Zoe Finch Totten seeks to seize America’s health care crisis as an opportunity to realign major forces in the health care and food industries so that they promote individual and collective health beginning with food quality.
The New Idea
Zoe Finch Totten is putting food back at the center of our national conversation about health. She believes in a simple formula: That our health depends in large part on the quality of the foods we eat. And yet in the United States, despite diet-related chronic illness on the rise and health care costs out of control, this simple truth seems to be largely overlooked. Over the last 50 years, Americans’ relationship with food has evolved into one of convenience that in many ways fuels preventable illnesses and strains our health system to treat those illnesses – forming a perverse equilibrium that the country’s political and economic forces have both enabled and sustained. Zoe founded The Full Yield to create a new equilibrium: One where the food and health care industries are no longer diametrically opposed but rather working together to promote health through mutually profitable partnerships.
The Full Yield, Inc. takes its name from farmers: if you start with high quality seeds, protect your soil to maintain and improve its inherent richness, water when necessary, and get lucky with the weather and the bugs, you’ll get a “full yield”—the greatest crops those seeds can produce.
Zoe uses this metaphor for both the individual body and for our collective culture: The Full Yield is both a comprehensive wellness program to help individuals transform their diet and a strategic and operational partner for corporations and industries interested in reducing the burden of health care expenditures and the economic cost of sick workers. The Full Yield generates demand for “health-supporting foods” from major forces in the U.S. economy like health care payers by framing health and wellness not only in terms of our well-being but also in terms of economic productivity. It then leverages this demand to push for alternative business models and supply chains within the food industry that support nutrition and health. Ultimately Zoe is working to prove that everyone – individuals, corporations, insurers, taxpayers, and even food manufacturers – can benefit from this new alignment, and that there is no other way to realistically address both a health and economic problem that will likely represent America’s greatest challenge over the next generation.
The Full Yield was founded in 2003 and its pilot partnership began in Massachusetts in 2008 with the nationally acclaimed Harvard Pilgrim Health Care, Roche Bros. Supermarkets, seven employers – including John Hancock, EMC, and the City of Boston—along with three food manufacturers and three food service providers. Her strategy is to stimulate similar regional groundswells across the United States, targeting health providers, employers, and food industry players willing to collaborate along a new value chain and lead fundamental transformation in their industries. The ultimate aim is to transform our culture from a health-depleting one into a health-supporting one.
The United States spends more on health care and less on food per capita than any population in the world. The Full Yield was created under the premise that the lack of awareness of the fundamental relationship between food quality and life quality has led to the rise of many preventable and costly diseases in the United States, resulting in losses in human productivity, quality of life, and many companies’ ability to manage their costs of operations. National health expenditures surpassed $2.6 trillion in 2010, nearly 18 percent of U.S. GDP and almost four times the $714 billion spent in 1990. And several studies suggest that these figures fail to capture the full economic cost of poor health embodied in productivity losses due to absenteeism, presenteeism (when employees are present at their jobs but unable to perform at full capacity) and disability. Every segment of society is feeling the burden, perhaps none more than the private sector, where family premiums for employer-sponsored health care coverage increased by 131 percent between 1999 and 2009.
Most disconcerting is that much of this country’s poor health is diet-related. Indeed, according to the Center for Disease Control, people with largely preventable chronic illnesses accounted for 84 percent of all health care spending in 2010. And the problem is only getting worse: The New York Times reported recently that by 2030, the cost of treating Type-2 Diabetes and cardiovascular disease – both preventable, diet-related diseases – could reach as much as $1.5 trillion annually.
When it comes to diet and lifestyle-driven diseases many are quick to blame the individual, but when two-thirds of society is overweight or obese one cannot ignore the contributing structural factors and societal failures. These include a food culture of convenience and highly processed food that is perpetuated by the food industry and its unrelenting marketing and lobbying machine. They include a health care industry with frequently perverse incentives and a medical model still designed around treatment rather than prevention. They even include the growing diet and nutrition industries whose approaches are often ineffective, promising quick and siloed fixes to complicated problems. All are underpinned by a society-wide failure to understand the fundamental value of food to our own health, and to societal and economic health. Together, these failures make it harder for individuals to make to right choices, and only by addressing them can we hope to shift America’s poor health trajectory.
