Take Two Carrots and Call Me in the Morning


Stateline Sep7

The idea behind “food is medicine” is that if chronically ill people eat a nutritious diet, they’ll need fewer medications, emergency room visits and hospital readmissions.

Half a century after Americans began fighting hunger with monthly food stamps, the nation’s physicians and policymakers are focusing more than ever on what’s on each person’s plate.

In the 21st century, food is seen as medicine — and a tool to cut health care costs.

The “food is medicine” concept is simple: If chronically ill people eat a nutritious diet, they’ll need fewer medications, emergency room visits and hospital readmissions.

The food is medicine spectrum ranges from simply encouraging people to plant a garden and learn to cook healthfully, as state Sen. Judy Lee, a Republican, does in North Dakota — “We don’t do policies about gardening,” she said — to an intensive California pilot project that delivers two medically tailored meals plus snacks daily and offers three counseling sessions with a registered dietitian over 12 weeks.

The California Legislature last year became the first in the nation to fund a large-scale pilot project to test food is medicine. The three-year, $6 million project launched in April will serve about a thousand patients with congestive heart failure in seven counties.

“The state puts a huge amount of money into health care, and one of the biggest costs is medication,” Assemblyman Phil Ting, a Democrat and chairman of the Assembly Budget Committee, said in an interview. “So the hope is people will live longer and this project will also reduce the need for medication.”

The food is medicine concept has been around for a while. Since the 1980s, nonprofits such as Project Open Hand in San Francisco, Community Servings in Boston, God’s Love We Deliver in New York and MANNA or Metropolitan Area Neighborhood Nutrition Alliance in Philadelphia have provided medically tailored meals for patients with HIV, diabetes, cancer and heart disease. They are largely funded by donations and grants.

Seeing the programs’ successes, some states are taking a larger role. Massachusetts is developing a food is medicine plan with a goal of integrating programs scattered around the state so more residents can benefit. Legislative policy proposals are expected next spring.

Food is medicine goes beyond traditional advice to eat more fruits and vegetables. Projects pay for people to purchase produce and offer nutrition counseling and cooking classes, so they’ll know which foods to choose or avoid and how to prepare them. For example, watermelon is healthy for some, but not for a diabetic.

On the local level, a community garden managed by a teenager in Sylvester, Georgia, aims — with the help of the local hospital — to improve the health of the town in the nation’s “stroke belt.”

Physicians in a dozen states write “prescriptions” for fruits and vegetables at farmers markets and groceries — scripts that can be exchanged for tokens to buy produce.

“Food is medicine is an idea whose day has arrived,” said Robert Greenwald, faculty director of the Harvard Law School’s Center for Health Law and Policy Innovation, one of the experts who testified in January at the launch of the congressional Food is Medicine Working Group, part of the House Hunger Caucus.

The Senate version of the farm bill includes Harvesting Health, a pilot project to test fruit-and-vegetable prescriptions. It’s modeled on work by Wholesome Wave, a Bridgeport, Connecticut, nonprofit that works with health centers in a dozen states where doctors write prescriptions for produce.

If enacted, the federal government would spend $20 million over five years on grants to states or nonprofits to provide fruits and vegetables and nutrition education to low-income patients with diet-related conditions.

The Supplemental Nutrition Assistance Program, the food stamp program known as SNAP, helps reduce food insecurity for 39.6 million participants, but studies do not show SNAP improves nutrition. Instead, there seems to be a correlation between long-term food stamp participation and excess weight gain.

Poor diet was No. 1 of 17 leading risk factors for death in the United States in 2016 — a higher risk than smoking, drug use, lack of exercise and other factors, according to “The State of US Health,” a comprehensive report by a team of academics published in the Journal of the American Medical Association in April.

