Health educator to CEO of About Fresh/Fresh Connect, with Josh Trautwein

Josh 0:00
Healthcare obviously has a stake in making sure that people have the food that they need to be healthy if we want to address health disparities that are attributed to food insecurity and diet related disease. That was sort of the just the progression and my mindset when I was first starting out just like a really ground up approach, looking around understanding the breadth and depth of the problem, connecting with folks understanding the existing solutions, and what opportunities there were to build from there.

Sujani 0:28
Welcome to PH SPOTlight, a community for you to build your public health career with. Join Us Weekly right here. And I’ll be here too, your host Sujani Siva, from PH SPOT.

Hey, Josh, welcome to the PH SPOT podcast. I am super excited, like I’m excited about all of my guests. But I discovered you and about Fresh and I was mind blown when I got into reading About- About Fresh. And, you know, for our listeners, this is going to be an interesting episode. And yeah, I just can’t wait to get into it. And so welcome. You are the co founder and CEO of About fresh and we’re just so thrilled to have you here.

Josh 1:09
Oh, thank you so much for having me, I’m excited to get into it.

Sujani 1:13
So you know, a lot of my guests are often you know, working in the field of public health, and I have, you know, a way of taking the conversation at a certain angle. And with you, there’s just so many different intersections of conversational topics that I want to talk to you about, you know, there’s the public health angle, there’s the angle of just like, you believing in yourself as the individual who can solve these big problems that we’re seeing in the world. There’s like entrepreneurship. So I’m excited. I don’t know where the conversations gonna go. But that’s the most fun part about these podcasts recordings. For me at least. So let’s start with you know, Josh, before About Fresh, I read that you were like many of our listeners working in public health and the point in which you decide to go and found this company, we can probably get to that point. But even before that, like who was Josh, as he was trying to figure out, you know, what am I going to do with university? What am I going to do with my life? Like who were you?

Josh 2:14
It’s a good question. Who am I, I grew up out in Milford mass in Central Massachusetts, kind of between Western Boston. And I think about like the starting point in my career as the onset of like, when it came to be exposed to social justice work more, even more broadly. I had a lot of really important mentors growing up there, you know, elementary school, high school, college that, you know, still continued to, you know, support me now. And, you know, they showed up for me, and not just me, but like other kids in my community in really, really important ways. Just put their arms around me and so that’s what really has always anchored my career in social justice and now in public health. So I went to Northeastern, you know, I studied sociology, just with the intention of becoming one of those mentors to others. I always grew up through high school, in college, either coaching nannying, babysitting, you know, working with kids tutoring, mentoring, and I wanted to do that as a career. So my first job out of college was at a community health center, the Mass General Brigham High Street, Charlestown health centers to get a lot of love for, you know, my community there and in Charlestown. And yeah, that that afforded me the opportunity to go a little bit deeper, like to work with kids, but to go a little bit deeper into public health, supporting a wide range of health and wellness needs, primarily for kids, but also, you know, young families. Yeah, that was my starting point in my journey to founding About Fresh prior to starting up the company.

Sujani 3:42
Yeah. And, you know, if I go back and look at the dates, the launch of About Fresh as a company was very much you know, within a few years of you graduating from your- your bachelor’s program, is that right?

Josh 3:55
Yeah, yeah, if I spent the year actually, as a health care worker, I was I was taking care of my grandmother full time at home, which was really powerful. Definitely shapes a lot of my work now being her full time caregiver. But yeah, pretty soon after that, worked at the health center for about a year and then founded About Fresh and got started on it, probably in 2012. And launched in 2013.

Sujani 4:17
The way I follow the story, it sounds like you were a community health worker on a nutritional program. And that were kind of the idea or maybe the frustration to want to solve this bigger problem came from?

Josh 4:30
Yeah, definitely. You know, it definitely started off as just a frustration and their pain point that I was experiencing, firsthand. I was, you know, a community health worker, collaborating with a, you know, a network of community based organizations in Charlestown to implement a really wide range of health and wellness programming, but you know, very much focused on nutrition. And so, I was running a program with clinicians at the health center for a group of low income single moms and then young kids that were mostly elementary school age, around on how to just navigate grocery shopping to support health, but respective of the fact that they were all managing against, like really modest grocery budgets. And at the same time that we were, you know, running that program, figuring out all the tips and tricks for like eating healthy on a budget, the only grocery store in the neighborhood closed, and it was set to close for two years. So that was the starting point of like my frustration, I think, with our food system, and, you know, just a recognition of one, just the disparity and access to healthy food, how that disparity adversely impacts health outcomes, and the limits imposed by sort of the constraints of healthcare to actually address food as a critical driver of health. And yes, that is absolutely the moment in time that inspired me to pursue this mission of, you know, ensuring that everybody has access to the food that they need to be healthy and happy and hopeful and, and connected to community. So every program that we’ve developed as followed, you know, from that moment in time,

Sujani 5:58
I love it. And for our listeners who don’t know about, About Fresh, maybe you could tell us a little bit about it, before we get into the origin story of what were some of those first steps that you took. And there’s two angles you can go from right when you’re feeling, you know, injustice, frustrations when you’re a public health practitioner in the world. And one angle is working with the system and trying to figure out how you could help the people that you’re serving, navigated, and maybe, you know, push for policies and remain within- within the system and do the job there. And I think we definitely need people to do that. The other angle you can go from is like, Okay, I need to step out of it, I need to be like the person who brings a new perspective to this new solution. And I’m going to go and build that. And you chose a second path. And I’m curious, you know, what kind of led to you saying, I’m gonna go and think about this problem from a different angle, and I’m going to be the one who’s going to build this. And then, for anyone who’s like listening and wanting that inspiration to take that first step. Do you remember what that like, first step was that you did see, like, I’m gonna do this, and this is the step I’m taking.

