Can food do the same thing as medicine?
The phrase “food is medicine” has become increasingly popular with doctors and dieticians, but it is also the name of an ambitious new statewide health initiative that hopes to decrease food insecurity and increase health.
In 2017, the Center for Health Law and Policy Intervention at Harvard Law School (CHLPI) and the Boston-based nonprofit Community Servings partnered to launch the Massachusetts Food is Medicine State Plan.
The first step of the process is to gather information, so the non-profits created a survey to collect input from health providers, insurers and food and nutrition service providers. They also held seven regional listening sessions to hear about the best practices and the challenges each area of the state faces.
Over 50 people attended the Cape Cod regional listening session in late June of 2018. All were interested in improving access to healthy foods, and included healthcare providers, food pantry workers and representatives from elder service organizations. They shared their ideas on what programs are actually working and what some of the obstacles are on Cape Cod.
Sarah Downer, an associate director at CHLPI, led the discussion.
“Our mission as a non-profit organization is to improve access to healthcare and quality of healthcare for folks who are underserved and have chronic illness,” she said. “My division at the Center is really focused on things across the care spectrum from prevention to end of life care. We look at strategies for how we really can make healthcare work – for our healthcare systems, for the folks who are needing it.”
Food and nutrition are central to their mission, Downer said, because so many health conditions like obesity, diabetes, heart disease and cancer are all affected by diet. Healthy food can help in both the prevention and treatment of those diseases.
“We’re at this moment of transformation of the healthcare system where folks are really starting to recognize that we need to look at food in a way that we have not done before,” she said. “There are also advances in research about what happens when you actually provide medically tailored food to people who have certain health problems.”
She used the FLAVORx research studies done by Kumara Sidhartha, MD, medical director at Emerald Physicians and medical director of the CCHC Physician Hospital Organization and the CCHC Accountable Care Organization, as a local example of research that showed the link between access to healthy food and improved health outcomes.
For FLAVORx, MassHealth patients with a body mass index (BMI) above 25 were randomly divided into two groups – treatment and control. Every week for 12 weeks, the patients in the treatment group were given a prescription to buy fruits and vegetables and a $30 token for local farmers markets. The control group was given gas cards of equal value. Both groups received nutrition and cooking education from registered dietician Nicole Cormier from Delicious Living Nutrition. Farmers’ market program was handled in partnership with Sustainable CAPE.
At the end of the 12 weeks of this randomized controlled trial, the treatment group showed significant improvements in blood glucose, total cholesterol, LDL cholesterol and BMI. The next step is to convince insurance companies to explore ways of paying for food prescriptions the same way they pay for procedures and medications, Dr. Sidhartha said.
Downer agrees this makes sense not only from a health and equity perspective but also from a cost one. She pointed to another study done when Community Servings, which partnered with researchers at Mass General Hospital to look at the insurance claims from patients Community Servings had been feeding over a five-year period. Those patients showed a 16 percent net reduction in healthcare spending for patients who received medically tailored meals.
The most significant savings came from a reduction of use of the most expensive areas of service: ambulance usage, emergency department visits and in-patient hospitalizations.
“There is a value proposition to this,” Downer said. “For the cost of one day in the hospital, you can feed that person three medically-healthy meals a day for six months.”
Cost of Hunger
The cost of hunger is staggering. A recently released study done by Children’s HealthWatch and sponsored by The Greater Boston Food Bank revealed that food instability cost t+he state of Massachusetts $2.4 billion in increased health-related expenditures in 2016 alone.
“We’ve been looking for ways that we can incorporate and integrate food and nutrition services into healthcare delivery financing,” Downer said. “Our end goal here is that we want the healthcare systems and the food care systems to work together to connect people to the food and nutrition that they need. Food and nutrition that is not only enough calories but also food and nutrition that support in maintaining and regaining their health.”
Some of the food interventions that have been discussed for the Food is Medicine State Plan include:
- Access to healthy food for those who are food insecure or malnourished.
- Medically tailored food for those who are at risk for acute or chronic illness.
- Medically tailored food for those with acute or chronic illness.
- Medically tailored meals for seniors or those with a disability who cannot shop or cook for themselves.
Programs like Community Servings are already providing those services in their area, but the Food is Medicine State Plan seeks to make sure that all residents in the state have equal access to healthy food.
The providers at the meeting on the Cape identified access to food and nutrition services for seniors, children and youth is the largest areas of need. Lack of access to healthy food and transportation issues were also sited as issues that need to be addressed more successfully.
The Cape Cod regional information gathering session was the last one of the series. Next CHLPI will condense all the data and feedback from the seven sessions and publish a report in October. They hope to begin implementing a plan in the spring of 2019.
Note: As of 5/1/2019, Emerald Physicians joined Medical Affiliates of Cape Cod (MACC), a division of primary and specialty care physicians from Cape Cod Healthcare.