Nourishing Knowledge: Melissa Topp Of Providence Health Plan On The Power of Food as Medicine

An Interview With Wanda Malhotra

Phosphorus and calcium — Phosphorous and calcium are essential for bone health, but extra phosphorous causes potentially harmful changes in the body including an increased risk of heart attack, and stroke. For this reason, people with specific chronic conditions such as kidney disease, or those taking certain medications, must be cautious of foods high in vitamins like phosphorus or calcium, including dairy products, organ meats, and whole grains.

In an era dominated by pharmaceutical solutions, there is a rising consciousness about the incredible healing and preventive powers of food. As the age-old saying goes, “Let food be thy medicine, and medicine be thy food.” But how does this translate in today’s world? Can we really use nutrition as a potent tool against sickness and disease? How does one curate a diet that supports health, longevity, and wellness? In this series, we are talking to nutritionists, dietitians, medical professionals, holistic health experts, and anyone with authoritative knowledge on the subject. As a part of this series, we had the pleasure of interviewing Melisa Topp, Executive Director, Care Management, Providence Health Plan.

Melissa Topp MSN, RN, has over 24 years of nursing practice experience, 15 of those years in managed care and leadership. She received her Master of Science in Nursing Informatics in 2013 through Walden University. Through Mel’s work, she was recognized in 2017 as a community leader in nursing, receiving the “2017 Leading the Way” award presented by the Oregon Nursing Leadership Council. She was also nominated for the Dr. Martin L. Block Award for Innovation & Excellence in 2022 which acknowledges an individual’s effort to enhance the lives of America’s seniors through clinical leadership, policy vision and by superior example. Mel currently works as Executive Director, Care Management at Providence Health Plan where she is committed to providing Holistic care. This includes a focus on the integration of healthcare services encompassing physical health, dental health, behavioral health, and social determinants. She has assisted and led programs promoting education of our public servants and health care providers who care for or experience people with chronic medical conditions, social determinants, mental health and/or substance use conditions. Mel is dedicated to processes which support delivering person-centered health care and decreasing fragmentation of services in a complicated health care system.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your backstory?

I was born and raised in Montana but came to Portland after high school to be a computer programmer. However, I ended up pivoting my focus to nursing school after being inspired by the nurses who cared for me during the birth of my first child. I practiced as a critical care nurse at Providence St. Vincent’s Hospital for several years, but after I got married and had children, I wanted to be more involved in their afterschool activities. Moving to the insurance side of healthcare allowed for flexibility in my schedule so I could spend more time with my family.

In my first role at the health plan, I was introduced to care management and intrigued by the idea of not only addressing the physical health of a community, patient, or member, but the holistic part of that person — their financial health, social health, spiritual health, mental health, dental health, and of course, physical health. The road to my current position as Executive Director of Care Management for Providence Health Plans was paved by my experiences in various care management lines of business.

After moving through the basics of care management, I had the privilege of exploring some impactful initiatives that couldn’t have been accomplished in other work streams or even through patient- or hospital-based services. Care managers are unique because they have the time to interact and intervene with members on a different level than providers. Having the support of a mission-oriented health plan like Providence Health Plan has allowed my team to pilot out-of-the-box programs like Food As Medicine, Medication Reconciliation, Optimal Aging, and In-Home Care Management.

What or who inspired you to pursue your career?

My inspiration for being a nurse came from my experience as a patient. When I was in labor with my first daughter, I had an experience in the hospital where I felt very nurtured as a patient, and I had another experience in the hospital where I didn’t. Those distinct experiences within one admission as a healthy young woman having a healthy baby completely changed my entire focus. I decided right then that I wanted to be a nurse. And more specifically, I wanted to be a nurturing nurse. So, I earned my bachelor’s in nursing practice, and in 2013, I earned a master’s in nursing informatics. In the end, I was able to combine my love of technology and my experience nurturing patients.