Dr. Kumara Sidhartha, an internal medicine specialist and medical director at Emerald Physicians on Cape Cod, Massachusetts, conducted a prescription study with Medicaid participants in 2016 and 2017. In his study, he wrote prescriptions or vouchers for one group to buy $30 in produce a week at the farmers market, and gave another $30 in gasoline vouchers a week — for 12 weeks. Both groups received cooking classes and nutrition counseling.

Twenty-four people completed the program, and those who received the fruit and vegetable prescriptions showed improvements in risk factors for chronic disease — better body mass index, total blood cholesterol, LDL cholesterol, blood glucose and hemoglobin A1c, Sidhartha said.

“Patients and physicians are so used to the physician writing prescriptions for procedures and pills,” he said. “This changes the health care culture of how the prescription is used.”  

Proponents of the California project hope it will demonstrate the cost-effectiveness of including medically tailored meals as an essential health benefit covered by Medi-Cal, California’s Medicaid program.

“This is potentially transformative because the health care system has been designed to cover acute services, and not many prevention programs are covered,” said Dr. Hilary Seligman, an associate professor at the University of California-San Francisco, one of two physician researchers who will evaluate the project by tracking participants’ medical records.

“For someone with congestive heart failure, their lives depend on their capacity to eat a lower salt diet,” Seligman said. “Making the food as appealing as possible is very important.”

Some legislators are skeptical about government moving into new food delivery systems.

“We need to feed the children who are hungry now. We need the backpack programs in school, the free and reduced-price breakfast and lunches to make sure that nobody is hungry today,” said North Dakota’s Lee, chairwoman of the state Senate Human Services Committee, at a food is medicine session at the National Conference of State Legislatures (NCSL) Hunger Partnership conference in July.

“But then we need to take those same children and help them learn how to do those things for themselves,” Lee said. “Let’s have a short-term solution: Let’s feed people. And then let’s have a longer-term solution: Help them feed themselves.”

Everyone in her state could have a garden, even apartment-dwellers, and they can learn to cook, she said, adding that cooking is a skill that’s been lost since schools there dropped home economics.

“Kids can learn and a parent can learn how to make a meal,” Lee said in an interview. “I’d rather figure out a way to give them cooking lessons with food. We’re not helping children become functional adults by giving them three meals a day.”

It’s not government’s job to provide every meal, she said, adding, “That’s the good news about North Dakota, compared with the Northeast and California.”

Georgia state Sen. Renee Unterman, a Republican and chairwoman of the state Senate Health and Human Services Committee and co-chairwoman of the NCSL hunger partnership, suggested at the food is medicine session that a community garden with a medical purpose in her state — and started by a child — could be a model.

Village Community Garden manager Janya Green was 12 when she started on the community garden as her 4-H Club project three years ago on 5 acres donated by the town of Sylvester, population 6,000, about 170 miles south of Atlanta. Anyone can pick free vegetables and fruit whenever they like. The garden features cabbage, carrots, kale, okra, bell peppers, squash, sweet potatoes, blackberries, blueberries, muscadine grapes and even bananas. Herbs are next.

A pond is stocked with fish, so residents can reel in healthy protein as well. A local county commissioner gave lumber for a 20- by 60-foot stage.

Phoebe Worth Medical Center installed an outdoor kitchen in the garden for chef-taught cooking classes. Darrell Sabbs, governmental affairs specialist at the medical center, hopes researchers from Emory University or the University of Georgia will study the health statistics of the neighborhood and gauge the garden’s health effects.

Dr. Marilyn Carter, an internal medicine physician who also trained as a pharmacist, lives in Sylvester and volunteers at the garden. She and a nutritionist wrote up health benefits of the produce for signs that will help people make smart choices.

“We’re in the stroke belt,” Carter pointed out, adding that many of her patients have heart disease and diabetes. People eat a typical Southern diet of fried foods and foods out of boxes that are high calorie and high fat, she said.

“I want people to know, ‘If I eat more kale and less white rice, my blood pressure will be better,’” she said. Her name for the garden: the Farmacy.



