But while these health factors, including hunger and nutrition, have become part of the conversation, they haven’t really become part of the. medical system, apart from scattered pilot programs and state experiments.
This is what some health groups, advocates and researchers are trying to change now. They want to make food insecurity part of the real metrics used to rate and pay hospitals and doctors for Medicare. Health systems or providers would be held accountable for screening patients’ food and nutritional needs and then managing them.
Gary Price, a Connecticut surgeon who is president of the Physicians Foundation, which formally submitted the proposed metric, noted that existing quality programs can financially penalize physicians if their patients do poorly in certain areas. But doctors don’t have much control, for example, when diabetic patients can’t afford to buy fruits and vegetables, instead filling themselves with processed foods that may be cheap but are not good for. them.
“There are problems that a prescription for drugs just won’t solve,” Price said. It’s high time we gave doctors the tools to tackle social factors – and held them accountable for doing so.
It’s a long, multi-step regulatory path – and there’s a parallel process with Medicaid. There is no guarantee that this will turn out as defenders wish; many other measures are already in use or under consideration, and they do not focus on poverty and health.
But it started, with conversations about what the post-Covid health system should look like with federal government officials at the county level. There is even data to support this new approach to integrating healthy food into medical care from Accountable Health Communities, the only federal health experiment that has incorporated such measures.
Existing prescribing programs are a mix of pilot projects, state exemption experiments, and philanthropic enterprises, and it has been difficult to select and standardize the data. Still, some things have been established, said Rocco Perla, who joined Onie in founding The Health Initiative, and is a Center for Medicare and Medicaid Innovation veteran.
For example, a person with diabetes who is food insecure – which means they don’t have reliable access to healthy, affordable food – adds $ 4,500 a year to a health plan.
It can buy a lot of tomatoes.
Give someone a prescription for free fruits and vegetables is not the same as pointing someone to a pantry or using food stamps to buy subsidized healthy foods at a farmers market. Make one prescription – written by a trusted healthcare provider – directly links food to health and can prompt healthy eating and behavior changes.
“When you seek to combine the power of a doctor’s advice, the intelligence and knowledge of a nutritionist, the engaging skills of community health workers to prevent type 2 diabetes… it can bring measurable results. ”Said Nischan, the chef has become a culinary activist.
Whether the goal is to prevent someone with prediabetes from developing full-blown diabetes or to prevent someone who already has a disease from getting worse, spending a few hundred dollars on fruits and vegetables is much cheaper. than dialysis and amputation, he added.
And healthy eating can have a positive impact on the community. For example, Oliver doesn’t eat all the eggs that come in his delivery box, but a neighbor happily takes the extras. When a delicious farmhouse cheese from Vermont appears, she keeps it for the passage of her grandchildren.
Chinikqua Joseph, who also receives the food boxes and joined the conversation at the Westhaven center, tells a similar story. She lost her home to a fire during the pandemic and had not worked regularly. But the food – from the Food Hub plus a few extra veggies she gets from working in a nearby community garden – means she has enough eggplants, radishes, and zucchini to share with her mom and godmother. Sometimes she makes vegetable-rich smoothies for three.
“I can continue to make healthy choices,” she said. And that frees up money that she can spend on other needs, as she rebuilds her life after the fire.
But while Oliver and Joseph get healthy foods, they don’t get “prescribed” foods or the coaching or health monitoring that goes with it. That part of the “farm” program was scaled back during the pandemic as the group increased the global distribution of emergency food, said Laura Brown, director of communications and policy at Local Food Hub. The Hub is feeding more people now than before the pandemic, more than 500 households, but with less obvious health link. The organization doesn’t want to cut people off when Covid is still an issue, but over time it would like to restore a health and prescription component, preferably with a reliable funding stream through Medicare, Medicaid or a health plan.
But until Medicare and Medicaid change their policies to define food as medicine, funding for health plans is still a patchwork, a grant or a donation there, a payment from an administrative fund there. . He is not being paid out of health care money, yet.
Two hours south in Roanoke, Va., Another prescription product plan managed by the Local Environmental Agriculture Project, or LEAP, has taken a different path, but with similar goals. Driven by hunger, it also changed unexpectedly during the pandemic.
LEAP offers a mobile farmers’ market – essentially a food truck filled with fruits and vegetables – and parks it near clinics, schools and other community focal points. Originally, the organization partnered with three local clinics and got grants to subsidize food. Eligible patients therefore received a prescription and filled it free of charge from the truck, said executive director Maureen McNamara Best. They also received peer education on how to cook and eat healthy. The results were measurable – things like a drop in blood sugar readings in as little as 16 weeks.
During the pandemic, the focus shifted from prescribing to simply providing good, fresh food to hungry people, as has been the case in Charlottesville and other sites across the country. Emergency food aid is not normally LEAP’s goal, but it was a must this year, and by working with food centers further afield, it has managed to stay open all winter.
LEAP also has community gardens and a shared commercial kitchen to help small local food businesses get started – think bakers, jam makers and caterers – as part of the group’s larger goal of changing the food system. For health, McNamara Best believes that prescribing is part of the “scaffolding” to address the social determinants of health and the broader challenges of health, poverty and equity.
By working with local farmers and paying them fairly, LEAP wants to make fresh, healthy and local food both affordable and accessible to everyone – not just to the relatively small number of people who are medically eligible for a few months of a year. prescription program, and not just to people who can buy gourmet greens at a farmers market. There should be “a lot of different ways of having choice and dignity” in the food people choose, she said. For everyone.
It’s a big goal. Prescription programs are working, she says. “But sometimes it’s so hard to find a way to fund it all,” she said.
In the short term, as the country is still reeling from the pandemic, providing healthy food to people is the obvious priority. But in the long run, integrating food, shelter and other social needs into health care will receive more attention, but not without hindsight.