The Full Yield’s strategy is built around a market-based model that leverages our collective recognition of the health crisis into demand for health-supporting foods on the part of individuals and institutions. Central to this strategy is directly connecting our health epidemic and its related costs back to the foods we eat, and then using economic logic (in addition to health) to push major industries to change how they go about doing business. The strategy is therefore deeply collaborative – requiring congruence between individuals, employers, health providers and payers, and the food industry, all of which commit to investments today that will pay great dividends in the future. In many respects, The Full Yield acts as a strategic and operational partner to make this collaboration possible, connecting the dots and showcasing through regional pilots how major economic forces can align themselves to begin solving this problem.
To understand Zoe’s strategy and assess its potential, it is essential to understand the historical moment that this country finds itself in. Despite the many structural failures noted above, the importance of preventive health care is now creeping into the national consciousness. Nearly every segment of society is thirsty for a solution because the cost of poor health has become a burden to all. Employers – who as a group represent the most powerfully funded change agents in our country – want more productive and less expensive employees. In fact, large businesses like IBM, Intel and Safeway have invested tens of millions over the last several years into corporate wellness programs and health centers. Meanwhile, health plans and disease management vendors want to capture as much of the employer market as possible and are struggling to find new approaches that improve health and reliably reduce costs. Policymakers want a way to ensure that Medicare and Medicaid remain solvent in the future and want to prevent public pension programs from driving state and local governments into bankruptcy. And for the first time ever, the health care reform act will hold hospitals liable if patients return with the same problems for which they were treated, shifting their responsibility more towards prevention. Indeed, the landscape is more accommodating to new thinking in this sphere today than it ever has been in the past. Remarkably, until now, very little of this thinking has focused on food.
One of The Full Yield’s mottos is “Put Food First.” At its core is a comprehensive wellness program focused on radically shifting participant diets from “health-depleting” to “health-supporting” foods. Individuals commit to a 12-month engagement that includes a 30-day full-immersion diet restricted to whole (unrefined and minimally processed) foods. Program elements include biometric and behavioral monitoring to track health status, disease risks, and progress toward better health; unlimited personal coaching and support; dietary guidance; cooking videos, recipes, and meal plans; pedometer and steps-based exercise; online food, activity, and health tracking tools; a member community and social supports. The program is fundamentally different from diet programs because its ultimate goal is wellness and long-term behavioral change, not weight loss (though weight loss typically occurs). The Full Yield shifts the focus from calorie counts to quality of food, categorizing all foods into health-supporting and depleting, and providing members with lists of specific products and brands that meet TFY criteria. Its programs are deliberately not incremental, but rather designed to push major dietary changes that are capable of shifting people’s palates and permanently transforming their relationship with food. In this way the Full Yield resembles an AA-like model of detoxification – and one that is bolstered by the increasing scientific evidence of the addictive nature of junk food.
Recognizing that overhauling one’s diet is demanding, The Full Yield works on various fronts to help it and its participants succeed. For one, it is embedded in the workplace where group dynamics increase membership and solidarity, and where a natural multiplier effect can take place. Second, whether a person enrolls through their employer, health plan, or as an independent consumer, much of the program is open to family members, including the weekly group coaching sessions, which bolsters both individual and societal behavioral change. Third, The Full Yield works simultaneously with health care payors (employers and health insurance companies) that sponsor the program and in many cases subsidize it, creating institutional support and demand that not only encourages individual participation (again, for cost-saving reasons as well as others) but also covers operational costs. Those putting money into the program recognize it as an investment that ultimately pays off – a perspective that is bolstered by the pilot program’s biometric and behavioral results. Finally, The Full Yield partners with food manufacturers, distributors and retailers to produce, package, and market health-supporting foods (both whole-food ingredients and also prepared, higher-margin meals) within corporate cafeterias and in surrounding supermarkets. Not only does this make it easier for consumers to find and buy health-supporting foods, it also allows the food players to benefit from rather than be penalized by increasing demand for higher quality food.
