Facing a fragmented healthcare system and nutrition access inequities across the U.S., Kroger’s healthcare arm, Kroger Health, sees its food-as-medicine work as a major solution.
On its journey to create personalized and affordable offerings aimed at disease prevention, Kroger Health is turning to a wide range of efforts, from shelf tags to its OptUp nutritional scoring system to dietitian counseling, Kroger officials said in interviews.
The company’s emphasis on making stronger connections between health and food comes at a time when chronic diseases are on the rise in the U.S. — a country where healthcare spending has topped $4 trillion yet quality lags behind other high-income countries, Kroger Health President Colleen Lindholz noted.
Since the pandemic started, many people in the U.S. have become more in tune with their own health, yet financial pressures can oftentimes leave consumers choosing between healthy food and other life necessities, Kroger Health Chief Medical Officer Dr. Marc Watkins said.
“We've known for a number of years that — even before this inflationary economy — folks are struggling with making decisions for things like paying rent, transportation. Sometimes they would do things like ration their medications,” Watkins said.
While “food-as-medicine” offerings are generating buzz within the grocery industry, changing how people eat is no easy feat. On top of that, Kroger Health also has to appropriately handle consumer privacy and be sensitive to how food connects to cultural backgrounds and individual health journeys. Food is personal, which poses opportunities and challenges to Kroger Health’s journey for personalizing food-as-medicine offerings.
Food as medicine is not a new endeavor for the grocery company, and Kroger Health currently offers telenutrition, food boxes, a nutritional scoring system called OptUp and Welsana, a diabetes prevention program.
Last week’s White House Conference on Hunger, Nutrition and Health, which aimed to energize work on addressing diet-related diseases and access to healthy, high-quality foods, will hopefully be a catalyst for new commitments by and greater collaboration between the food and healthcare industries, Kroger Health executives said.
More food-as-medicine projects are in the pipeline or pilot phases for Kroger Health. As innovation continues, Kroger Health is leveraging the company’s thousands of healthcare professionals and associates to gather both input and data.
“We’re kind of like a huge laboratory for the country, and what I mean by that is we have 500,000 people that work for The Kroger Company,” Lindholz said.
Vision for “value-based healthcare”
Kroger Health’s vision is to create “value-based” healthcare solutions — aligning incentives with healthier outcomes — that complement primary care services.
Food as medicine has a “big role” in value-based care because it can improve food and nutrition security, Andrea Brookhart, director of population health and wellness at Kroger, said.
“The incentives aren’t aligned to create the need for those collaborations and data connections and the effort that it takes to help people stay out of the hospital,” Brookhart said.
Kroger Health’s holistic approach to health includes aspiring to fill more nutrition prescriptions and fewer drug prescriptions, which Lindholz said can help Kroger gain market share with people that need medications while also promoting food-as-medicine services.
“We really believe that there’s this huge opportunity for us to lead this wave of wellness across this entire nation that will then, over the next decade, [reduce chronic disease].”
President, Kroger Health
Connecting organizations, industries and other key stakeholders; growing consumer awareness; and encouraging people to use food-as-medicine services, though, are just some of the challenges facing Kroger and other companies. Kroger Health is also careful to avoid becoming the “food police” by educating people to help them make healthier choices, rather than telling them what to buy, Lindholz said.
“Our food philosophy is: all foods are good but it’s just portion sizes, it's the source, a combination of the baskets that really matters,” Lindholz said.
Kroger Health avoids using the term “food as medicine” on a consumer-facing front to not push away shoppers who equate “healthier” with “more expensive,” Lindholz said.
Five years ago, Kroger Health was formed when the grocery company brought together its clinic and pharmacy businesses and dietitians to work collaboratively across the entire company, from merchandising to e-commerce, Lindholz said.
Lindholz has worked for Kroger for 27 years, primarily in pharmacy roles, and became president of Kroger Health in April 2017.
Originally from the “one-stoplight” town of Goshen, Ohio, Lindholz started working in a pharmacy while in high school with plans to attend medical school. She began her pharmacy career after her dad lost his factory job as she was finishing pharmacy school.
Her career ties back to her aspirations to follow in the footsteps of her mother, a gospel singer, who she said was outgoing and wanted to impact people’s lives for the better.
“The first person I helped to quit smoking, which was actually in 1999, I still have a relationship with that family. … And so I appreciate the opportunity to be able to build those relationships that are the reason that I get up in the morning,” Lindholz said.
Busy behind the scenes
Kroger Health had big plans in 2020 to put nutrition technicians in “a lot” of its stores to engage with customers, Lindholz said. When the pandemic hit, Kroger Health pivoted to tele-nutrition and found surprising success, Lindholz said, explaining that consumers sometimes feel more comfortable talking to dietitians in private and can provide an inside look at what’s in their refrigerators and pantries.
