“Food as Medicine” Part Three: Successful Models in Chicago and Nationwide

Groundbreaking “Food as Medicine” programs in Chicago and across the United States have set examples for future “Food as Medicine” programs to follow.

In Part Two of our Food as Medicine series, we examined the socioeconomic data underpinning the emergence of Food as Medicine as a solution strategy. Now we’ll take a look at a handful of the various Food as Medicine program models currently tackling the hunger-health nexus.

Food Insecurity Screenings

Food insecurity screenings are a fundamental, procedural first step towards bridging the gap between food security and healthcare providers. Healthcare providers can quickly implement them as a routine procedure during patient visits. The data they generate can also serve to track patient progress and inform future programmatic solutions.

Hunger Vital Sign Screening Tool[1]
  • Description: This is a two-question screening tool based on the U.S. Household Food Security Scale. It helps identify households or individuals experiencing food insecurity. The two screening questions are as follows:
    • Within the past 12 months, did you worry whether your food would run out before you got money to buy more?
    • Within the past 12 months, did the food you bought ever not last and you didn’t have money to get more?
  • Screening tools enable healthcare providers to:
    • Refer patients to food pantries or social services
    • Examine readmission rates
    • Monitor a community’s food insecurity
    • Track patient progress
    • Determine a patient’s food benefit program eligibility
    • Monitor and evaluate “Food as Medicine” programs
    • Advocate for funding opportunities, such as grants or expanded SNAP funding

Food as Medicine Programming Models

Programmatic approaches directly address the food security or health needs of a community. They often require physical resources—such as staff or food—making them relatively more expensive. However, as discussed earlier, “Food as Medicine” programs reduce the healthcare costs incurred by food insecure patients, making such programming a valuable investment.

