Coalition-Building: Inside the Food is Medicine movement in Massachusetts
Cooking up the Rx to address food insecurity at the state level
F ood is Medicine may be a trending topic in health care, but it’s far from a new concept:
Food as medicine is not only an important aspect of treating illness but preventing it. Half of US adults have at least one preventable chronic disease related to poor dietary habits. Back in 2003, an extensive report by the World Health Organization (WHO), “Diet, Nutrition, and Chronic Disease,” recognized the link between food and the prevention of diabetes, cardiovascular disease, and cancer. But access to healthy food is a problem and a key social determinant of health.
While nutrition and diet are obvious underpinnings of a healthy lifestyle, the idea of “prescribing” meals to patients based on their clinical needs has emerged as a growing area of interest in policy and industry circles alike. At the national level, the Food is Medicine Coalition serves a key role in recommending federal policy and promoting research and best practices across the U.S..
While the national consensus is important, it’s the state-level efforts that are serving as a key lever for reimbursement of “medically tailored meals” for chronically ill patients who have trouble accessing healthy food. This summer, the newly formed Food is Medicine Massachusetts (FIMMA) coalition published a state plan with research-based recommendations for how the public and private sectors, as well as nonprofits, researchers, and other groups can move forward to promote healthy eating for vulnerable patients and communities across The Bay State.
We sat down for a virtual coffee with two of the founding members of FIMMA, Kristin Sukys and Kathryn Garfield, to learn more about their work and discuss the opportunities for food reform and innovation.
A Brief History of FIMMA
FIMMA is a joint effort of The Center for Health Law and Policy Innovation (CHPLI) of Harvard Law School and Community Servings, a not-for-profit food and nutrition program active across the state. The two organizations happened to be neighbors, and over the last several years the Food is Medicine Massachusetts coalition developed somewhat organically through their shared interest in policy, advocacy, research, and program and service-based interventions related to health for the state’s most vulnerable patients and families.
FIMMA was formally set up as part of the formation of the Massachusetts Food is Medicine State Plan (Executive Summary). According to Sukys and Garfield:
“We gathered individuals and organizations from a wide number of sectors to create a planning council that would advise and assist us with the creation of the State Plan — individuals that were governmental, “quasi-governmental,” community-based organizations (CBO), payers, providers, and more, in total over 40 organizations. We set up a number of meetings, conducted data gathering efforts, refined surveys, set up listening sessions around state, spoke with regional partnerships.
Throughout the work, beyond the specific recommendations that emerged, what really bubbled up were numerous candid conversations about how to move forward with implementation. We assumed the planning council would play some role in helping us drive implementation after the report’s publication, but we actually underestimated the level of interest that we’d created from across the state.
FIMMA has since grown to a coalition of 100 members who represent over 50 organizations across the state. As a nascent organization, FIMMA has set out to implement recommendations through broad, multi-stakeholder collaboration.
One Program Does Not Fit All
While “food is medicine” is a trending topic, we learned there are four broad subcategories at play here:
- Medically Tailored Meals: The most robust intervention, designed for the sickest of the sick, i.e. people who generally several comorbidities, cannot cook or shop for themselves, and require meals prepared for their clinical needs, delivered to their house with minimal preparation required.
- Medically Tailored Food: For people who are chronically ill with clinically based dietary needs, but who can cook or prepare a meal for themselves or their family members, e.g. healthy grocery bags or meal kit and recipe delivery
- Nutritious Food Subsidies: For people who have, or are at risk for, a diet-related disease and are unable to access healthy food due to geography (food desert), financial constraints, or other reasons, a clinical team may provide patients with vouchers for redemption in a “food pharmacy,” grocery store, or other facility.
- Population-level Healthy Food Programs: Broader programs that provide generally nutritious food for populations that have or are at risk for developing food insecurity or diet-related disease.
Defining the Language and the Market
Our discussion uncovered numerous insights related to the opportunities for reform and innovation, present-day challenges, and details on how this movement will move forward in Massachusetts.
On the need to standardize CBO operations:
“We have all these interventions and programs happening in FIM, but we’re using different language, without any definitions and standards. … For example: we have about 26 medically tailored meal providers across the state. On first glance that’s a lot; but when you go deeper, there’s a big difference between Meals on Wheels providers who are doing absolutely critical work for our elders — but who are typically offering 2–3 different kinds of meals — versus an outfit like Community Servings who have 15 meals you can offer in different ways. It’s hard to really prescribe meals [in a uniform way ] across all the CBOs in the state…This is a medical intervention, and the research is showing that it works, but it does so based on the specifics, not the concept alone.”
On the roles of data, technology, and innovation for FIM:
“Some organizations are using iPads to coordinate drop offs, gather real time data, get user feedback, and so on. … The number one role of tech is to gather data and continue to make [the] case for this movement. Using technology to their advantage and lowering the burden of data collection is a key part of that strategy.”
On Medicare Advantage and other market dynamics:
“There’s definitely a strong movement from payers in this direction. The increased interest in providing meals is partially because of some great new opportunities — Medicare Advantage is expanding the opportunity to deliver meals as a supplemental benefit, especially for individuals living with chronic illnesses. The value-based insurance design demonstration does some of the same things, but through a model that specific plans have to apply to — we’ve heard a lot of interest on both of those fronts.
Medicaid managed care organizations are also keen on this space, just because of the inherent flexibility they have to provide additional benefits.state Medicaid programs are also showing increasing interest in leveraging mechanisms such as Section 1115 Demonstration Waivers to improve access to Food is Medicine services.”
A Three-Pronged Path Forward
In order to advance the Food is Medicine movement in the state of Massachusetts, FIMMA is initially focusing on the following areas:
- Improving the capacity of health professionals to identify and address the need for food is medicine interventions
- Establish consensus-driven standards for Food is Medicine interventions in the state, across Food is Medicine CBOs, and other on-the-ground partners
- Develop plans for a research agenda that will advance the public health and medical understanding of food insecurity and Food is Medicine programs, and fill existing knowledge gaps
A special thanks to the FIMMA team for taking the time to chat with us. For more information, flip through the report’s executive summary, visit their blog, and follow them on twitter and reach out to learn more about their efforts.
