased risk of developing multiple chronic conditions.

Research has shown that individuals living in food-insecure households are more likely to develop chronic conditions such as obesity, diabetes, hypertension, and heart disease. This is because they often rely on cheaper, high-calorie, and nutrient-poor foods, which can lead to an unhealthy diet and subsequent health issues.

How do we address their needs?

An article that was published in the Journal of the American Medical Association found that  expanding insurance coverage for MTMs to all eligible individuals with chronic illnesses in the United States could potentially prevent approximately 1.93 million hospitalizations and save up to $4.8 billion in healthcare costs per year. The potential cost savings were primarily driven by reductions in hospitalizations, emergency department visits, and skilled nursing facility stays. 

Although health plans have begun covering these meals, only 1% of eligible patients actually receive these meals. 

Nutrible solves this by:

1. Making it easy for clinics and community organizations to order meals for patients. This is important for community clinics and organizations, because they have limited resources and time. Our platform makes it easier for them to add healthy food to their workflows.

2. We transform “corner stores,” restaurants, and even gas stations that are located in food deserts into healthy food oases. We do this by sourcing food from within the community where patients live. This ensures that families know how to access healthy food even after they stop using Nutrible. 

3. According to the USDA, about 5 million eligible individuals are not enrolled in SNAP benefits. Additionally, many people are unaware of government programs like Double-Up benefits and free senior food delivery services. As such, Nutrible provides easy signup or easy navigation to these programs.

Patient Feedback

Patients love Nutrible! Our Nutrition-In-Reach program is a diverse group of patients from across the country, who speak different languages, different backgrounds, and have different care needs. We test every engagement process with them and get weekly feedback. There are currently 9 patients in the program.

Provider Feedback 

Providers love Nutrible! Kwamane Liddell, JD, MHA, BSN is an experienced emergency nurse, where he witnessed the devastating impact of food insecurity in Black and Latino communities. He cared for patients who lost their lives or well being due to preventable strokes and heart attacks. This experience helped him design the provider interface for Nutrible. The most common word used in feedback when we surveyed nurses, doctors, and other caregivers is “easy.”

Team Members

Founder - Kwamane Liddell, JD, MHA, BSN is a health equity visionary, lawyer, and business leader who has saved lives as a nurse, and believes healthy and affordable food should be accessible to everyone. Prior to Nutrible, he led Optum’s Southern Orange county market where he earned 5 STAR Quality measures for 40,000+ medicare and medicaid beneficiaries.

Patient Experience - John Wilson, MBA - 10yr sales and marketing experience, former Strategic Growth Manager at Dell, Howard University MBA, and friends with Kwamane for 15+ years.

Lead Dietitian - Anita Noad, RD, LDN - 8yr experience as a Registered Dietitian, University of Florida Graduate, this is her second startup, and Anita a fluid in Spanish and Portuguese.

Lead Engineer - Afnan Nadeem - Graduated in 2021 in Computer Science with a focus on AWS technologies. Built Nutrible with full integration capabilities and HIPAA compliance. App passed compliance at two California based health systems.

Sales - Tina Tigues - 3yrs experience as a virtual sales assistant. She engaged all 21 of our unpaid enterprise users in our proof of concept stage and supports John in outbound sales.

We have served more than 1,500 patients.

There are three primary ways that we can benefit from:

• We are experts at engaging patients, doctors, and hospitals. However, we struggle to get the attention of payers. We would benefit from support on how to get in front of payers who are working to solve these problems. We are particularly interested in:

California MediCal Plans

California Medicare Advantage and Commercial Plans

Massachusetts Medicaid Managed Care Plans

Massachusetts Medicare Advantage and Commercial Plans

Any Medicare Advantage or Commercial Plan located in these states 

Any Medicare Advantage or Commercial Plan

• We find that employer-sponsored plans are strong options, but we do not have experienced pitching employed plans. We would love guidance in this area.