It has been said that our mistakes can sometimes be our greatest teachers. Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

Looking back, there’s one story from my time as a student nurse that always makes me laugh. As I shared previously, after the delivery of my first child, I wanted to be an obstetrics nurse. I wanted to help other moms have babies, and I was determined to fulfill the role of the nurturing nurse by holding patients’ hands through the delivery. However, during one of my first rotations, the mom I was helping care for ended up needing a C-section. In the rush to get her to the operating room, I was given one job ― to get the IV poll with the bed into the operating room. As we came to the threshold, I couldn’t get the IV poll through the doorway. In the chaos, I didn’t realize the IV pole was too high, and I panicked. The senior nurse very calmly told me to adjust the IV pole to make it shorter. The solution seemed so obvious, but at that moment, I couldn’t see it. From that experience I learned the value of stepping back and evaluating a situation. I also learned it was not my calling to become an obstetrics nurse, and I instead switched to critical care. The IV poll experience opened my eyes and taught me the basic concepts of being calm and analytical.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

There are many traits that contribute to becoming a strong leader, but the three I strive to achieve every day include:

1. Compassion ― My nursing background has provided me with a great perspective working as a leader in care management. Whether it’s a patient or a member standing in front of me, my experience on both sides of the care spectrum has taught me compassion and drives me to go beyond what is present to see the whole story.
2. Excellence ― I believe in excellence, as aligned with Providence Health Plan’s Mission and values, but also excellence in the capacity of expectations. I have high expectations for myself, for my team, and for my leaders, to deliver the best customer service and the best care management services possible. To do that requires us to know what tools are needed and what’s working or not working. It also requires us to understand that mistakes are going to be made, and to have the resolve to embrace them and facilitate growth. We need to think outside of the box, and quite frankly, we need to optimize what’s in the box.
3. Joy ― I find this work extremely rewarding, and I bring joy to my team by showing them that the rewards of the work we do are right in front of us, even if results are not immediate. For example, one of our members was struggling with substance use disorder and was homeless and malnourished. We were able to provide support and education to him and engage him in the primary care provider medical home, as well as buy him food and clothes, and help him prepare for a job interview. After about a year, his life had transformed to include a better relationship with his daughter. I brought those results back to my team, and I said, “We provided some of the basics of health and human need to save his life.”

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

Out of the current projects my team and I are currently working on, two stand out. The first is our In-Home Care Management program that we provide for our members who need additional support in the home. Those care management supports include home visits, environmental scans, basic vital signs, light housekeeping, transportation, as well as grocery shopping and meal planning.

The second is our Food As Medicine, or food disparity program. We’re almost ready to launch our next phase of this program, which provides food to members who identify as having a food need. What’s exciting about this program is we have simplified our eligibility criteria. The only question members must answer to qualify is, ‘Do you have a food need or is there a gap or an area of nutrition that you are not able to meet because of a food disparity?’ If the answer is yes, we can deploy a food intervention, typically within the same week.

Through this program we can serve members in all different categories of pay, to include Medicare, Medicaid, and commercial plans, providing the intervention of food, whether that be a gift card where they shop for themselves, a food box where they get the ingredients in a recipe card to make their own food, or a prepared meal that they could heat up in the microwave. And that was tailored and complemented with weekly education and coaching from either our care Management nurse staff or our health and Wellness coaches in our health coaching team.

Our Food As Medicine pilot program provided valuable insights into areas where we did well, as well as opportunities for improvement. What was amazing about that work was the alignment with chronic conditions, which we know have a direct correlation to a higher food need. With our simple criteria, we’re able to completely align that to members with chronic conditions. One of the chronic conditions we uncovered during the pilot is a dental need. We discovered one of the most important things we must consider is a member’s ability to start the digestive process by chewing.

In addition to being able to chew their food, members must also be able to choose their food. Some level of choice, dignity and choice is important for sustainability and engagement. We believe in tailoring our support to truly identify what the members’ goals are and help change their thought processes. We’ve found the most effective way to enact positive change and improve member outcomes is to make health and lifestyle intervention a two-way conversation rather than a directive.

OK, thank you for all of that. Let’s now shift to the core focus of our interview about cultivating wellness through proper nutrition and diet. To begin, can you tell our readers a bit about why you are an authority on the topic of nutrition?

My experience on the topic of nutrition is rooted in care management. In care management, we assess a member’s health condition or their ability to maintain health and wellness to decrease exacerbation of illness or disease. Early on, health assessments were very physical — measuring heartbeat, respiratory rate, blood pressure, weight, and body mass index. And those results would indicate some level of food management. But what was missing was any consideration of chronic conditions and the type of food imperative for that member to eat to help manage their chronic condition.

For example, when a person has diabetes, insulin or oral medication is prescribed. However, in some cases, diabetes can be controlled without medicine, by keeping your weight down, exercising, and maintaining a healthy diet. We are quick to understand when someone is not adherent to taking their medication, but to effectively approach diabetes and other chronic conditions from all angles, we must go a step further to identify social, economic, and geographic barriers to obtaining healthy food.