Josh 7:15
I do, I remember all of that pretty vividly. So first, just kind of like level set on who we are at About Fresh, as you’ve sort of, you know, alluded to where, you know, we started off as just this like really grassroots, community based organization literally incubated kind of like within the neighborhood of Charlestown from all the insights that I gained from like working at a health center. And we’ve grown to become a national organization that combines grocery retail technology, analytics, and then community driven activism to reshape our food and healthcare systems in service of health equity, and food justice. And we have two programs, our original program, that was the starting point for About Fresh, it’s called Fresh Truck, it’s a mobile market, we convert school buses into grocery stores, that we operate across Boston to get food into neighborhoods that lack access to affordable fresh food options. And then our newer program that we started incubating back in program launched in 2014, but we started incubating it as a tech enabled platform in 2019. It’s called Fresh Connect. That is a technology enabled food prescription composed of a web application, and then a prepaid debit card that allows healthcare organizations to cover the cost of food at a national network of 10,000 grocery retailers, for patients that and members of health plans that are experiencing food insecurity. And we’ve developed a debit card that can be programmed with spend parameters based on a patient’s health profile. So it’s a really powerful mechanism to embed food into care delivery, and then to generate the data and insights to inspire longer term healthcare transformation and to build the case for like why health care needs to be an investor into food access. And so that’s, you know, a really exciting expansion of our mission and the scope of all the work that we do. But you know, just getting back to that original starting point. You know, I believe deeply that all the best social innovation comes from community and is built from the ground up. And so I was very fortunate to have won the opportunity to like work on the frontlines of like food access in my role at the health center, and to work in the frontlines of like public health within a clinical setting within a really tight knit community in Charlestown and you know, I have a broader community across Boston, that I was able to tap into one to understand more deeply the breadth and the depth of food insecurity in Boston. And what that means to our healthcare sector in terms of how you know food insecurity, lack of access to healthy food, lack of purchasing power, for healthy food, contributes to really avoidable and disparate health outcomes most severely impacting women or trans community, and people of color. And I just started exploring that theme or like trying to understand the contours like what constitutes food security, like what has to be true for people to have access, reliable and consistent access to all the food that they need to be, and not just healthy, right, but like healthy and happy and hopeful and that that brings on a different set of like solutions. I think like when, when you apply that lens, as opposed to maybe just solving for hunger, or maybe just solving for health, you start thinking about happiness and health and hope and like the role of food as it relates to, you know, connecting with loved ones and with community and what it means to our ability to like, celebrate our culture and our heritage, you come up with a different set of solutions. So that was my starting point, you know, I just- I just drew on a lot of my first hand experience, in my community, you know, around Boston, all those same mentors that I was referencing before, to try to understand the problem. And then to try to understand what the existing solutions were. And then I started exploring, like, what opportunities were there to sort of build on a lot of the existing work that has been done to address food insecurity. But with a bend towards how do we embed this into healthcare delivery, because I was coming from that place as a public health worker, of like frustration and awareness that like food is not an embedded feature of care delivery in the US, by and large, definitely was not at that time. And like, this is 2011. You know, our State Health System was just transitioning towards, you know, a model of accountable care with our MassHealth, ACO pilot and 1115 waiver. And, you know, so I started to learn more about that payment innovation and how that was creating an opening for us to partner with health care to recruit them as an investor behind our mission, like a shared value investor behind our mission to increase healthy food access, understanding that healthcare, obviously, as a stake in making sure that people have the food that they need to be healthy if we want to address health disparities that are attributed to food insecurity and diet related disease, you know, in in service of health equity and cost avoidance as well, you know, it’s an economic imperative, which is probably the main motivator of why health care is getting in the game, on integrating food into health care delivery. So that was sort of the- just the progression in my mindset, when I was first starting out, just like a really ground up approach, looking around understanding the breadth and depth of the problem, connecting with folks understanding the existing solutions, and what opportunities there were to build from there.

Sujani 12:16
So as you’re researching until maybe even a step back, like you’re thinking about all of these ideas, and you know, in terms of like action items, are you like writing things down? Are you going out and talking to people? And then like, what are you doing in terms of like, thinking, are you just like, you know, putting a chair on your lawn and staring up at the sky just thinking about these problems? I’m curious.

