Fresh Food Farmacy

Food is medicine: field studies

Can patients prescribed fruits and vegetables achieve better health outcomes?

Allison Hess
Vice President, Health Innovation
Geisinger Steele Institute for Health Innovation

EATING THE RIGHT FOOD PLAYS AN IMPORTANT ROLE in overall health and the treatment of diet responsive conditions. By pairing fresh and nutritious food along with education and clinical services as part of a prescription-based program to their most at-risk patients with diabetes, Geisinger has improved patient outcomes while lowering per-patient costs.

Its Fresh Food Farmacy program provides qualifying patients with access to fresh, healthy, nutritious food, paired with education and clinical services, and more importantly empowers participants in the program to manage their medical conditions through food-related behavior and lifestyle changes.

Charting Preliminary Outcomes

To date, the program has shown that participating patients have 75% less hospital admissions, 30% less Emergency Room visits, and are more likely to close their preventive care gaps by having more regular visits with their primary care physician, when compared to a cohort population of those who participate but not enroll in the program. In addition, their participating patients with Type II Diabetes average a 2 point reduction in HbA1c, which when compared to already published literature could lead to a potential cost savings of $16,000-$24,000 per patient.

Information provided by Geisinger Health Plan

Geisinger Health Plan recently chose Scranton, PA as its third “Fresh Food Farmacy” location. A Community Needs assessment of the area identified alarming rates of diabetes coupled with increasing food insecurity statistics, with hunger, job security, transportation, and stable housing among the biggest social determinant issues that impact health outcomes for Scranton residents.

Without job security, individuals struggle to afford the food they need. Without reliable transportation and confronted by numerous food deserts, many patients rely on food service locations based on access that may not always offer the most nutritious food for themselves or their families. In cases where people are without stable housing, it becomes a challenge to store the food they can obtain from local food pantries.

Information provided by Geisinger Health Plan

Using food-as-medicine not only addresses food insecurity in these communities by providing patients and their families with a significant quantity of healthy, reliable food; it can also demonstrate how positive clinical impacts may help patients live healthier lives.

Providing increased awareness without judgement for these patients helps to strengthen a collaborative, community approach and serves as a catalyst to help patients better recognize the correlation between diet and health. This extensive education also includes grocery store tours, cooking demonstrations and group-based peer learning to help patients learn more about the impact of food on their diet responsive conditions.

Using Food to Treat Type 2 Diabetes

Responding to a National Epidemic

THERE IS A DIRECT CORRELATION BETWEEN food security, literacy, and access and health outcomes. In particular, there is a bidirectional relationship between food insecurity and Type II Diabetes. Processed foods are big contributors to rising rates of diabetes and aggravate other chronic conditions. Maintaining a healthy weight and learning to better control autoimmune disorders are all interconnected in the battle against diabetes.

We wouldn’t provide patients with three days of insulin a week and expect them to stretch out their dosage, or go for days without medicine and still adequately control their condition. The same applies to food when using food-as-medicine.

According to the Centers for Disease Control, by 2050, nearly 1 in 3 people in America will have type 2 diabetes. As a healthcare organization, Geisinger has invested heavily in the treatment of diabetes, yet despite the resources made available to their patients, they still saw an increase in the prevalence of uncontrolled diabetes. Lacking access to nutritious food as well as the awareness of how food impacts their chronic conditions often resulted in negative clinical results.

Information provided by Geisinger Health Plan

In Pennsylvania, 1 out of 8 individuals are food insecure and in our patients with Hba1c>9, it can be as many as 1 in 4.

As Geisinger started to consider a fundamentally different approach to how they treated Type II diabetes, they recognized that without the proper food available for this diet responsive condition, patients would likely remain unmanaged and have further health complications.

Geisinger’s Fresh Food Farmacy program, while recognizing that a patient’s situation may change at any point during their journey, began annual screenings of EHRs (electronic health records) to identify patients who were both food insecure and suffered from uncontrolled Type 2 Diabetes (HBA1C levels greater than 8). Qualifying patients are referred for proactive reach out, can request to join, or are referred by their physician or other health care provider.

Each week, patients receive enough food to prepare healthy and nutritious meals for their whole family, twice a day for five days, utilizing recipes provided by Geisinger registered dieticians to encourage them to explore and prepare new healthy options on their own. Staples include fresh fruits; whole grains; lean proteins such as chicken, fish, turkey, pork, and vegetarian friendly entrees; and additional staple items within guides for diets with limited sodium, saturated fats, and carbohydrates.

PhotoGRAPHY by Douglas Gayeton - CLICK TO ENLARGE

By identifying the connection between food insecurity and adverse health outcomes, Geisinger developed a team-based approach to improving their patients’ health.

Patients often “give up” on trying to manage their diabetes, becoming complacent with poor health and frequent visits to the hospital become part of their routine. Breaking that cycle by providing a program where they can see the direct impact on their clinical outcomes, empowers patients in Geisinger’s program and not just benefits them physically and clinically, but also emotionally. They see the true benefits derived by developing a healthier diet.

Do Fresh Food Pharmacies Work?

Tracking Patient Outcomes

When a participant first enrolls, baseline labs and biometric data are collected. Throughout the participant’s involvement in the program, markers are pulled to assess program effectiveness as well as identify any continued barriers or concerns, with the findings reviewed by the entire care team during Medical Home Meetings attended by the health coach, health manager, registered dietician, pharmacist, CHA, and other members of Geisinger’s leadership team.

Information provided by Geisinger Health Plan

Trends are continually assessed and solutions developed to target specific needs as well as tailor plans to ensure the patient has the proper tools to adequately self manage their condition.

To date, the program has shown that individuals who utilize the FFF have had 75% less admissions and 30% less ED rates than those of a similar cohort. They are also more likely to get preventive care gaps closed and have more regular visits with their primary care physician.

Information provided by Geisinger Health Plan

The program has also decreased A1C by 1-2 points, depending on the risk stratification of participants as well as their level of commitment to the program. The program has also captured an overall improvement in other health outcomes, including BMI, BP, LDL, and has assisted with care gap closure. Finally, Geisinger has also seen a transformation among patients who are now in control of their disease management (DM) rather than allowing DM to define them. Based on self-reported data, patients have also reported an increase in fruit and vegetable consumption, physical activity and improved overall health.

Coda

While each of their members has unique needs, Geisinger hopes that the ROI and patient outcome data they’re gathering with their multifaceted fresh food farmacy program will make it more likely for insurers to cover not only food as a benefit, but to provide clinical oversight utilizing coordinated clinical resources and the community-based organizations needed to help their members be successful long term.

Food is medicine: field studies