Food-is-medicine programs are spiking in popularity, with health systems, grocers and delivery services getting in on the action. But the efforts are far from hitting their stride.
Programs have had trouble securing funding and settling on a uniform definition of what food-is-medicine really is — or what it should be as such efforts try to tackle poor nutrition. Even the name of the initatives is up for debate, with some organizations using "food is medicine" while others opt for "food as medicine."
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Food insecurity affected about 34 million people in 2021, according to a February report from AHIP, a trade group for insurers. Without a clear path forward and sufficient funding, several organizations may be unable to continue providing food and nutrition assistance.
“I think food-is-medicine has become a really exciting buzzword, but as it's become a bigger and bigger buzzword, it's become less meaningful,” said Josh Hix, co-founder of Season Health, a company that develops and delivers meal plans for individuals with chronic illnesses. “People use food as medicine to apply to everything from preventative wellness care to inpatient [intensive care units], feeding tubes and everything in between.”
The concept of food is medicine has taken many forms. For some organizations, it's connecting people to area food banks. For other groups, programs center around patients with diabetes or cancer and their nutritional needs. Most programs are geared toward Medicare and Medicaid populations where food security and nutrition tend to be a larger issue.
In 2022, the White House endorsed food-is-medicine programs at its annual Conference on Hunger, Nutrition, and Health and encouraged states to file for 1115 waivers, which allow states to use federal dollars allocated to Medicaid for experimental programs that may benefit Medicaid beneficiaries.
Charitable organizations also have become more involved. Since 2019, the Rockefeller Foundation has been a major funder of efforts to combat food insecurity, dedicating $20 million. In January, it pledged an additional $80 million to be dispersed over the next five years.
Many programs have expanded to provide services to individuals to people with health conditions as well as to those who wish to prevent them.
Kaiser Permanente, which operates programs and assesses their effectiveness, said a quarter of the 12.5 million people in its health plan, and nearly half of its Medicaid recipients, experienced food and nutrition insecurity in the past year.
“The collective vision is that at the end of the day, nobody goes to bed hungry and all people regardless of where they live [or] their economic status have resources with support that they need to get and stay healthy,” said Pam Schwartz, executive director of community health at Kaiser Permanente. “We're all trying to build our muscles around the different roles that folks have in being part of the solution.”
Kaiser launched three studies in April 2020 to track the health of patients who received medically tailored meals after being discharged from hospitals with a chronic condition. The studies tracked 2,100 patients who received nearly 120,000 meals, and found individuals with heart failure were less likely to be hospitalized again.
It also has conducted studies on produce prescriptions, where a healthcare provider prescribes certain food items like fruits or vegetables for patients and found patients in programs had a significant reduction in blood sugar levels.
Kaiser and Instacart, which handles grocery delivery services for the program, are studying how much convenience in obtaining more nutritious foods can play a part in improving patient health.
Finding stable financial support for initiatives remains a challenge. Government funding, partnerships with insurance companies and philanthropy have been the main avenues for most programs. Potential funders such as insurers want data on whether the initiatives improve patient health, which would reduce healthcare spending and claims.
“That's really where we've hit some speed bumps so far — we need to prove to commercial payers that it is worth their investment in food as medicine,” said Evan Sarris, deputy director of government relations for Kroger Health, a unit of Kroger that has been involved with food security efforts for more than a decade. “With some of these food-as-medicine programs, it is a lifestyle change and that takes some time to see results that are going to matter.”
Smaller programs can face higher hurdles. DC Greens, a nonprofit organization founded in 2009 that offers a produce prescription program in the Washington, D.C., area, receives most of its funding from philanthropy and partnerships.
"We are a large program right now, we have close to 1,000 people in our program — and we don't have more because there's no more money," said Andrea Talhami, director of programs.
Many organizations have applied for 1115 waivers. However, a program has to have funding from other non-federal sources and be proven to benefit the Medicaid population.
Some programs, like those of DC Greens and Kroger Health, also received grants from the Agriculture Department through the Gus Schumacher Nutrition Incentive Program, which ran from 2019 through 2023 and provided over $270 million to 197 projects.
Some programs are reaching out to insurers, which are getting more involved.
Elevance Health hired its first food-as-medicine program director in 2023 to oversee its efforts. Its Elevance Health Foundation has given $27 million in grants toward organizations tackling food insecurity.
"Food can be one of many tools to improve the management of chronic conditions and outcomes can be experienced through decreased emergency department visits, hospitalizations or readmissions, increased medication adherence, and even increased primary care engagement," said Dr. Kofi Essel, food-as-medicine director. "We also believe food can be used as a powerful tool to improve engagement and overall experiences with our health plan."
Good Measures, a for-profit organization, provides guided meal plans, helps consumers pick groceries best suited for their health needs and offers registered dietitian nutrition coaches and delivery. It is partnered with insurer Centene in several states as well as Point32Health, formerly the Harvard Community Health Plan and Tufts Health Plan.
“Payers [are] looking at distinction or market opportunity in terms of [having a] first-mover advantage and having nutrition and access to nutritionists as a core benefit,” said Donna Lencki, Good Measures' CEO. “I'm seeing that they actually are looking at the whole population — not ... as a point solution for one of the key things like diabetes or weight management — but the whole population so that you can provide someone who's well with a nutritional benefit or you can provide [it to] someone who may have diabetes.”
Still, getting patients to sign onto programs has proven to be a challenge, since many of those in need don't know the efforts exist.
Kaiser Permanente developed an interactive texting platform to help with outreach, initially reaching out to patients in the Supplemental Nutrition Assistance Program and its program for women, infants and children.
“We outreach to the most vulnerable people using a neighborhood deprivation index,” Kaiser's Schwartz said. “[We’re] looking at zip codes, where people with low income are living and then we outreach to them to find out if they are already on SNAP and if not would they like help…so that we can move people along in the process.”
Good Measures' CEO Lencki said she can see food-is-medicine programs growing in use for all types of patients, regardless of existing conditions, specifically through more employee-sponsored insurance coverage.
“Remember when we didn't have dental and we didn't have vision and we didn't have fertility benefits and all of that?” Lencki said. “What we're seeing is finally, the plans especially, but the country and [Centers for Medicare and Medicaid Services] are definitely looking at the cost of diet-related disease and the allocation of money that can actually address that. It's almost like a reallocation of the funds … I can pay for this prescription or maybe if I can focus on diet-related disease, I can offset the pharmaceutical costs.”
Correction: A previous version of this article incorrectly said Kaiser Permanente has 12.7 members in its health plan.