Through programs like these, healthcare leaders are seeing that we need to give the same time and effort we invest in helping members access their medication to also helping them access the food that they need to be healthy. We must be more detailed, and we must be more diligent in providing the right food as medicine for members and their specific needs.

We all know that it’s important to eat more vegetables, eat less sugar, etc. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the main blockages that prevent us from taking the information that we all know, and integrating it into our lives?

One of the main challenges we hear about from our members is that although they want to eat healthier foods, geographically their proximity to a supermarket or a store with a wide selection of produce and other nutritional staples is limited. In fact, about 19 million Americans, or about 6% of the population, live in a food desert with limited access to a supermarket or grocery store, according to the USDA. As a result, we’re investigating ways we can partner with community organizations to provide food delivery to members who live in rural areas.

Another reason it is often difficult for people to integrate proper nutrition into their daily lives is lack of education. We spend a lot of time working with our members to not only to inform them about nutrition facts and healthy choices, but to also review their experience shopping for food. For example, we want to know how they felt about their trip to the grocery store, if they had enough money to get everything they needed, and how they felt after eating a meal rich in vegetables and whole grains. There’s a lot of understanding that can come from the experience of food. We must consider members’ daily schedules and family dynamics so we can teach them individualized, actionable strategies to help them successfully incorporate healthy food into their lives. Having an open, honest, and supportive conversation without stigma or judgement can really break down a lot of barriers.

From your professional perspective, do you believe that nutrition plays a pivotal role in supporting the body’s natural healing processes and overall well-being, particularly in cases of chronic diseases? We’re interested in hearing your insights on the connection between a holistic approach to diet and its benefits for individuals facing health challenges.

Diet and nutrition are 100% related to maintaining overall health. There is a mountain of evidence that shows food intake and food choices can directly affect a person’s health, whether the goal is to promote recovery, decrease exacerbation, or to stabilize an existing health condition. According to the National Institutes of Health, nutrition is important for the prevention and treatment of most chronic conditions and diseases, including hypertension, diabetes, and stroke. Previous studies found approximately 11 million deaths worldwide could be attributed to dietary risk factors each day with the main issues being high intake of sodium, low intake of whole grains, and a low intake of fruits.

Based on your research or experience could you share with us five examples of foods or dietary patterns that have demonstrated remarkable potential in preventing, reducing, or managing specific health conditions? If you can, it would be insightful if you could provide real-life examples of their curative properties.

In general, current nutritional guidelines recommend a balanced diet of minimally processed foods to maintain a healthy lifestyle. However, there are several vitamins and minerals that are particularly beneficial for people living with chronic conditions:

1. Protein and veggies — Protein levels in your diet are important for building and maintaining muscle. Protein also plays a vital role in producing antibodies needed to fight off infections and illness. Good sources of protein include meat, fish, poultry, eggs, dairy products, beans, lentils, nuts, and seeds. Vegetables including spinach, broccoli, sweet potatoes, and beets, are essential for managing complete nutrition, as they lower blood pressure, improve digestive health, and are the best source of provide vitamin A, a nutrient essential for many metabolic processes in the body.
2. Phosphorus and calcium — Phosphorous and calcium are essential for bone health, but extra phosphorous causes potentially harmful changes in the body including an increased risk of heart attack, and stroke. For this reason, people with specific chronic conditions such as kidney disease, or those taking certain medications, must be cautious of foods high in vitamins like phosphorus or calcium, including dairy products, organ meats, and whole grains.
3. Reduced carbohydrates and sugar — Carbohydrates found in foods such as fruits, vegetables, and whole grains, provide energy to fuel the body, including the brain, heart, and central nervous system. They also aid in digestion, manage blood cholesterol levels, and help control blood glucose and insulin metabolism. However, for someone living with diabetes, too many refined carbohydrates, like white bread or candy, can cause blood glucose levels to rise to dangerous levels. Possible complications of high blood glucose include heart disease, stroke, kidney damage, nerve damage, eye damage, and skin problems.
4. Low sodium and low fat — Low sodium and low-fat diets are typically recommended for people at risk for heart disease. A basic heart-healthy meal plan emphasizes vegetables, fruits, and whole grains, and limits high-fat foods such as red meat, cheese, and baked goods, as well as high-sodium foods such as canned vegetables or processed meat.
5. Dental health — While not necessarily a dietary pattern, it’s important to note that compromised oral health can make eating any food a challenge. We learned from our Food As Medicine pilot that people who have dental needs struggle to get the proper nutrients needed to maintain optimal health. The good news is, there are a variety of healthy foods, such as potatoes, eggs, oatmeal, and rice, that someone who has compromised chewing can eat. We provide members who have dental challenges with suggestions and education about how to properly prepare whole foods so they’re soft enough to chew, yet still enjoyable to eat.

