Memorial​ Hermann​ targets​ food​ insecurity,​ asks​ if​ patients​ are​ hungry

Food insecurity is a problem in Harris County, Texas. About 18% of adults and 26% of children in the county have difficulty accessing food.

Research on food insecurity indicates that lack of nutritious foods can lead to other health problems, worsen existing diseases and increase costs. A 2015 study published in Health Affairs found that food-insecure children were twice as likely to report fair or poor health and 1.4 times more likely to have asthma compared to children who weren't food insecure. Older adults who were food insecure also had more difficulty with daily living than those who weren't food insecure. A different study found malnutrition increases healthcare spending by about $15.5 billion per year.

Determined to tackle the issue, Memorial Hermann, a 16-hospital health system based in Harris County's Houston, began to ask its patients in October 2015 about their access to food with the goal of getting them healthier by eating better.

The program started in the emergency department in select Memorial Hermann hospitals staffed with patient navigators. The navigators primarily see patients in the ED who are uninsured or on Medicaid to help them find a permanent medical home and help prevent readmissions, according to Carol Paret, Memorial Hermann's senior vice president and chief community health officer.

As part of the program, navigators ask each patient if at any time within the past 12 months they were worried food might run out and if they had difficulty gaining access to nutritious food.

If patients say they are lacking access to nutritious food, the navigator explains the options available in the community to get food.

Memorial Hermann has partnerships with several food banks in the Houston area so the navigators are able to give patients details about the programs. The navigators are even trained by staff at the food banks on the appropriate questions to ask patients in order to determine if they suffer from food insecurity.

The program has since expanded to Memorial Hermann's community health centers and to all of its inpatient settings. It is also no longer limited to just uninsured or Medicaid patients, but any inpatient. The effort has been such a success among doctors and patients, Memorial Hermann plans to roll it out to all ED patients by August.

Physicians have found the program to be "eye-opening," Paret said. Doctors were shocked to find out some patients were food insecure.

"You can't always look at someone and be able to tell their situation," she said. "It points out that medical care can't be done in isolation."

It has also caused doctors to view their most difficult patients differently, Paret said. Patients who don't take their prescriptions or follow care plans are often viewed as noncompliant by doctors. But the program opens doctors up to the issues in their patients' lives that might be preventing them from following a care plan, such as loss of employment.

The program has led to changes in patients' care plans. For example, some patients will admit they can't afford food because the drugs they've been prescribed are so expensive. This has led doctors to seek alternative treatments or cheaper generics for patients.

Memorial Hermann also has begun to partner with Houston-area food banks on other initiatives.

For example, navigators from the system visit the food banks and offer free consultations with patients to set them up with primary-care doctors or other affordable health resources in the area. "We really want to deal with the social determinants of health that are driving so much of the healthcare spend," Paret said.

The work done by Memorial Hermann has inspired other area providers to also try to tackle the issue. Memorial Hermann has been working with other hospitals to adopt the program. The hope is the hospitals will be able to share data so they can better understand the social issues that affect the well-being of Houston-area residents.

"We can begin to paint a picture of Houston and what we can do to close care gaps," Paret said.