Health Systems Turn to Food Pharmacies to Improve Nutrition
April 1, 2023
By Melinda Young
EXECUTIVE SUMMARY
More health systems are creating food pharmacies to help patients with nutrition, food insecurity, and to improve their community’s health.
- Food pharmacies provide nutritious food to improve patients’ health.
- Hospitals can give patients a couple of weeks of meals when they are discharged.
- They can prevent patients from choosing between paying for food or medication.
Solving community food insecurity could be as simple as opening a food pharmacy — or as some health systems call it, a “Food Farmacy.”
Increasingly, population health efforts are turning to social determinants of health, including finding ways to overcome obstacles like food deserts and poor nutrition. New programs tackle the food insecurity issue by prioritizing nutrition and food access the same as medication — a necessary treatment for various chronic conditions.
Food pharmacies are a growing trend, says Kristin O’Neal, BSN, RN, ACM-RN, CCM, a former transitions of care administrator for a large healthcare system in Norman, OK. O’Neal is scheduled to speak about food pharmacies at the ACMA National Case Management Conference in April in Washington, DC.
“Having sustainable and nutritious food is just as important as the medications we’re recommending because it can help prevent chronic diseases,” O’Neal says.
Food pharmacies are a tactic for battling sickness and for improving a community’s overall health, says Brittany Damerow, RDN, SNS, a coordinator and dietitian for the Food FARMacy at Hurley Medical Center in Flint, MI.
“We began our program in 2017 because there is such a need in our community to create better health,” Damerow explains. “We focus on people who are facing food insecurity,” Damerow adds. “It’s important to define food insecurity by the U.S. Department of Agriculture’s definition — a lack of consistent access to food to live an active and healthy lifestyle.”
Managing Chronic Illness with Food
The health system created the Food FARMacy in Flint to help people manage their chronic illnesses and prevent illness. It also gives people the opportunity to learn better nutrition and gain access to healthy foods.
“We are focused on people who already have established healthcare. We do that population management piece, but we require a referral from a healthcare provider,” Damerow says.
Any member of the Hurley Medical Center care team — including case managers, social workers, primary care physicians, and others — can refer patients to the Food FARMacy.
Food pharmacies used their own methods for screening people to receive the food, what types of food to provide, and when and how long they will receive meals or food. (For more information, see the story in this issue about hospitals’ food pharmacy operations.)
One tactic is to provide meals to patients as they leave the hospital. These could be a couple of weeks of nutritious frozen meals or nonperishable food, based on the patient’s allergies and cultural preferences. Hospital dining staff can make these meals, and they can be delivered in light, freezer-friendly bags to patients. If patients are homeless, hospital staff could give them a bag of foods that do not require a microwave, can opener, or refrigerator.
A food pharmacy can complement a health system’s other efforts to help patients manage their diabetes and heart failure issues. This is especially true when patients must choose between paying for food or medication.
“The last thing we want is for patients to choose between food and medicine,” O’Neal stresses. “Food is number one on the Maslow’s hierarchy of needs, so it was a no-brainer to start a food pharmacy. It was hugely successful, touching patients in ways I don’t think anybody ever expected.”
Food pharmacies are popular with patients and can lead to health benefits. The organizers of one hospital’s Food Farmacy surveyed customers and found a 6% decrease in average weight over three months, says April Schetler, MS, RD, FAND, an assistant vice president of community health engagement at Virtua Health, headquartered in Marlton, NJ. The survey results also revealed a 3% decrease in patients’ average hemoglobin A1c levels, a 33% average increase in consumption of daily fruit and vegetables, and a 46% decrease in patients rating their overall health as poor.
“For us, it’s about trying to see the big picture when it comes to someone’s quality of life and general health,” Schetler says. “It’s an uncomfortable reality that many people in the communities we serve have to make impossible choices in order to stretch what money they have as best they can.”
When a health system provides people with access to free, healthy foods and offers counseling and coaching, it is eliminating a major financial stressor and ensuring no one in that person’s household is going to bed hungry.
“When Virtua Health launched its Eat Well programs five years ago, I think it caused some people to scratch their heads,” Schetler notes. “Investing so significantly in programs like this seemed outside the realm of a health system, known for hospitals, primary care, and [more].”
But since 2018, health systems are becoming more expansive and proactive in how they improve population health in a meaningful way. “In many ways, it’s common sense,” Schetler says. “It takes considerable resources and energy to restore a person’s health after they become ill.”
There is a huge benefit to health systems working to prevent illness — an approach that is better for the person and reduces the strain on providers.