Josh 12:40
Yeah, sometimes I mean, all those things. So I’ll tell you, I’m a big Evernote user. Yeah, you know, if anybody doesn’t know what Evernote is, it is the most simple like kind of like note taking app where you can tag notes that you write along the lines of like different themes, you can go back and like look at them later, you can look at a collection of whatever notes you’ve compiled over time, along the lines of themes. And I’ve noticed that day packed at college ranging everything from like management practices to like, frameworks for thinking about social innovation to conversations I have with people, like I’m a voracious note taker. So yes, like very simply, like I was, I was writing down notes. And, you know, I’d say another big part of my practice of just like, you know, learning and, you know, an expression of my curiosity is like just showing up, right, like, I was going to grocery stores, right, and just like looking around to try to just like, understand more about the mechanics of like, grocery retail, I was talking to people that were in the business, I was showing up at a ton of community programs, lots of folks that like, you know, I was already working with and just asking deeper questions, more specifically, along the lines of, you know, food access, food equity, food justice, talking to my patients, right? Like, I think we’re really lucky as public health workers, you know, that we have intimate access and trust to folks that we hope to serve like that what you know, there’s not any one single better guidepost, or social innovation than actually being able to connect with the folks that are experiencing the disparity that you’re attempting to address. And as a public health worker, we have a lot of just built up trust and an opportunity for like intimate conversations that are really, really hard to come by. And so, and I still continue to rely upon a lot of those that, you know, that built up trust and those relationships that I have to inform my work, but yeah, nothing. I’m a really chaotic, unstructured thinker. And you know, that that serves me well. Yeah, it was just a series of conversations and writing notes and a lot of just deep reflection. I mean, I probably did sit in a lunch outside, just to just think on, you know, what the next move was and what the opportunities might be. And you know, I’m a big believer in drawing on kind of like the history and work that’s already being done to inform what’s possible into the future. So connecting with a lot of peer organizations, you know, David Waters, a community servings, who has been leading the movement are on medically tailored meals and has expanded community servings in a really powerful way statewide across Massachusetts and this led advocacy efforts for like food as medicine was like one of my earliest mentors and I think it’s important to honor that work that’s already been done, but also to access those practitioners as a source of inspiration and as an informant for what else might be possible. So David and others were a hugely important part of also shaping you know, what, what went into the early stages of About Fresh and continue to be really formidable sources of support and inspiration as we’re moving forward here.

Sujani 15:23
Yeah, I think what I loved about what you were kind of describing about this process of, you know, figuring out how to solve this problem is, many of us probably have lots of knowledge and awareness of population that we’re serving and the populations that our ideas could eventually benefit. And I think, you know, you going into the grocery stores and talking to the people and almost testing our assumptions, and talking to the people who are going to be part of the solution is key. Couple of weeks ago, I went to this startup competition and they ask the panelists, if you were to do this all over again, like, what would you do? And what would you not do? And I was kind of reflecting about my journey. And I think what I was telling myself is, I would definitely get off my chair and away from the computer and go and talk to people and like, test the assumptions that you’re having in your head and talk to the people who are going to be part of the solution, right, like your mentor, the grocery stores. And so yeah, I really love that. And I think for any of our listeners who have these, you know, I feel like, you know, some of us have this, like itch to want to just solve a problem. And one, you have to believe that you can be part of that solution that the person who could actually come up with the solution for this problem, and then go out there and start talking to people to start telling the people about your ideas, start testing those assumptions. And yeah.

Josh 16:47
And I think I’d like to, to that end, super important. And I think that’s, that is a never ending pursuit to continually test your assumptions and like, prove to yourself why it is that you’re right. Right? Like, even if you feel pretty grounded, I think just that continuous exercise always nets out and better solution. Yes, that- that I think that practice of testing assumptions was like a really, really, really important part of like, how I entered a lot of those conversations. And I think it’s, it’s deeply embedded in into the culture of how it is that we, you know, set strategy and make decisions, you know, even 10 years later, right, as we evaluate our programs, and and how to continue to move forward and iterate.

Sujani 17:27
Yeah. So am I accurate? When I think of kind of the the evolution of About Fresh that the first thing that kind of materialized out of this mission, or this company, if you will, is the food truck?

Josh 17:43
Yes, yes. So our mobile market, our mobile market was-

Sujani 17:46
Sorry, yeah. Mobile Market.

Josh 17:48
Yeah, no. It’s a food truck, for sure. It’s a food truck, little bit different take on a food truck. And I’d say, food trucks in Boston, we’re just kind of coming on the scene. When I was first thinking about, starting About Fresh with our original program, Fresh Trucks, I took quite a bit of inspiration from kind of that free truck movement in Boston. Mayor Wu, our mayor in Boston now was a city councilor then and actually drove a lot of the policy to make it possible for food trucks to come to Boston. So it’s amazing to have her in the mayor’s office now. And it’s a little bit of a full circle moment for us just as far as the city leadership that made it possible for Fresh Truck, our original programs come to life. And yeah, I mean, you know, and, you know, the organization looks so much different in our early days, than it does now, like our original program, like we literally took an old sporty foot school bus, got it, put in a bunch of shelves, and then start pulling up at, you know, terminal produce terminal markets, loading it with food, and then just pulling up in communities and selling fruits and vegetables. You know, it was a super, super, super scrappy operation. And it was beautiful for that reason, you know, and again, talk about an opportunity to be in community with people and to engage with folks and to get feedback. You know, the program just by virtue of the fact that we were so deeply embedded into communities by literally driving food in neighborhoods was a really powerful mechanism, again, to just connect with folks and to learn more about the mission that we were pursuing. And then, you know, and then putting that aside, just food and food brings people together in a really powerful way. Grocery shopping, you know, you get people talking shit about who has the best recipe, like the culture and like, what they’re cooking that night, like we got people bring us food, we still do. Stuff folks like our shoppers, they’ll cook for us occasionally. You know, and then the culture and the history of like food. It’s remarkable, all of that came together in the early stages of Fresh Truck. And, you know, we came at sort of that original program with not a lot of resources, right? Like we did a little Kickstarter to buy a truck, which benefitted us you know, like you no one being forced to be scrappy, forces you to be creative. And it put us into a position and I think this is the right discipline even if you’re well resourced anyway, to make only small investments, and then to iterate and learn, inevitably, from only small mistakes, right? So just that discipline of like testing and iteration out ahead of any type of meaningful growth and scale has always been also an important part of our practice. And that was definitely how Fresh Truck came together, we made a ton of mistakes, you know, like, we put the exit door to get out of the mobile market, like if you think about sort of the the flow of how you would go shopping on a fresh truck, you walk in the front door, you pick up a basket, there’s, you know, beautiful fresh food all around you, you pick it out, you go shopping, and then you check out at the back of the truck, same way you would like any type of like small format market or a bodega. And what we set up the exit, so you go out the back of the truck, which means you’re parked on the side of the road, you’re kind of going out into traffic.