Medically-tailored meals (MTMs), Food Pharmacies, and Food Prescriptions (FRx)
  • Description:
    • Medically Tailored Meals (MTM) are approved by a Registered Dietitian Nutritionist (RDN) to address a diagnosis, symptoms, allergies, medication management, or side effects.[2] MTMs are often delivered to a patient’s door.
    • Similarly, food prescriptions are when a physician refers a patient to a food pantry for specific foods based on their identified health needs. After seeing a physician, patients are referred to a pantry for specific foods based on their identified health needs.
    • A food pharmacy is a food pantry that takes food prescriptions.
  • Benefits:
    • Studies show that medically tailored meals reduce ER visits and medical spending.[3]
    • MTMs for certain disease diagnoses can be funded using state or federal healthcare benefits.
  • Examples:
    • Veggie Rx in Chicago, Illinois is a food pharmacy partnership between the Chicago Botanic Garden and Lawndale Christian Health Center aimed at improving health outcomes for the North Lawndale community, particularly those with diet related illnesses. The Botanic Garden harvests veggies and packs Veggie Rx Boxes, and the Lawndale Christian Health Center writes prescriptions for patients to exchange for such boxes. Veggie Rx has also hosted cooking demonstrations and nutrition lessons in partnership with the Chicago Partnership for Health Promotion. The program is funded through the USDA’s Gus Schumacher Nutrition Incentive Program, formerly known as the Food Insecurity Nutrition Inventive (FINI) Program. 733 boxes were distributed in 2017.
    • Community Servings in Boston delivers prescription meals to patients with HIV-AIDS, diabetes, cancer, kidney disease, or other serious illnesses. They contract with Commonwealth Care Alliance, which provides medical care and social support to chronically sick or elderly patients.
    • Eskenazi Health in Indianapolis, Indiana provides 30 days of medically tailored meals delivered to the door of recently discharged patients free of charge.
    • Eat and Be Well Medical Pantry in Oak Park, Chicago, Illinois is a collaboration between West Suburban Medical Center and Temple Jeremiah food pantry. Physicians at West Suburban Medical Center write prescriptions for nutritious foods which patients can fulfill at Temple Jeremiah. Six weeks after a patient’s initial prescription, the physician and patient have a follow-up appointment, where the prescription can be renewed or changed.
    • West Town Health Market in West Town, Chicago, Illinois is funded by the Food Insecurity Nutrition Incentive (FINI) Grant Program. Presence Health partners with small farmers and urban growers to obtain produce at no cost. Physicians at Presence Medical Center and workers at local service organizations are given easy-to-fill-out food prescription forms. Clients can then access the fresh market by obtaining either a prescription from a physician or vouchers from local social service providers. Clients also receive one-on-one nutrition consultations during food pantry visits.
    • The Preventive Food Pantry at Boston Medical Center is the first medical center with a fully operating pantry. BMC primary care physicians administer a questionnaire to determine if a patient is food insecure, which surveys special nutrition needs and the number of people in each client’s household. Their pantry then pre-selects food options based on dietary restrictions. Patients are also referred to nutrition-centered cooking classes which help them use food from the pantry effectively.
    • Methodist Healthcare Ministries in South Texas partners with Wesley Nurses to have nursing staff at their food pantries who check blood pressure and blood sugar of food pantry clients.
    • ProMedica in Toledo, Ohio is a nonprofit health system that administers food insecurity screening to all patients. It also has a food recovery partnership with a nearby casino. Food insecure patients are given food prescriptions which can be fulfilled at an in-house food pantry. As a result, ProMedica has seen a 3% decline in emergency dept. usage, 53% reduction in readmission rates, and 4% increase in primary care visits after screening.
    • The UCHealth Family Medicine Center Food Pharmacy is modeled off of Boston Medical Center’s Grow Clinic. Patients can receive food assistance either via referrals or by being screened on-site. Their food pharmacy has hired a part-time pantry manager who can oversee volunteers and provide meal recommendations. In addition, the food pharmacy shares data with health staff in order to track patient outcomes.
Mobile Medical Services
  • Description: Bringing physicians or dietitians to food pantries to diagnose food insecure people
  • Benefits: Health clinics can diagnose and provide medical advice to food insecure people who may not have otherwise gone to or had access to a health service provider.
  • Examples:
    • Open Arms Ministry in Chicago, IL has a collaboration with the Heartland Alliance through which nurses and doctors visit the Open Arms food pantry twice a month to treat clients.
Mobile Food Services
  • Description: By bringing nutritional food to health service providers, food pantries can provide food to even more food insecure people.
  • Benefits: Meet clients where they are, when they are there. Unused food can be transported elsewhere. Can have a weekly schedule with different locations.
  • Examples:
    • The Greater Boston Food Bank uses a converted school bus to provide a free, monthly mobile farmer’s markers at various community health centers. Health center patients can collect fruits/veggies when leaving their appointments.
Connecting Patients with Benefits Programs
  • Description: After identifying potentially food insecure patients, health clinics direct patients to in-house or community help for applying to SNAP or other social benefit programs.
  • Benefits: As discussed previously, compared to low-income non-participants, SNAP participants…
    • Incur $1,400 less for health care annually.
    • Have fewer child ER visits for asthma.
    • Have fewer pregnancy-related ER visits.
    • Have lower probability of ER visit for high blood pressure.
    • Are less likely to skip medications.
  • Examples:
    • Arkansas Children’s Hospital worked with the state health department to establish an on-site WIC office. Food insecurity screenings are provided at every health visit. Those who are health insecure receive a grocery bag filled with food as well as info on social services, such as WIC, SNAP, and housing programs.
    • Boston Medical Center has trained some of their medical staff on how to help patients complete applications for food stamps and other benefits.
Nutrition Education
  • Description: Healthcare providers can provide nutrition education to food insecure clients.
    • Written Materials (do not require staffing)
      • Recipes,
      • Pamphlets/brochures,
      • Info boards/signage, or
    • Physical Lessons
      • Cooking classes
      • Nutrition workshops
  • Benefits: These lessons promote healthy eating habits. They can also be tailored to the needs and culture of the community and the food available in local pantries on any given day. In addition, food pantry clients may not be familiar with how to cook the foods available at a pantry. Nutrition education can empower clients to confidently cook available food.
  • Examples:
    • Boston Medical Center has a demonstration kitchen that provides healthy, affordable meal lessons.
      • Philanthropic support enabled outreach, community buy-in
      • Started small, advocated for more funding and space
    • Share Our Strength’s Cooking Matters classes are a partnership between the Arkansas Hunger Relief Alliance, a local children’s library, and Arkansas Children’s Hospital. Lessons are taught by local chefs and nutritionists. Patients learn how to plan, budget, shop, and cook with food security in mind.
    • Irving Park Community Food Pantry in Chicago, IL provides nutrition education classes led by undergraduates studying dietetics at Dominican University. Lesson instructors provide cooking, nutrition, and general health advice. After each lesson, instructors administer evaluation forms to inform lesson improvements.
    • Beyond Hunger (formerly Oak Park River Forest Food Pantry) in Chicago, IL provides cooking demos, recipes, and samples of dishes made from pantry items. They also distribute brief handouts and recipes on how to make the most of food supplies through behavioral changes.
Collaborative Research
  • Description: Healthcare and food security providers can partner with local universities or students to conduct research studies, needs assessments, feasibility studies, etc. in order to inform potential future programmatic approaches.
  • Benefits: Research collaborations can often be achieved without costing any money. They can help health and food security service providers tailor a programmatic solution to the needs of their community. In addition, research insights can be used to justify funding proposals.