In this way, the wellness program is the cornerstone of a much larger effort to use demand from two major economic engines (employers and health payers) to shift another (the food industry). The Full Yield’s Massachusetts pilot was able to create this very chain reaction. It began with Harvard Pilgrim Health Care (HPHC), one of the nation’s most respected health providers that recognized that as a society we have become good at managing illness but have done a poor job of keeping people healthy. HPHC was intrigued by The Full Yield’s food-based wellness program and collaborative business model (the only one of its kind), invested pre-paid revenue in the pilot, and offered free participation to some of their accounts to test both the efficacy of the program and of the collaborative way to build a culture of wellness in the workplace. Again, the logic was straightforward: HPHC would help companies move their employees to better diets in order to improve productivity and satisfaction in the short term and lower preventable healthcare utilization and related costs in the long term. As employers signed on, Zoe identified partners in the food industry that could begin meeting demand for healthy prepared foods. This included the national catering group Flying Food Group (which prepares and packages food for Starbucks nationwide) as well as Roche Bros. Supermarkets, Aramark, Sodexo, and Epicurean regionall. Together, these various actors created an environment that sustainably facilitated healthy decision-making about food, albeit on a limited scale.
The Full Yield is unlike other efforts to reform our food system because rather than working at the margins, it seeks to channel powerful economic engines and use their own economic incentives to fuel transformative change. This strategy is highly efficient – making purposeful use of what already exists, from production and processing infrastructure to channels of distribution and sales. It is also well poised for scale, which is an essential component of any effort that hopes to make a dent in our health as a nation. As The Full Yield team begins to shift its attention to expanding nation-wide, it is actively involved in conversations with many major health plans, disease management companies, pharmacy benefits managers, retail pharmacy chains, some state and city governments and dozens of major employers. Zoe’s hope is to create similar regional groundswell through collaborative partnerships like those in the Massachusetts pilot.
Individuals who enrolled in The Full Yield Program have clinically and statistically improved their blood pressure, cholesterol, weight, and BMI, have increased their physical activity, and report experiencing more energy, better sleep, and reductions in medications because they followed program prescriptions and changed the quality of their diet. In addition, they reported that their families, friends and colleagues are paying attention and eating better too. Participant retention in the pilot was 35 percent after the full 12 months, a remarkable accomplishment given the rigor and length of the program, and given the difficulty most health improvement plans have with retention. During that time, the vast majority of participants lowered their weight, BMI, cholesterol, and blood pressure, and 21 percent of participants decreased their risk profile by at least one risk factor. As part of its growth strategy, The Full Yield will continue to expand and refine its clinical as well as behavioral and quality of life metrics because it recognizes the importance of demonstrating the cost-saving potential of the dietary shift.
Zoe founded The Full Yield as a for-profit business because she felt this organizational structure would give it the greatest chance of succeeding in creating systems change within the healthcare and food industries. The business is very much a business/social hybrid, the core purpose of which has always been to facilitate transformative change in the healthcare and food industries and promote health. Between 2004 and 2011, she raised approximately $5 million from investors which together with HPHC’s pre-paid revenue facilitated the launch of the program and pilot and which is helping them develop similar contracts nationally. On The Full Yield Board are Gary Hirshberg – Chairman and founder of Stonyfield Farm – as well as executives from Group DANONE and Daymon Worldwide.
Zoe grew up in a family of changemakers and big thinkers who spent much of their lives challenging conventional wisdom. Her mother’s maternal family helped populate Fairhope, Alabama, an egalitarian society and one of the few enduring utopias of the Progressive era, and supported the advancement of the Bookmobile in Kentucky, taking the model beyond cities and into rural counties for the first time. Zoe’s father helped document Lyndon Johnson’s poverty programs and both of her parents were actively involved in organizing Martin Luther King’s efforts. According to Zoe, “I grew up believing this is how one is meant to live life: with purpose.”
Raised by a cultural anthropologist, Zoe grew up in rural Central and Latin American and Australia as well as in the U.S. Everywhere they lived, her family cultivated much of their own food, from produce to livestock to “wilding,” and a painting of her family root cellar appeared on the cover of The New Yorker in 1980. Through these experiences Zoe developed a deep fascination with other cultures and traditions, and also came to appreciate the central role of food in human and planetary health, and in the creation and evolution of culture.
A graduate of Vassar College, Zoe went on to study midwifery at Yale, where she was directly exposed to the short and long term, individual and collective, physical and emotional costs of preventable disease and the ways in which the healthcare system disempowers and miseducates patients while the food system under-nourishes and misguides them. She describes this as life altering. By the end of her first month of her 29-month program, “using food as the Trojan Horse to improve and empower individual lives through a re-design of our health care and food systems” was at the epicenter of her thoughts and the template for the Full Yield Program and its collaborative business model were thus born.