Diabetes Care
Another health system’s food pharmacy employs a registered dietitian to order food and ensure every item meets American Diabetes Association guidelines, says Allison Hess, MBA, vice president of health services at Geisinger in Danville, PA. Geisinger’s Fresh Food Farmacy targets people with food insecurity and type 2 diabetes. It has successfully improved patients’ health and prevented ED visits and readmissions.
At the same time healthcare organizations are devoting more attention to patients’ nutritional needs and barriers, one decades-old nutritional solution is seeing its target population decline steadily in recent years. The Older Americans Act of 1965 created the National Aging Network and State Units on Aging. One of its programs is congregate meals for seniors.1
All states offer dozens of sites with federally funded, free meals for seniors older than age 60 years. All they have to do is show up at one of the meal sites. Some sites will provide transportation. But participation has dropped in the past decade.
It is something providers and case managers could refer to older patients with social determinants of health challenges, and yet it does not happen nearly enough, says Nandita Chaudhuri, PhD, a research scientist with the Public Policy Research Institute at Texas A&M University.
“If these programs were mentioned in reputable paperwork for all physicians, then the problem would be solved,” Chaudhuri says. “It’s a care coordination crisis, overall.”
For any health system that aims to improve population health, particularly among older Americans, this is a good resource. (For more information, see story in this issue on congregate meals.)
“The social determinant of health is [to improve] the general well-being of the older American population and the psychological well-being and social opportunities because most older Americans are lonely at home,” Chaudhuri explains.
First Steps
A first step in implementing a food pharmacy is to screen patients for a nutritional need. “We basically ask if in the last three months they ever went without food or worried about having a sustainable food supply for themselves or their families,” O’Neal explains. “It’s asked at admission to ensure all patients have this [screening] completed.”
Patients’ responses allow case managers to dig deeper and talk with them about other food options, such as state-funded snack benefits, Meals on Wheels, congregate meals at a community meeting site, and more.
“Are there local sources around their area, like food banks, that could be long-term options for the patient?” O’Neal asks. “Some payers have home-delivered meals to patients after hospitalization.”
Meeting short-term needs is important. Helping patients with long-term food insecurity is more of a challenge. “Long-term substation is more challenging, other than having patients go to local food banks,” O’Neal says. “There’s a gap that definitely needs to be explored a bit more.”
Case managers and providers should be sensitive to how patients perceive this kind of help because it takes time develop trust. “Screening for social determinants of health, in general, is a vulnerable topic, and you have to do it delicately and explain the why behind it,” O’Neal says. “Certain patients are guarded and apprehensive.”
For example, patients could be upset about answering questions related to their diet and ability to afford food. One way to build trust is for case managers to explain they are asking these questions to benefit the patient and help with their recovery, O’Neal suggests. By explaining how the case management/transitions of care team wants to provide them with solutions after discharge, it breaks down the barriers.
Consistency also is important. If the case manager tells a patient they will be discharged with some meals and to expect a follow-up call in a week, the case manager needs to make that call on time. If they do, patients are more likely to answer the call and talk about other problems because they have seen how they received at least one benefit without strings attached.
“There’s a technique and art to building rapport to get information to patients, and it helps to be consistent,” O’Neal says. “Do what you say you’re going to do, and don’t make promises you can’t keep.”
Food pharmacies also can be a way to engage with patients about social determinants of health. It is a good starting point, and a benefit that most patients appreciate once they receive it.
“The biggest piece on the transitions of care side is building that bridge to the patient,” O’Neal says. “The team can follow up with patients who have complex needs. When they’ve benefited from the food pharmacy, they’re much more likely to engage with the team and talk about other barriers they may have.”
Patients might say, “By the way, I don’t have a ride to my primary care appointment you made for me,” or “My medication costs $300 when I left the hospital, and I didn’t pick it up.”
“By offering food, the rapport we built with them helped connect them to our team, so we could help them with further needs and reduce inpatient readmissions and reduce utilizations in general, based on anecdotal evidence,” O’Neal says.
Eventually, successful food pharmacy programs can expand to offering food packages to patients visiting EDs or primary care clinics.
The food bags change according to the population. For instance, EDs would offer light bags filled with protein-rich items like tuna packs and ready-made meals, O’Neal says. Some food pharmacy programs are robust and expand offerings to more people in their communities.
“It’s really exciting, and I love that work,” O’Neal says.
REFERENCE
- USAging. Older Americans Act. 2023.
Solving community food insecurity could be as simple as opening a food pharmacy. Increasingly, population health efforts are turning to social determinants of health, including finding ways to overcome obstacles like food deserts and poor nutrition. New programs tackle the food insecurity issue by prioritizing nutrition and food access the same as medication — a necessary treatment for various chronic conditions.
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