Sujani 17:53
Right.

Josh 18:07
You know, and like, we just didn’t think of that, of course, you didn’t think that we’d never run a mobile market before. And if we had built four trucks off the rip, with, like, just all doors off the back, that would have been four trucks that we would have had to fix and renovate to make sure that we weren’t sending our customers out in the traffic. And then we realized 40 feet was too long. So we started using 26 foot school buses, and we figured out different ways to make them more space efficient. So we can carry the same amount of food, make it easier for people to navigate the truck. And, yeah, so just just going back to like that original principle of just like curiosity, learning, testing your assumptions. You know, we did a lot of that in real time when we first launched Fresh Truck. And it was an amazing learning experience and Fresh Truck, I’d say for any of the new work that we’re pursuing now, the stuff that we’re thinking about doing in the future, really all comes back to Fresh Truck, you know, Fresh Truck is the number one design guideposts in the community and the team and just that operation are such an unbelievable source of inspiration for how it is that we go about pursuing our mission, it still is always will be, and it’s at the heart of all the work we do,

Sujani 21:51
As, taken look at your 2018 annual report. And, you know, I think you have some timelines in there, which I recommend everyone go check out and some of the elements of this community you’ve built from partnerships to volunteer to, it’s just incredible. And I’m glad you mentioned the Kickstarter component, because a lot of fear from wanting to start something and be the person that’s, you know, going to drive the change are finances. And so, you know, a lot of folks think, you know, I have this idea, but I don’t know how to get it funded, and where do I go for the money? And that’s a great idea. And maybe you could kind of explain those first few years of how your organization was trying to figure out the finances and maybe even like, what- what a Kickstarter campaign is for anyone who may be curious.

Josh 22:42
Yeah, you know, Kickstarter is a, you know, web based platform that allows you to create a campaign to like, start a company, or build an invention that you might go sell at some point into the future, you know, for a lot, a lot of bands, and artists use it to like pre fund a new project, a lot of documentaries are, like funded that way. And you know, the idea is that you can create that campaign, you can create a video, or I think just like a text campaign, and then you can create opportunities for people to contribute like a large crowd of people to contribute a small amount of dollars to bring the project or the business to life, or like a product or something like that. And then in return, you can offer different rewards for like everybody that invests in your project. So if it’s like a band, and you want to make a new CD, it’s kind of like people are pre buying a CD. In our case, we just sort of use Kickstarter as a way of reaching out into our Boston community to say, hey, we have this idea for turning a truck into a grocery store to address food access, what do you think, and were able to raise $30,000 to build our first truck using Kickstarter. Yeah, it was super, super successful. You know, it’s a great way of also just like recruiting support from a community of people. And you know, and it was, it was a great source of initial investment. But it is super risky. It’s super, super risky. And I felt that risk and got burned by that risk a little bit in the early stages of, you know, About Fresh, I’d also say it’s an incredible privilege to be able to have, like the flexibility to be able to pursue, you know, a startup, given the degree of risk that it brings on, if you have student loans, if you have obligations to family, if you just don’t have the financial capacity, which- which I didn’t like, at the time. It’s a whole lot harder and a whole lot riskier. And the downside is a lot more, you know, I took on like a lot of credit card debt. I worked a couple other jobs when I was first starting up About Fresh, but you know, I have a college degree. I live in Boston, like I live in the US. You know what I mean, I’m in, you know, just this incredible ecosystem of like health care actors and, you know, a really potent philanthropic community. You know, I went to Northeastern University, which is there in Boston, and also in and of itself as a tremendous community and having that- that bachelor’s degree behind me, all those things were incredible measures of like privilege that can’t be discounted, and what it takes to actually be successful, or to even have the opportunity to pursue a startup or a new idea like this, I don’t want to discount any of that privilege and all of the luck that I enjoy just- just, you know, having access to different people and meeting different people. So I want- I want to name that first. But yeah, it was a grind at the start, you know, I think, for a couple of reasons, I studied sociology in school, you know, I spent a lot of time in human services. So the program design, the outreach, building, the partnerships, you know, thinking about those fundamentals of what constitutes just like really high quality Human Services Program, kind of knew all that, but you know, didn’t know a lot about finance, accounting, you know, the more traditional elements of just like broad based business strategies, scaling, growth, strategic communications, you know, and so I was what I don’t know, it’s 23-24, or something at the time, when I was like, trying to, you know, cook up this whole idea, I just had a lot to learn. And so, you know, it was drinking out of a firehose, and then a lot of trial and error, and like, a lot of errors. And, you know, we ran out of money at like, super early stage, you know, to the point where we had to scale back a lot of our programs, and then, you know, go back to the drawing board to figure out simultaneously how to fundraise how to improve our programs, how to create more of a longer term plan for just like, you know, financial sustainability. And that brought on really material financial instability for me, you know, like, where I had to go get like more jobs, and I had to figure out ways to like pay rent, and cover like the rest of my living budget. And it was like, all at once really scary from like the standpoint of my own economic stability, but like, also embarrassing that we were floundering at this early stage back in like 2013. And I didn’t have as much support as I do now, I didn’t have a big backboard, and, you know, funders and a national network of partners and stuff like that, kind of like validating all of the work that I was doing. I did have a handful of small close mentors, but it was small and it was tight. And the level of confusion at that moment in time without the benefit of more professional experience was just, it was severe. It was- it was a lot. So it is emotionally fraught, and risky. And yeah, just just emotionally straining to start, start something up all that was true for me. And I think like all the best entrepreneurs, this is something I aspire to have the endurance, to just withstand those moments. And I’ve tried to channel that and source that from people that I’ve seen do it before, you know, my grandmother, and my mom are like huge sources of inspiration. They’re both single moms work super hard, multiple jobs, you know, and so I draw a lot from them just in terms of, you know, channeling that work rate, and like, earnings, and just that, that hope that we’ll figure it out. And we did, but it’s, it’s real, it’s really real. It’s nothing nice at the early stages, given all that risk. And there’s other inflections where, you know, it gets it gets risky or complicated or emotionally fraught, or just stressful. You know, that’s a I think that’s a persistent feature of startups.

