By Alex Evans, PharmD, MBA
Poor nutrition is a leading cause of chronic disease in the United States and increases the risk for overweight and obesity, diabetes, heart disease and cancer. Despite this, according to the Centers for Disease Control and Prevention, nine out of 10 Americans consume too much sodium, less than one out of 10 Americans eat enough fruits or vegetables and half of American adults have at least one sugary beverage every day. Because access to healthy foods is limited in many parts of the country, poor nutrition is also a leading source of health disparities.
Innovative Food as Medicine partnerships are promising to reduce these health disparities and prevent chronic disease by treating good nutrition as a health benefit. Here, we'll look at what Food as Medicine programs are, the benefits to patients and organizations and how they are being implemented across the country.
What are Food as Medicine programs?
Also known as Food is Medicine, these programs approach nutrition and healthy food choices as a method to prevent, manage and treat chronic disease. They are provided to patients with little to no cost sharing. In addition to helping maintain a healthy diet, they also fight food insecurity, which has been associated with both poor mental and physical health.
There are several ways these nutrition programs have been implemented, including:
- Medically-tailored meals. In this approach, meals are fully prepared for patients based on recommendations from a nutrition professional and individualized based on patient needs and preferences.
- Medically-tailored groceries. Rather than preparing meals, another option is for a nutrition professional to select groceries for the patient to cook at home.
- Produce prescription programs. Vouchers are provided to the patient so they are able to buy fresh produce at participating partner locations.
What are the benefits?
Payers, pharmacists and patients can reap large rewards from this holistic approach to patient care.
One of the most widely-cited meta-analysis evaluates the impact of healthy food programs in Medicare and Medicaid programs on overall health, disease state outcomes and cost. This study simulates the effects of Food as Medicine programs on Medicare and Medicaid beneficiaries aged 35-80 years with over 82 million beneficiaries included in the analysis
They compared no intervention to either a 30 percent subsidy on fruits and vegetables (the "F&V incentive"), or a 30 percent subsidy on a range of healthy foods, including fruits and vegetables, whole grains, nuts and seeds, seafood and plant oils (the "healthy food incentive"). In the proposed model, the 30 percent credit would be provided via an EBT card, similar to the way SNAP benefits are administered.
They found both interventions to be highly effective in improving health outcomes and reducing cost. Specifically, they found that over a patient's lifetime, the F&V incentive:
- Prevented 1.93 million CVD events.
- Added 4.64 Quality-Adjusted Life Years.
- Saved $39.7 billion in formal healthcare costs.
In addition, they found that over a patient's lifetime, the healthy food incentive:
- Prevented 3.28 million CVD events and 120,000 cases of diabetes.
- Added 8.4 Quality-Adjusted Life Years.
- Saved $100.2 billion in formal healthcare costs.
Pharmacists move patients to action
Pharmacies, especially grocery store pharmacies, are in a unique position to help patients on the path to health by learning about and implementing healthier food choices.
As the pharmacy manager of a grocery store pharmacy, I saw firsthand the impact this could make. I once had a patient with type 2 diabetes who picked up her medicine every month from me, typically while doing her grocery shopping. During my cart inspections, which we shared a good laugh about while I rang up her medicine, I often found nothing except sugary drinks, beef, potatoes and condiments. She said, "I'm just a meat and potatoes kind of girl" and also cited cost as a reason for not buying healthier foods.
One day, though, I found a coupon for her branded oral antidiabetic that reduced her copay from $100 to $25, which she was ecstatic about. I asked her if she would be willing to spend some of the monthly savings on healthier foods and offered to walk the aisles with her to show her some of my favorite choices and discuss how to cook them. While she declined the offer, she was extremely thankful that I cared enough to spend time helping her. Going forward, she looked forward to showing off her carts with her efforts at improving her choices. After about one year, she was excited to tell me that her A1c had finally reached 7 percent.
While I identified this patient because I knew her — and she picked up her medicine every month from my pharmacy — if pharmacists had access to a list of potential patients, we could truly unleash our potential as a Food as Medicine program partner. This could be based on dispensing data, payer plan data or both. For example, if a patient had diabetes and their payer provided them medically-tailored meals as a benefit, that knowledge would allow us to speak to them at their next pharmacy visit and ensure they are taking advantage of their plan's benefit.
Payer partnerships are key to success
While pharmacists can identify their patients needing nutrition intervention and provide member-centric care, payers have the ability to touch many lives by offering Food as Medicine programs as a health plan benefit. In these cases, having the right partners can make all the difference.
Philadelphia-based Health Partners Plans (HPP) began their journey into Food as Medicine in 2014 as part of wider efforts to focus on nutrition and exercise to keep its members healthy and out of the hospital. In 2015, they partnered with MANNA, a non-profit providing medically-tailored meals and nutrition counseling.
To make this program a reality, case managers contacted members who were candidates for the program. After an assessment of interest and need, a referral was sent to MANNA, who then contacted the beneficiary within one to two days to schedule meal deliveries and a nutrition counseling session.
HPP initially enrolled 200 Medicaid patients with diabetes and then expanded the program to 1900 patients, including Medicare beneficiaries and those with other chronic conditions.
They, and their beneficiaries, saw impressive results. Six months after the program's launch, there was a 27.7 percent decrease in hospital admissions, 6.9 percent decrease in ER visits, 15.9 percent decrease in PCP visits and 7.1 percent decrease in specialist visits. In addition, more than one in four patients saw a reduction in their HbA1c.
In a member survey, the overwhelming majority of recipients reported the program helped them meet their medical needs, reach their health goals and understand the importance of healthy eating as it relates to their chronic disease.
