Fresh Food Farmacy

Eating the right food plays an important role in a person’s overall health and in treating diet-responsive conditions. Geisinger pairs fresh and nutritious food with education and clinical services as part of a prescription-based program and provides this program to their most at-risk patients with diabetes. In doing so, it has improved patient outcomes while lowering per-patient costs.

The Fresh Food Farmacy program provides qualifying patients with education, clinical services, and access to fresh, healthy, nutritious food. These resources empower participants in the program to manage their medical conditions through food-related behavior modifications and lifestyle changes.

In comparison to a cohort population of people who participate, but do not enroll, in the Fresh Food Farmacy program, enrolled patients have demonstrated the following benefits of the program:

• 75% fewer hospital admissions
• 30% fewer Emergency Room visits
• More regular visits with primary care physicians, reducing gaps in preventative care

In addition, participating patients with type 2 diabetes average a 2-point reduction in HbA1c, potentially leading to savings of $16,000-$24,000 in healthcare costs per patient, according to published literature.

Geisinger Health Plan elected Scranton, PA as its third Fresh Food Farmacy location. A Community Needs Assessment identified alarming rates of diabetes coupled with increasing food insecurity statistics in the area, where hunger, job security, transportation, and stable housing are the biggest social determinants that impact the health outcomes of Scranton residents.

Without job security, individuals struggle to pay for the food they need. Lack of reliable transportation, coupled with numerous food deserts, leads many patients to rely on food service locations that may not always offer the most nutritious options. For those without stable housing, storing food acquired from local pantries can also be a challenge.

Food is Medicine not only addresses food insecurity by providing patients and their families with a significant quantity of healthy, reliable food, it also demonstrates how positive clinical impacts can help patients live healthier lives.

Providing increased awareness without judgment helps to strengthen a collaborative, community approach and serves as a catalyst to help patients recognize the correlation between diet and health. This education includes grocery store tours, cooking demonstrations, and group-based peer learning to help patients understand the impact of food on their diet-responsive conditions.

A direct correlation exists between food security, literacy, access, and health outcomes. There is a particularly strong relationship between food insecurity and type 2 diabetes. Processed foods contribute significantly to rising diabetes rates and aggravate other chronic conditions. Maintaining a healthy weight and learning to better control autoimmune disorders are interconnected in the battle against diabetes.

According to the Centers for Disease Control, nearly 1 in 3 people in America will have type 2 diabetes by 2050. Despite Geisinger’s significant investment in diabetes treatment, the prevalence of uncontrolled diabetes has continued to increase. A lack of both access to nutritious foods and awareness of how food impacts chronic conditions continues to result in negative clinical results.

Geisinger recognized that their patients’ conditions would likely remain unmanaged and they would face further complications without access to proper food. As a result, they began to consider a fundamentally different approach to treating type 2 diabetes. The Fresh Food Farmacy program was created and began annual screenings of EHRs (electronic health records) to identify patients who were both food insecure and suffering from uncontrolled type 2 diabetes (HBA1C levels greater than 8). Qualifying patients were then referred for proactive outreach. Patients can also request to join or be referred by a physician or healthcare provider.

Each week, patients receive enough food to feed their entire families two meals per day for a period of five days. These meals use recipes provided by registered dieticians to encourage patients to explore additional new and healthy options on their own. Staples include fresh fruits, whole grains, lean proteins (e.g., chicken, fish, turkey, pork), vegetarian-friendly entrees; and staple items that fall within dietary guidelines for limiting sodium, saturated fat, and carbohydrate intake.

By identifying the connection between food insecurity and adverse health outcomes, Geisinger developed a team-based approach to improve their patients’ health.

Patients often give up on trying to manage diabetes and instead begin to accept poor health and frequent hospital visits as mere additions to their routine. Providing a program where patients can experience clear improvements to their health directly related to healthier eating habits helps break that cycle and empowers patients. Ultimately, Geisinger’s program benefits patients physically, clinically, and emotionally when they see the actual benefits derived from transitioning to a healthier diet.

When a participant first enrolls, baseline labs and biometric data are collected. This information is used throughout the participant’s involvement in the program to assess effectiveness, identify barriers or concerns, and make any necessary adjustments.

Findings from patient data are reviewed by the entire care team during Medical Home Meetings, including the health coach, health manager, registered dietician, pharmacist, CHA, and other members of Geisinger’s leadership team. This team continually assesses trends, develops solutions to target specific needs, and tailors plans to ensure each patient has the proper tools to adequately self-manage their condition.

Geisinger’s  Fresh Food Farmacy program has reduced the A1C of program participants by 1-2 points, depending on their risk stratification and level of commitment to the program. Moreover, participants have also experienced an overall improvement in other aspects of their health such as BMI (body mass index), blood pressure, LDL cholesterol, and reduced care gaps. Overall, Geisinger has seen a transformation among patients who are now in control of managing their disease rather than allowing disease management to control them. Based on self-reported data, patients have reported an increase in fruit and vegetable consumption, in physical activity, and in overall improved health.

Geisinger hopes to leverage the gathered ROI (return on investment) and patient outcome data to encourage insurers to cover food as a treatment, and also to provide clinical oversight for the coordinated clinical resources and community-based organizations that increase patients’ likelihood of achieving long-term success.