Sujani 27:49
Yeah. Thank you for painting that honest picture for us, because it’s easy to kind of see the highlight reels and then-

Josh 27:57
Exactly.

Sujani 27:58
-not really kind of understand what it took to get to where you are and in like you said, the, the need to change something out there in the world run so deep. And you know, having the inspiration of strong individuals in your life, like your mom and grandmother, I think keeps you going right in, that they’ve been able to do it gives you that motivation and that light in that fire under yourself. To keep it going.

Josh 28:26
Absolutely. Got to find it from somewhere.

Sujani 28:28
Yeah, exactly. For me, too. It’s my mom, single mom, my dad passed away when we were really young. So, you know, I kind of see her and the way she’s persisted. And just the resilience I think, you know, you can draw from that and get inspiration from that. You mentioned like your your grandmother was one of the the people who you’ve drawn inspiration from and a lot of the things that you done that about cash comes from kind of what you’ve learned to her and I’m curious if you can point us to different things in your company that you know, directly tied to your grandmother.

Josh 29:06
Sure. Yeah. Man, Rita Trautwine. My grandmother, she was, you know, an amazing person. My grandfather, unfortunately passed away before I was born when my oldest aunt was eight years old. My mom was only six. Yeah, so she had her work cut out for her with like four kids, you know, and growing up, my mom worked a lot worked a couple jobs. And so I spent a lot of time after school and on the weekends, just like what come up with my grandmother. And, you know, the thing I admire about her that translates into, you know, I think our organizational culture, certainly how I approach my work and just the DNA of About Fresh in different ways, is just like her resilience and composure, you know, and like, this is true from my mom too, like this is so much hard stuff happening at different moments over the course of their lives. They still smile their way through it. You know what I mean? Like they- just I remember my- like my grandmother is 84 years old, she got in a car accident, you know, she broke some ribs, broke some fingers, she was alright. But she didn’t call anybody to get her out of the hospital, you know. And so after she was discharged, she didn’t want to bother anyone. And, you know, I mentioned at the top, she developed Alzheimer’s, and the last couple of years of her life is brutal. It’s a brutal, brutal, brutal disease, there was a full time caretaker. And, you know, she remembered me enough to know that it like, you know, she could trust me, and she loved me, but you know, forgot who I was. And, you know, for anybody that’s been a caregiver, particularly to a family member that is experiencing that type of like, cognitive decline. It’s sad, and it’s, it’s, it’s emotionally straining, and it’s frustrating. But it can also be really funny. There was a lot of just like, really humorous moments where, you know, my grandmother because of how she was experiencing Alzheimer’s, at that time, just had a lot of really funny stuff to say, and her most authentic self like, came out, and it was confused at different moments. And it was really funny. And we found a way despite the tragedy to laugh together, and as her motor skills were, like, declining, I just like my final memories of her before she passed, where’s just her not letting me help her up off the couch. She was just like, like, so defiant.

Sujani 31:13
As you’re talking about your grandmother, and then looking at pictures on your website, in your annual report, I see that I see the culture that you’ve built with that kind of laughter and just community and making everyone smile despite-

Josh 31:31
Yes.

Sujani 31:32
A problem-

Josh 31:33
Yeah.

Sujani 31:34
-of food insecurity that you’re trying to solve, which, you know, it’s, it’s not a fun place for people to be in. But I see that pictures of your community members, you know, shopping and being around you, the volunteers and your team members, like I feel it and I see it in those pictures.

Josh 31:50
Yeah. And then just despite all that, just like working hard, and like staying tough, been so important, it’s so many different moments to draw on that. And so yeah, she’s- she’s embedded into our DNA that way.

Sujani 32:02
Yeah. Incredible. Thank you for sharing that.

Josh 32:06
Ofcourse. I love lifting her up whenever I can. She’s the best.

Sujani 32:09
Amazing. So Fresh Connect, is that an idea that was kind of already there, but just not implemented? Until, you know, a few years later? Or did that come your conversations?