Medically tailored food is the future of health care


Medically tailored food is the future of health care

Imagine you’re living with type 2 diabetes. You’ve been trying to manage the condition for years with a typical medication. What if instead of metformin — a drug that works to lower sugar in the blood, — our doctor could simply prescribe meals tailored to your unique diagnosis that help control your blood sugar? A growing body of research indicates that such a shift in treatment, away from Big Pharma and towards common-sense treatment measures, is the future of U.S. health care.

For too long, the sickest patients in this country have been ill-served by a system that rewards doctors and insurers for the volume of services they render versus the quality of health outcomes their methods deliver. “Food Is Medicine” is a new approach that nonprofits, politicians, medical centers and nutrition experts are increasingly recommending as a low-cost, high-impact intervention that complements or supplants the use of expensive, pharmaceutical drugs.

In recognition of this growing medical consensus, the House Hunger Caucus recently launched a bipartisan Food is Medicine Working Group, led by Rep. Jim McGovern (D-Mass.) and other caucus members, the overarching goal of which is the better alignment of government nutrition policy and health outcomes.

Some of the group’s suggestions are policy initiatives including: incentivizing the purchase of healthy food, strengthening the Supplemental Nutrition Assistance Program (SNAP), adding medically tailored meals to the care plans of those fighting severe and chronic diseases and programs through which doctors can prescribe well-balanced diets.

Chronic diseases afflict 120 million Americans and account for an astounding 75 percent of U.S. healthcare spending. The need for creative solutions to help our nation’s highest need consumers of health services is significant. By taking steps like those outlined above by McGovern in January, we will be moving towards a more effective system for keeping people healthy and out of the doctor’s office. We will also be saving patients and insurers a lot of money.

The Hunger Caucus’ Food is Medicine Working Group meets this week to discuss the research, policy and practice of incorporating medically tailored meals into healthcare across the country.

Medically tailored meals (MTM) are meals tailored to the specific medical conditions, medications, side effects, allergies and other needs of a person living with severe or chronic illness. In this briefing, two recent studies will be discussed, both of which present compelling evidence that MTM can significantly improve health outcomes while curbing care costs. Both studies involved MTM provided by Food is Medicine Coalition nonprofit organizations. FIMC is a national alliance of MTM providers that I am proud to lead as the President & CEO of God’s Love We Deliver.

As a result of the findings published in a 2013 study, MANNA in Philadelphia partnered with Pennsylvania-based Medicaid managed care organization Health Partners Plans on an ongoing contract that resulted inthe delivery of medically tailored meals to HPP members living with illnesses like diabetes, heart disease, malnutrition and kidney failure.

That study found a 28 percent reduction in inpatient hospitalization and 9 percent reduction in ED visits, when members received medically tailored meals. Another MTM provider, Community Servings in Boston, conducted a retrospective claims analysis study with Massachusetts General Hospital and determined a 16 percent net healthcare cost savings with MTM. Results were published in Health Affairs.

In each instance, medical diets helped keep ill patients out of the hospital, which is critically important considering that one can provide half a year’s worth of medically tailored meals for the cost of one night in a hospital.

God’s Love We Deliver has found similar results in people living with HIV and FIMC agency Project Open Hand in San Francisco demonstrated cost savings for patients with type 2 diabetes and increased adherence for people living with HIV.

The Food is Medicine Coalition strives for a positive continuation of the trend towards expanded healthcare access brought to this country by the Affordable Care Act close to a decade ago. The ACA allowed organizations focusing on the medically underprivileged, like those within the Food is Medicine Coalition, to work in a grassroots manner with regional Medicaid programs to implement additional benefits, like medically tailored food and nutrition, to high-need patients’ care plans.

The good sense of keeping a healthy diet shouldn’t be news to anyone. We sometimes lose sight, however, of how our basic everyday behaviors influence our long-term health. “Food Is Medicine” is more than a quaint cliché. It’s a proven, viable healthcare solution that must become a more central aspect to how we deal with an American epidemic of chronic illness.