Funding Avenues

Healthcare Funding

Attacking food insecurity as a healthcare issue has the added benefit of enabling access to certain healthcare-specific funding opportunities. Food security and healthcare providers should look for existing state funding for health/nutrition programs when implementing a “Food as Medicine” solution. The availability of such funding varies from state to state. However, it is certainly worth looking into, especially when modeling a program off of a preexisting program that is utilizing such funding.

  • Medicaid may cover services such as:[4]
    • Home-delivered meals
      • Under Section 1915(c) Home and Community Based Services waiver
        • Seniors, people with disabilities or mental illnesses
      • Under Section 1115 Demonstration Waivers
        • Give states broad options for expanded eligibility
  • Medicare may cover services such as:[5]
    • Nutritional counseling
      • Under Medicare Part B
    • Home-delivered meals
      • Under Medicare Part C (Medicare Advantage)
        • Example: Central Health Medi-Plan SNP in Los Angeles
      • Under Special Needs Plans (SNPs)
  • When looking for benefits funding, providers should look into the following government funding mechanisms:[6]
    • Medicaid
      • 1915 (c) Waivers
      • 1115 Waivers
      • Traumatic Brain Injury (TBI) & Aged and Disabled (AD) Waivers
      • Delivery System Reform Incentive
      • Payment Models
      • Community First Choice Option (CFCO)
      • In Lieu of Services Option
    • Medicare
      • Medicare Part B- Nutrition Counseling/
      • Medical Nutrition Therapy (select populations)
      • Medicare Part C – Medically Tailored
      • Home Delivered Meals (at plan’s discretion)
    • Other
      • Dual Eligible Demonstration Projects
      • (Medicaid/Medicare)
      • Private Insurance

Grant Opportunities

  • The Gus Schumacher Nutrition Incentive Program, or GusNIP (formerly the Food Insecurity Nutrition Incentive, or FINI) is a USDA-funded opportunity that supports projects which increase fruit and vegetable purchases among low-income individuals who receive SNAP benefits “by providing incentives at the point of purchase.”

There are three models for such programs:

  1. Individuals who purchase a SNAP eligible food are given incentives to purchase fruit or veggies
    1. Individuals who purchase fruit or veggies are given incentives to purchase SNAP eligible food
    1. Individuals who purchase fruit or veggies are given incentives to purchase fruit or veggies (this is the GusNIP-preferred model)

Proposed projects must have the support of the state agency responsible for the administration of SNAP (in the case of Illinois, this would be the Illinois Department of Human Services). GusNIP projects are meant to bring together various food system stakeholders and develop innovative mechanisms for SNAP benefit redemption. More info about GusNIP can be found on the USDA website.

Challenges

The benefits of Food as Medicine programs are abundant and undeniable. However, as with any new programming, there are challenges to starting and maintaining an effective Food as Medicine effort.

  • Impact evaluation
    • Control variable is hard to identify and measure
    • How do we know what health issues were avoided?
  • Scope of Impact
    • Can be restrained by food deserts and public transit
    • Requires savvy planning
  • Staffing Capacity
    • Volunteers, interns, or paid staff?
    • How will training be administered?
  • Screening Fatigue
    • Healthcare providers must ask the same food insecurity screening questions to every patient
    • Results of food insecurity screenings must be recorded and acted upon
    • Healthcare providers may already be burdened with existing patients and screening procedures
Thank you for reading our “Food as Medicine” research series. We’ll be posting more research on Food as Medicine and other hunger-related topics in the future, so make sure to subscribe to The NFPN Blog!

By Ryan Maia, AmeriCorps VISTA, Northwest Food Partners Network

Last Updated 10/28/2019


[1] http://www.hpoe.org/Reports-HPOE/2017/determinants-health-food-insecurity-role-of-hospitals.pdf

[2] http://www.fimcoalition.org/our-model

[3] https://www.ncbi.nlm.nih.gov/pubmed/29608345

[4] https://www.chlpi.org/new-publication-the-food-is-medicine-advocacy-toolkit/

[5] https://www.chlpi.org/new-publication-the-food-is-medicine-advocacy-toolkit/

[6] https://www.chlpi.org/new-publication-the-food-is-medicine-advocacy-toolkit/


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