Josh 32:22
No, that would Fresh Connect was it was an accident, it was totally organic. Yeah, it was is- maybe not an accident. But it was an outgrowth of Fresh Truck that materialized in a very, very organic way. You know, and it makes too much sense when you take a step back and contemplate what the program actually does now. But you know, the starting point for Fresh Connect, were- we’re again, just coming back to a series of conversations we had with our community of shoppers, the way that our truck is set up, if you’re shopping on a fresh truck is that you know, you’re buying all the food, we accept cash credit, and like EBT. And we do all the normal stuff, coupons, that type of thing for our shoppers, you start to pay for our food, and it was super cheap, right? Like we’re a nonprofit focused on food access. So not really trying to get rich, our aim is really still now to just make sure that we breakeven on food costs, that as we grow as mechanism for financial sustainability, we’re not continuing those costs don’t continue to scale with us. And we wanted control over the inventory, we wanted all the gear that we sourced every single day to be like, really high quality culturally relevant to all the communities. So we wanted all that control over the inventory. And obviously, the only way to do that is to buy food, you can’t really rely on donated inventory, if you want to manage against just like those values of like freshness and consistency in, in variety, in line with- with culture across all the neighborhoods we’re serving. So that was one of the fundamentals of fresh truck. And even though our prices are low on the truck, and we’re at that time, we were still hearing back from our shoppers like, hey, you know, this is, you know, still not all of the food that I would otherwise want to buy for myself, or you know, my family. And so we started to just think about like that tension. And like how it is. And this is true for all of us at a certain stage, like how we negotiate grocery shopping, and what food we eat depending upon how much money we have in the bank, you know, like we all have different moments, or lots of us do anyway, even if we’re not experiencing food insecurity, like make trade offs, and we negotiate about what it is that we eat, depending upon what food budget we have at our disposal. And then for low income people experiencing like food insecurity. It’s not just like food insecurity, right? Like, it’s also a risk of like housing instability. And there’s a lot of other critical expenses that are all kind of like a zero sum equation. You know, it’s like rent or food or medicine or health care expenses or school supplies and transportation, you know, all those things are really, really essential. And so we started that conversation with with our shoppers just got us thinking about like the role of like purchasing power and affordability and shaping whether or not we have access to food. And then- and then we had dietitians and nutritionists and social workers at first asking us like hey, like I have this patient is food insecure. They have no money for food, you know, can I just cover it for them? You know, like, either they had a grant, or sometimes people were paying out of pocket. And we’re like, yeah, sure. And then we would do that literally just like sometimes do like, we’d have a nutritionist come on the bus, like take out their own credit card, buy food for a patient. And then we started coming up with like a super basic like coupon like paper coupon that would say the name of a health center, that like a nutritionist, or a social worker could hand out to a patient that they were encountering that was experiencing food insecurity. And that patient could use that coupon to go shopping in the truck. And it’d be like $10 of free food. Super simple. And then we would just invoice the health center for whatever coupon showed up. And it was, it was great. Like, you know, it was- it was a really great program, easy way for like, kind of our healthcare partners, mainly community health centers at that time to just fund food for patients and super popular patients loved it, because like, they had the flexibility to go shopping when they wanted to, they didn’t have to go to like, you know, a pantry on one specific day or go pick up food on one specific day, they can kind of use that coupon when they needed it any one of our sites around Boston.

Sujani 36:02
And how many sites did you have at the time?

Josh 36:04
I don’t know, somewhere between six and 10. I guess.

Sujani 36:08
These are all like, the Fresh Truck. Right?

Josh 36:11
Yeah.

Sujani 36:11
Okay.

