December 2018, Volume XXXII, No 9
Meals for Healing
Second Harvest Heartland’s FOODRx program tackles food insecurity and chronic illness, paving the way for better outcomes and lower costs
Ralph and Lisa, a married couple in St. Cloud, Minnesota, have a range of challenging health diagnoses between them, including type 1 diabetes, type 2 diabetes, and congestive heart failure. They also struggle with food insecurity, with Lisa’s health conditions making it difficult for her to work. At a recent trip to their doctor’s office, they were offered a unique opportunity to enroll in a new program, FOODRx, that would provide them with a monthly box of shelf-stable, wholesome food at no cost—food specifically chosen to support their health conditions.
They gave us healthier foods, like beans and milk, that we incorporated into our diet,” says Ralph. Lisa’s blood sugar levels showed improvement after they started receiving the boxes, and Ralph lost weight. When the program ended after 12 months, the family continued to enjoy their new favorite healthy foods. “I buy a lot more healthy food now than before the FOODRx boxes,” says Ralph. “I know how to enjoy it more.”
It’s no secret that nutrition plays a vital role in wellbeing. Health care professionals and hunger-relief organizations alike have looked across the divide at one another and seen the value of one another’s work.
But what about that divide? A physician may give a chronically ill patient detailed nutrition advice, but if that person doesn’t have consistent access to healthy food due to financial or logistical barriers, there’s not much either the patient or physician can do. Even if that patient makes her way to a local food shelf, she may be wary of choosing unfamiliar items or produce that she doesn’t know how to prepare or is worried she won’t like. The question is how both guidance and affordable access can be woven together, with nutritional support undergirding medical interventions in a way that promotes better health outcomes and reduces medical costs.
The Minnesota pilot program FOODRx, spearheaded by regional hunger-relief organization, Second Harvest Heartland, aims to bridge the historical divide between health care and nutrition support for food-insecure people with chronic illnesses. It aims to reach diverse populations with an intervention that can both manage and improve disease states—as well as improve outcomes and cost effectiveness for health care leaders and providers.
“FoodRx pilots showed improved health outcomes, lower costs, and fewer hospital visits.”
The High Cost of Hunger and Disease
Research has firmly established strong links between hunger and chronic disease. A 2017 report from the U.S. Department of Agriculture concluded that food insecurity is tied to 10 out of 10 major chronic illnesses (only 3 of 10 could be strongly associated with low income), with even relatively mild hunger raising rates of hypertension and diabetes by 20 and 59 percent, respectively. These chronic diseases have the greatest impact on quality of life, life expectancy, and societal costs in the form of medical expense and emergency room visits.
Another study at the University of Minnesota estimated that food insecurity in the state leads to $800 million to $1 billion in annual health care costs. A 2013 study conducted by the Boston Consulting Group also found strong connections between hunger and chronic conditions such as diabetes and heart disease and, even more provocatively, estimated that providing food through health care channels could lead to providing 30 to 45 million needed meals per year in the state. FOODRx sprang from this insight—that the doctor’s office could be a means of reaching hungry individuals who might otherwise not access food shelves or state supplemental nutrition benefits.
“If we can effectively integrate our work into the health care system, we can reach people we don’t usually reach,” says Jason Reed, Second Harvest’s Director of Strategy and New Ventures. “And our data showed that hungry people were accessing the health care system more often than the general population.”
FOODRx has strategically addressed the hunger-chronic disease linkage with a focus on creating a workable model that could be employed throughout the state. Its foundational idea is creating better outcomes and return on investment for health care systems, along with a financial model based on scale and sustainability. This business model is crucial—rather than create a philanthropy-based model FOODRx has focused on funding from health care systems, insurance providers, and other partners that stand to gain positive financial benefits for value-based cost lowering and positive health outcomes.
“FOODRx enabled us to test this value-based care model and see whether patients improved their health,” Reed adds. “Pilots showed improved health outcomes, lower costs, and fewer hospital visits.”
FOODRx pilots have focused on acute and chronic hunger among low-income patients in the Minnesota health care system. Qualifying individuals receive roughly 25 meals in a 30-pound box of food every month for six to 12 months. A staff dietitian at Second Harvest develops and designs the food boxes, which are tailored for chronic conditions such as diabetes and heart disease. The contents of the boxes, which contain recipes and nutrition information, can also be tailored for specific cultural populations such as Somalis, Latinos, and traditional American (these are options, not proscriptions—in one case, for instance, a younger Somali individual preferred the traditional American food option). Giving patients agency in choosing the boxes they prefer increases the likelihood that they will consume the contents.
“We were able to meet with patients at least quarterly, to talk about what was in their box, and which foods were good for their chronic disease states,” says dietician Paula Redemske, who worked with a pilot at the CentraCare Family Health Center in St. Cloud. “I saw people we’d had trouble getting into the clinic come and sit through education sessions and be successful because we were providing the food for them.”
“Addressing hunger as a health problem within the health care system makes a lot of sense.”