• We recently earned a partnership with a 180,000-member health plan that we are very excited about. However, in our business model, we pay vendors net-0 to deliver food to patients. However,  health plans pay us net-30-90. We would benefit from help developing relationships with banks or learning about alternative funding sources besides investors.

Currently, 85% of the $7B that health insurance companies pay for medically tailored meals goes to mail-order meal companies. These companies only serve patients while they are being reimbursed by health plans, which means that patients who live in food deserts often revert to unhealthy options once the payments stop.

In contrast, our approach involves transforming local businesses, such as stores, restaurants, and gas stations, into healthy meal oases by sourcing nutritious food directly from suppliers within their own communities. This enables our patients to access healthy options even after they stop using Nutrible, and it also provides a significant economic incentive for local businesses to offer healthy choices that we can purchase. By doing so, we empower our patients to make healthier choices and create a sustainable, community-based solution to address food insecurity.

Our 5 year goal is to redefine food deserts on a national scale. We want so many “corner stores” and gas stations to offer healthy food and fresh produce that the absence of super markets has little impact on the overall health of communities.

In simple terms, providing medically tailored meals (MTMs) to patients with chronic illnesses is expected to improve their health and reduce hospital readmissions. The theory of change can be outlined as follows:

Activities: Design and deliver MTMs that meet the specific dietary needs of patients with chronic conditions such as diabetes, heart disease, or kidney disease.

Immediate Outputs: Improved patient adherence to prescribed diets, better management of chronic conditions, and enhanced overall well-being.

Longer-term Outcomes: Reduced hospital readmissions, decreased emergency department visits, and lower healthcare costs for the target population.

The logical links between these elements are based on the premise that when patients receive and consume MTMs, they are more likely to adhere to the necessary dietary restrictions, leading to better management of their health conditions. As a result, they are less likely to experience complications that require hospitalization or emergency care, which ultimately reduces healthcare utilization and costs.

Evidence supporting the existence and strength of these links comes from third-party research, such as studies published in JAMA Internal Medicine and Health Affairs, which show significant reductions in hospital admissions, emergency department visits, and healthcare costs among patients receiving MTMs compared to those who do not. Additionally, data from interviews with the target population and findings from process or impact evaluations can further strengthen the theory of change.

Theory of Change:

1. Activities: Implement initiatives to increase access to affordable, healthy food options in food deserts, such as opening community grocery stores, farmers' markets, and supporting urban agriculture.

2. Immediate Outputs: Improved availability of fresh produce and nutritious food in food deserts, increased consumption of healthy food options by residents, and enhanced community engagement in promoting better nutrition.

3. Longer-term Outcomes: Improved overall health and well-being of residents in food deserts, reduced prevalence of diet-related chronic illnesses (e.g., obesity, diabetes, heart disease), and increased economic growth and development in the affected communities.

The logical framework suggests that when access to affordable, healthy food options is increased in food deserts, residents are more likely to consume a nutritious diet. As a result, their overall health and well-being improve, which reduces the prevalence of diet-related chronic illnesses. Additionally, increased economic growth and development in these communities can occur as new businesses and job opportunities emerge.

Evidence supporting the existence and strength of these links includes third-party research, findings from process or impact evaluations, and data from interviews with the target population. These sources collectively demonstrate the positive effects of increasing access to healthy food options in food deserts, such as improved health outcomes, reduced prevalence of chronic illnesses, and increased economic development in affected communities.

A web app 

We strive to serve a diverse patient population and our team is committed to reflecting that diversity. Our priority is to ensure that our clinical teams can communicate effectively with our patients and understand their unique needs and backgrounds. To achieve this, we are working to contract with dietitians who are already serving or have experience with communities that are similar to our target population. Our team currently consists of seven members: 

• including our founder who is African American,  and one other team member 
• four Asian members, 
• one Latino member, and 
• one White member. 

The team comprises 60% male and 40% female members.