Josh 36:12
Yeah, these are all just fresh talk weekly market sites, different neighborhoods around Boston, usually close by to community health centers, because those were our initial partners. Yeah, we just, you know, a handful of sites around the city, we’re up to, I think we have probably 22 weekly market locations now that Fresh Truck goes to all year round. So quite a bit bigger now than we were before. And then you know, that- that program just organically grew, you know, we started offering it as like kind of like a service as an add on to fresh truck for all of our Community Health Partners. And, you know, we got some initial grant funding, and we started to turn the screws on just that initial paper based program. And that was the original version of Fresh Connect, right, it materialize sort of just that organically. And then over time, we started to think about like, wow, wouldn’t it be great if people could go shopping at like more places than just Fresh Truck. And that’s counterintuitive for some people? Because it’s like, well, you know, don’t you want all the money to be coming to, like your mobile market? And it’s like, no, like, we’re not married to the invention of like, how do we grow this mobile market to be as big as possibly can, we’re married to our mission of making sure that people have reliable access to food. And to the extent that we can deliver on this, we want that food to be accessed in a manner that’s convenient and flexible, and provides people with a maximum amount of choice. And the reality is that, like, existing grocery stores are already really, really, really good at that, you know, we have a really limited sort of footprint, within kind of our mobile market model, that limits the amount of inventory that we can carry. And you know, we’re only ever in a neighborhood for a window of like, one to two days a week for two to three hours at a time. And like, don’t get me wrong, Fresh Truck is ultra powerful. And we have like 10s of, you know, more than 10,000 people that rely on us every year to access food, for different reasons. And it’s a super joyful experience, right? Like, we’re just like the local supermarket for lots of folks in the neighborhood. And, you know, and we’re doing a ton of organizing around food justice. So I’m not trying to diminish Fresh Truck by any stretch, but, you know, in line with that value of like, constantly interrogating your own assumptions, you know, we started to dream about like, what if it was possible to expand this program across the full breadth of the food system, bring the entire food system to bear down, like on this program, and then to open up the entire food system as a potential option for how it is that people could go about accessing food, you know, by way of a healthcare investment in your purchasing power. We kind of got into that dream state of like, Man, how do we make that possible? Like how do we how do we expand Fresh Connect, what it was time is a paper coupon is payment method to other grocery stores. And, you know, and so we really started to think about just the design principles and what we need to be true about the program in order to bring- bring it to scale. You know, I think starting with like the shopper kind of user experience, first that patient user experience, it’s like, alright, well, convenience, flexibility, and like joy are all things that were already wrapped up in the Fresh Truck that we wanted to carry over into Fresh Connect, then we started to think about like convenience on a different level. When we started to think about expanding this to other grocery stores, we wanted large and small format retailers, like farmers markets, we didn’t want it to be relegated to one grocery store, trying to come up with a payment solution that was agnostic to retailers. And we wanted to make sure that the point of sale experience was frictionless, like we knew full well sort of the embarrassment and fear and uncertainty that comes along with like just in general with managing the cash flow if you’re low income, it’s I mean, it’s something I’m familiar with like I’ve overdrafted debit cards have had that embarrassing experience but I don’t have enough money on my card or money in my wallet to buy the thing I thought I was going to buy in we wanted to sort of eliminate the cognitive burden and the stress associated with that uncertainty. And however it was we thought about like scaling this program. So to that end, like the the point of sale experience for how it is that somebody went about using you know, Fresh Connect into the future had to be frictionless because on our trucks it was really straightforward. In a piece paper it’s at 10 bucks. Bring that up on our trucks, you know, you can buy anything on our trucks, you know, using that piece of paper. And it was easy to make sure that like we were living by that value and how we were implementing the program. But when we started to think about the implementation of like, you know, our food prescription program within a grocery retail setting, it became infinitely more complex. Because on the healthcare side, you know, the only way we were getting healthcare to invest in consumer purchasing power for people was if it was aligned, kind of what their strategy around improving health outcomes, and driving down healthcare costs that are associated to diet related disease, which means that like, we had to set parameters around that spending inside of a big huge grocery retail setting and across a bunch of different types of stores. And that’s just like a super challenging process from like, sort of a technology and data standpoint. But we had to think about like, Okay, how is it on the healthcare side now as a healthcare user, that we ensure that we are enabling healthcare to make a very precise investment only in the foods that are aligned with patient’s healthcare goals? And then, how do we do that while also making sure that that point of sale experience going back to the patient is also frictionless so that people know what foods they can buy. And at that point of sale experience is in bringing on any confusion or embarrassment or like too much of a cognitive burden in terms of like, navigating what you can buy and what you can’t. And so I think all of those values in original design principles are wrapped up into Fresh Connect now, and it’s evolved into, you know, a prepaid debit card that is built on some of the same payment rails as EBT. Right? So EBT is obviously an ubiquitous payment method across a lot of different types of retailers, from farmers markets, all the way up to the big box stores. You know, we recently just announced the launch across all Kroger, Walmart and Albertsons stores, extending us into all 50 states into DC, across more than 10,000 retail locations total. So we’ve opened up the food system, at least by that much for all Fresh Connect users. And at this point, right now, Fresh Connect cards pay for only just fresh fruits and vegetables across all those retail locations. But we’ve been able to program our card, like leveraging some of that sort of underlying pre existing EBT payment rails and technology to automatically recognize approved healthy foods at the point of sale without any manual sorting at all whatsoever. So when you’re actually up at the register, if you have a basket of food, that is fresh fruits and vegetables, and then you know other stuff, our card will automatically recognize and adjudicate only just those fresh fruits and vegetables, and then prompt you to complete the transaction in the same way, like you know, you’re expending a balance and a gift card. So we really are, you know, in a huge amount of credit to our design team that has thought about this and our product team over how to deliver on that over three years, they’ve really achieved and been able to deliver on all those critical design principles for how it is that we make sure that our shopping experience is frictionless. It’s intuitive. And it’s it’s really joyful for all of our card holders and lives up to our covenant to our healthcare partners that we’re you know, we’re going to steward their investment into food access in a way that’s aligned with their- their population health strategy. So really excited that we were able to bring that vision to life, obviously, and for what that means in terms of the potential to scale the impact of our mission. But yeah, the starting point was Fresh Truck. You know, it was Fresh Truck is an outgrowth of fresh truck and just really deep engagement with our community partners and shoppers at Fresh Truck.

Sujani 43:15
That’s incredible. I think that I had read that the component of like, frictionless solutions, like I think I was hooked at that point, especially, you know, you’re addressing things like the embarrassment people feel in either like they have to pull out coupons versus you know, beautiful looking card that you can probably just scan like the- the level of stress that goes into, like pulling out coupons versus this card is I think, yeah, unmatchable, you know, maybe we can spend the last few minutes here talking about it from the kind of like the health care providers’ perspective, I think, before we started recording, I mentioned how a lot of our listeners are public health professionals. And if there’s any way that some of them could maybe reach out to you or help you on your mission through the organization they’re part of, I recently read that like, I’m not from the USA, I’m in Canada. So I don’t know too many of the organizations but that you have a snow partnership and you’re available across like 10,000 shops. So I think like Fresh Connect could be used across the country in the US. What are some ways that individuals could maybe reach out to you or your team to support this mission? Because as you explain for a healthcare organization to get on board, like to make sense, you know, operationally for them and yeah, maybe you can talk to us about that.