Do experts generally agree that merely choosing healthy foods isn’t sufficient, but that understanding how to consume them is key to unlocking their full health benefits? (For example, skins on/off, or cooked/raw, or whole grain/refined grain) Could you provide advice on how to approach this and sidestep common errors or misconceptions?

The most important part of working with patients or members to help them make healthy lifestyle decisions, whether it’s exercise or nutrition, is to be cautious about ensuring they still have choice. We can’t lay down directives ― we must instead have two-way conversations. As payers and providers, it is our responsibility to arm people with knowledge, the ability to make choices, and the freedom to act on those choices, versus just telling them what to do. That just doesn’t work.

In our assessment of each member and the Food As Medicine intervention, we not only provide education on which foods to eat, but we also assess the members’ ability and desire to cook. For example, if they’re living in a hotel and don’t have the means to prepare food because they don’t have a microwave, stove, or oven, we help come up with solutions. Or, if they’re living in an apartment and have a microwave, but not a full kitchen, we provide nutritious, fully prepared meals that can be warmed in the microwave.

Many of our members have the means to cook, but don’t know where to start. In this case, we provide the ingredient box which lists a recipe with step-by-step instructions. Even with these instructions, a member might say something like, “I love to eat fruit and vegetable skins.” We use feedback like this as an opportunity to educate people about the nutritional content of fruit and vegetable skins and their benefits and risks. We also provide them with proper washing and preparation techniques and guidance around specific dietary restrictions or allergies so they can be cautious, while still ensuring that they have a choice about how to fuel and nourish their bodies.

Other members opt to receive a gift card to go grocery shopping for themselves. With that, we offer support from our health coaching team, dietitian, and nurse care manager. Additionally, because we want to also sustain engagement and education, we connect members with additional resources after our intervention. Not only can they come back and ask us questions, but we also connect them to local resources where they can go to learn how to prepare a meal in person. We also make videos where they can log in and watch meals being prepared from the comfort and convenience of their own home.

With the recent prominence of nutrition’s integration into healthcare, what’s your perspective on the collaborative approach between medical professionals, health coaches, and nutrition experts when it comes to delivering holistic patient care? Can you please explain?

In my experience and conversations with all members of a care team, including the patient and the providers, they’re all committed to healthy food choices as much as they are to shelter, medication, and treatment. The delivery of this intervention is challenging, so when we can offer an option for our community partners to turn to our providers and say, “Hey, PHP, here’s a member that could use your food intervention,” that is helping the bigger ecosystem of this initiative. There is no doubt in my mind that there is collaboration on food as medicine across the nation.

For example, America’s Health Insurance Plans (AHIP), a national association whose members provide health care coverage, services, and solutions in the U.S., is driving food as medicine or food nutrition as part of a focus for teams like mine to manage, and to continue to drive forward. We hear about it from providers and social determinant of health codes ― one of those is specific to food. We are seeing it come to the table more, which is great, but now we need to get the resources out there. It’s disheartening for everyone when you identify a need, but you’re not able to intervene. We need interventions like Food As Medicine to be accessible so we can provide wrap-around services to assess, identify a need, and deliver. Right now, we can offer at least one intervention, but we’re looking to offer more than one so that we can sustain engagement and provide some sense of normalcy for folks that need food to maintain health.

It’s been suggested that using ‘food as medicine’ has the potential to reduce healthcare costs by preventing disease severity. However, there’s concern about the affordability of healthier food options. What solutions do you believe could make nutritious choices accessible to everyone, ensuring that food truly becomes a form of medicine for all?

Number one, I would say patience. Again, interventions like Food As Medicine do not provide instant gratification. You do not see somebody eat an apple and poof ― they’re healthy. Change takes time. We’re also going to need patience when it comes to cost savings. There is a lot of passion in our country for food management and food accessibility. Many local farms provide veggie vouchers where residents can go and get free vegetables. In addition, there are many supermarkets and grocery stores committed to increasing food access. However, although members may have access to food when they can’t afford it, they still need help identifying healthy food choices, and that drives down utilization.