Without the limitations of the store fleet, the virtual format, which is available in all 50 states, has allowed the company’s dietitians to reach more people around the country, said Taylor Newman, Kroger’s director of nutrition, adding that the dietitians will help people who shop at stores besides Kroger.
Kroger Health is currently testing having a dietitian stationed within its pharmacy departments for customer interaction at the pharmacy counter and is also testing gatherings at in-store bars where people can have a glass of wine and better-for-you appetizers while learning about health and nutrition. While the company is still figuring out what those interactions will entail, human connection around health is at the heart of the events.
“People want to be around people like them … so it's really nice to bring together groups of people who may have diabetes or heart disease or even people that are just trying to be healthier,” Lindholz said.
With in-store shopping now back in full swing, Kroger Health is still figuring out what in-person options should look like: “Is it more about gatherings and more about having that dietitian that’s attached to every store? Or is it about having them offering more or less advertising at the store level and then they're connecting with our dietitian online?” Lindholz said.
Kroger has pledged to put 15,000 “healthier items” on its shelves by 2025, Lindholz said. By the end of the year, almost all of the products in Kroger’s stores will have an OptUp score, Watkins noted.
Kroger is using its OptUp nutritional scoring system to understand how nutritious its private brand products are and has reformulated a “significant” amount of its own brands to make them better through dietitian guidance, Lindholz said.
“All of the brands that Kroger owns, they are very interested in the nutrition aspect. They have told us, ‘If there’s ever a product of ours you can’t recommend, tell us and we will fix it and so we’ll lower out of sugar, we’ll lower sodium,’” said Newman.
Kroger Health has been encouraging suppliers to consider reducing the amounts of ingredients like sodium and sugar while keeping the price affordable, Watkins noted.
In partnership with United Healthcare, Kroger is piloting neighborhood nutrition programs with on-the-ground nutrition techs, Lindholz said.
Kroger Health is also working with food benefit card companies as the grocery company aims to have its own food formularies and become what Lindholz described as the first food benefits manager in the U.S.
Kroger wants to be the first retailer in the country to link nutrition scores to electronic medical records, allowing physicians — with their patients’ permission — to follow what their patients eat, Lindholz said, noting the company has been working on this project for the last few years.
“From a physician standpoint, we’ve built a platform that sits on top of our fulfillment system and pharmacy and on top of our electronic medical record at [The Little Clinic] that’s going to allow us to embed that score back into the EMR [electronic medical records],” Lindholz said, noting Kroger is also working on a way to “bill it back to the insurance company.”
Kroger said it will collaborate with other grocery retailers to implement OptUP system “to test and determine whether it can transform into a national nutrition scoring system” as part of its commitments tied to the White House Conference on Hunger, Nutrition and Health. Kroger and Kroger Health are also launching a new Zero Hunger | Zero Waste Innovation Fund to help support new health-focused solutions.
Along the way, Kroger has run into challenges. OptUp, for example, has undergone multiple iterations, Lindholz said. Kroger Health “failed miserably” at first with nutrition prescriptions when it initially had physicians write paper prescriptions: “We weren't able to operationalize that nor figured out how we could meet all the patients where they were in the number of stores that we had,” Lindholz said.
Kroger moved nutrition prescriptions online, where dietitians help people build their carts and provide education, and found the digital service was a “much better execution,” Lindholz said.
Using data and research to drive innovation
Kroger has been slower to “come out the gate” publicly because the company has been focused on how its health efforts impact its employees, said Meggen Brown, Kroger Health’s chief nursing officer.
Kroger Health is tapping into its workforce of half a million people to gather data and provide them with resources. With individuals’ permission, Kroger Health uses data tied to their loyalty account and analysis by 84.51°, Kroger’s retail data science company, Brown said.
From survey questions to listening sessions to answering questions on Yammer, Kroger’s internal version of Twitter, Kroger has established ways to promote its healthy initiatives internally, Brown said. Kroger also has a wellness interest group where its dietitians will share resources and recipes.
Kroger Health is also using OptUp data to help inform and scale food as medicine. OptUp is linked up to the grocer’s loyalty program, which means the grocery company knows the OptUp score of the 62 million households in its database, Lindholz said.
Research is another major component. Kroger funded a clinical research study by the University of Cincinnati that evaluated the impact of dietary intervention on primary care patients shopping at Kroger. Currently, Kroger is supporting studies to better understand DNA and microbiomes to unlock another level of personalization, Lindholz said, noting that previous research has found healthy bacteria in people’s guts can predict whether how they respond to illnesses.
Timed to the White House Conference on Hunger, Nutrition and Health, Kroger announced it’s an inaugural partner of the Rockefeller Foundation and American Heart Association’s national Food is Medicine Research Initiative, which is set to launch next year.
“We really believe that there’s this huge opportunity for us to lead this wave of wellness across this entire nation that will then, over the next decade, [reduce chronic disease],” Lindholz said.