Josh 44:37
Yeah, sure. So, yeah, we are super excited to connect with like organizations large and small, like we work with small community based organizations who use Fresh Connect as kind of the technology backbone to deliver maybe a food prescription program that they already have in place. There’s lots of programs like the original fresh connect, that are using paper like wooden tokens like different analog mechanisms to deliver really great food prescription programs that are Oftentimes in search of just like a technology enabled solution, we are capable of kind of just sort of handing over our technology to community based organizations who want to use that and replacement for their existing program mechanics in a way that still allows them to own their program. But you know, using technology to streamline admin and to have greater visibility into data. So I’d start there. And then, like I said, we’re partnering with a small community based organizations recently announced a new partnership with the Rockefeller Foundation and the Veterans Health Administration spanning Salt Lake City, and Houston, which is, you know, really, really exciting. So we’re working with large integrated health systems, you know, we have a network of health systems across Massachusetts we work with, and then we’re in about six other states. And we work with all sorts of different people from within the healthcare ecosystem, from you know, like CFOs, and CEOs that are thinking about big population health decisions to, you know, heads of like health equity, and food security strategy from within health systems. And then providers and clinicians. And, you know, frontline like care navigators and public health workers. In a lot of ways, those folks that are on the frontlines were our best advocates and like entry point into a system, right, because they understand what the reality is on the ground, you know, really, we’re happy to connect with anybody that’s like within a healthcare setting, and is trying to think about how it is that you know, you incorporate food into your care delivery model. And, you know, we have a process set up where certainly, we can introduce Fresh Connect, you know, and just like how the program works at a high level, and we have a team that’s dedicated to doing that, and we’ll be very happy to connect with folks. But we have a really streamlined and efficient and thoughtful scoping process, like in place to really deeply understand like, kind of like existing healthcare workflow, and where fresh connect could fit in, in a way that like, makes it really easy to just incorporate fresh connect as an overall component of, you know, how a plan or a provider is taking care of patients. And, you know, and Fresh Connect was designed to be, you know, interoperable with existing healthcare IT infrastructure, and it was designed kind of with the limitations and the complexities of clinical settings in mind, like appreciating the fact that like lots of providers, you know, maybe don’t have the time to facilitate enrollment into a program like Fresh Connect, and then it might be on a care navigator, or, you know, a desk administrator. And so we really take a lot of care upfront to think about, like, okay, where does Fresh Connect fit? And so that would be kind of like the first step in partnering with our team to think about, like, how to incorporate Fresh Connect into your practice, or your plan, or your care model is just coming from that place of empathy and understanding, you know, what it will take for it to work specifically for your organization. And, yeah, like I said, we were just- just having launched across all those retailers and you know, investing quite a bit and a lot of growth scaffolding over the course of the last year, we’re definitely excited to like spread our wings, stand up new partnerships, and bring bring Fresh Connect to more households.

Sujani 47:58
Incredible, incredible work, you’re doing Josh. Like I- like I said, I’ve been completely mind blown by the work that you’re doing and develop fresh team. And I’m hoping we can keep in touch and help you out with your mission in some way. And maybe to wrap up our session. Any last words of wisdom for individuals, like you, Josh, who saw a problem and wanting to solve it?

Josh 48:23
Yeah, well, I mean, just, you know, sometimes it takes like, you know, somebody or something or a moment to just like prompt you to actually take action on an idea you’ve been thinking about a lot. So that’s me, right? Now, if you’re thinking about an idea that you’ve been sitting on it, just go do it, or like explore it. And I want to say thank you, you know, my role now is a little bit more like I have more of an office job now, not a frontline worker anymore, not my professional career anyway. And so I just, I just want to thank the folks that are still at it. It’s It’s a thankless job, and it’s a tiring job, and it’s not a lucrative job. But, you know, for other reasons we talked about in this conversation, it’s ultra important. And so just want to express that gratitude and honor the folks that are still doing the frontline work. Yeah, and then just invite partnership. You know, it’s just like, you know, Fresh Connect at its core is just like a really simple sort of technology backbone to fund food for people that are experiencing food insecurity and encountering diet related disease, you know, so we really do greet our work with an approach towards like fellowship with like, you know, all the frontline workers that might be listening right now working in public health. And yeah, just just really want to invite that partnership. And again, just express my gratitude. Thanks so much for having me. This is a great conversation.

Sujani 49:34
Hey, I hope you enjoyed that episode. And if you want to get the links or information mentioned in today’s episode, you can head over to pHspot.org/podcast. And we’ll have everything there for you. And before you go, I want to tell you about the public health career club. So if you’ve been looking for a place to connect and build meaningful relationships with other public health professionals, from all around the world, you should join us in the public health career club. We launched the club with the vision of becoming the number one hangout spot dedicated to building and growing your dream public health career. And in addition to being able to connect and build those meaningful relationships with other public health professionals, the club also offers other great resources for your career growth and success, like mindset coaching, job preparation, clinics, and career growth strategy sessions in the form of trainings and talks, all delivered by experts and inspiring individuals in these areas. So if you want to learn more or want to join the club, you can visit our page at pHspot.org/club. And we’ll have all the information there. And you know, as a space that’s being intentionally curated to bring together like minded public health professionals who are not only there to push themselves to become the best versions of themselves, but also each other. And with that, I can’t wait to see how this is going to have a ripple effect in the world as we all work together to better the health of our populations and just have immense impact in the world. And I hope you’ll be joining us in the public health career Club.