During our first Food As Medicine pilot, we found some evidence of better utilization of community food access programs through engagement with primary care providers. So, you start out with a member who may not be engaged in care at all, and you build trust through a “simplified” food intervention, which can be complex to deliver. That trust creates a path for our members to engage with their primary care provider. From a savings perspective, you might have more utilization in primary care, but what you’re going to see down the road is preventative measures for more serious care that could have been prevented with annual wellness visits, preventative screenings, and treatments. You also see the more specific and very direct interventions are for complications of chronic conditions that lead to amputations, nerve damage, heart damage, or breathing concerns.

There are savings in food as medicine interventions, however, the cost of food is concerning. We must leverage those entities out there that provide food and we also need to level set on the importance of food for our communities. And that takes a village. It takes more than just a provider and a healthcare insurance company to make this work holistically.

Everyone’s body is unique, and what works for one might not work for another. How does one navigate the vast array of nutritional advice available today to curate a diet tailored to individual needs, ensuring health and longevity?

That’s exactly what our pilot was set out to do ― assess the member for their specific needs. What is their chronic condition? Or maybe they don’t have a chronic condition. Maybe they just don’t have access to food. How do we deliver on that? Answering those questions is key, but the answers must be reinforced when a member sees their provider. What is the reinforcement of that diet? What is the reinforcement of that assessment, especially after engagement with us may have completed? We must ensure community resources are available for them to turn to if they have more questions, or if something changes.

We must be able to reinforce at all levels or points of service with members who are interacting in a community, including blogs on specific like websites like Providence.com, tools that we have out there for members, education on medications, etc. It’s about identifying the members, their individualized needs, and being able to deliver on those individualized needs, at least to some degree. Sometimes we can’t meet all the individualized needs, but it’s important to deliver on some of them while continuing to identify opportunities for improvement.

As our understanding of the intricate link between food and health continues to evolve, we’re curious to know which emerging trends or breakthroughs in nutritional science excite you the most. How do you envision these advancements shaping the future of healthcare?

What excites me the most is the advancements in crop management. There are huge greenhouses and plots of food throughout the world where farmers are working on growing organic crops in controlled environments where we hadn’t seen them before. This allows for food management, or at least access, which doesn’t necessarily depend on the climate in which it’s growing. It’s exciting to see the technology that’s going into growing organic crops in condensed greenhouse-like structures where you’ve got layer upon layer of crops, instead of crops growing across 40 acres of land. Innovative solutions like this are important because they give food producers the ability to deliver the supply chain in a different way that’s going to be more effective.

How can we better educate the public about the medicinal properties of food, and what role do professionals like you play in this educational journey?

To better educate the public about the benefits of food as medicine, we must continue to stay out in front of the community. As I mentioned previously, providers are using social determinant of health codes to diagnose food needs, AHIP is talking about it, and people like me are giving presentations to healthcare industry leaders at health conferences, but we also need to incorporate the medicinal aspects of food in conversations with patients and members.

We often hear about food banks and access to food, soup kitchens, shelter dinners. But what we must add to that story is that at the food bank, you will have options of vegetables, fruits, staples, canned goods, and dairy, and the reason for that is because food is part of your regimen to stay healthy. For example, if you go to the soup kitchen and are served lentil soup, we must get it in the conversation that lentil soup is full of protein. If you choose a side of bread, we must provide information that although it’s fine to have one slice of bread, you should be careful to consume too much because bread contains carbohydrates. If you want a second helping, sure, but let’s talk about that. I think if we can just start putting snippets in those conversations about the medicinal aspects of food, that will get in front of those communities in a meaningful and impactful way.

Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success and good health!

About the Interviewer: Wanda Malhotra is a wellness entrepreneur, lifestyle journalist, and the CEO of Crunchy Mama Box, a mission-driven platform promoting conscious living. CMB empowers individuals with educational resources and vetted products to help them make informed choices. Passionate about social causes like environmental preservation and animal welfare, Wanda writes about clean beauty, wellness, nutrition, social impact and sustainability, simplifying wellness with curated resources. Join Wanda and the Crunchy Mama Box community in embracing a healthier, more sustainable lifestyle at CrunchyMamaBox.com.