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Federal, private funders bet food-as-pharmacy programs will deliver healthcare cost savings
When low-income patients with high blood pressure fill their “produce prescriptions” at certain New York City pharmacies, they walk away with $30 in vouchers to spend on fresh fruits and vegetables at the city’s farmer’s markets.
The city’s “Pharmacy to Farm Prescriptions Program” has reached more than 1,000 hypertensive SNAP recipients since it launched in 2017, and has grown from 3 to 16 participating pharmacies. It is set to report outcomes data next year.
The program is supported in part by a grant from the U.S. Department of Agriculture (USDA), which is poised to make an even bigger impact on the food-as-pharmacy programs that have been growing in popularity. The 2018 Farm Bill established a national Produce Prescription Program that sets aside millions in grants each year.
With diet-related illnesses like heart disease and obesity costing hundreds of billions of dollars each year in the U.S., other funders are also expecting a healthy return-on-investment (ROI) in these programs, which means more initiatives like New York City’s may find the means to thrive.
Not Just for SNAP Recipients
USDA has been supporting projects to increase healthy food consumption among SNAP recipients since 2014, under the Gus Schumacher Nutrition Incentive Program (GusNIP, formerly the Food Insecurity Nutrition Initiative). The bill now guarantees GusNIP can administer $25 million in produce prescription grants—not just for SNAP-based programs—for the fiscal year beginning in 2018, jumping to $45 million for the 2019 fiscal year and rising to its cap of $56 million in 2023. The first grants will be awarded in October.
The Local Food Hub in Charlottesville, Virginia, currently receives funding from local businesses and philanthropies, but has applied for a federal grant. Its Fresh Farmacy program provides low-income patients who have chronic disease with produce from local farmers. Participants pick up their “shares” every other week during the growing season.
“We have seen first-hand the impact of incorporating healthy food to manage weight, maintain healthy blood glucose levels, and reduce the risk of diabetes complications,” said Patricia Polgar-Bailey, a nurse practitioner at the Charlottesville Free Clinic, which participates in Fresh Farmacy.
Non-Profit and Private Sectors Pitch In
Federal dollars aren’t the only way to keep food-as-pharmacy programs afloat. Wholesome Wave, a non-profit that was co-founded by Gus Schumacher, has been supporting produce prescription projects since 2010.
Wholesome Wave gets money from philanthropies and corporate partners – including Target, Chobani, and Humana, to name a few – to foster such programs.
“There are non-profits and private-sector supporters trying to prove the model in the interest of getting insurers and the healthcare industry to really step up,” said Julie Peters, director of programs at Wholesome Wave.
An example of the organization’s support: it’s putting money into a produce prescriptions pilot for diabetes at Community Health and Wellness Partners (CHWP) in Logan County, Ohio, which is also supported by state and federal dollars.
Healthy Food = Healthier Lives
Once a month, participants attend nutrition classes taught by staff dietitians, and subsequently receive vouchers for up to $120, depending on family size, to purchase produce at local grocery stores or farmer’s markets.
Among those who have completed three months of classes, HbA1c has already declined 0.6 percentage points on average, said Jason Martinez, a clinical pharmacist at CHWP who has analyzed preliminary data from the program.
Will these improvements translate to reduced healthcare costs? That has been the case at Geisinger Health System’s Fresh Food Farmacy initiative. The program focuses on patients with type 2 diabetes who experience food insecurity. In addition to 15 hours of disease and nutrition counseling, participants get enough healthy food for 5 days of the family’s weekly meals.
Over 18 months, participants’ HbA1c levels fell 2.1 points on average, compared with declines of 0.5-1.2 points for those taking two or three medications only. Along with improvements in weight, cholesterol, and hypertension, that has translated to an 80% drop in healthcare spending for 37 of about 200 participants who were insured by Geisinger, according to early data.
“We know the cost of the program, all-in, for the food and the clinical care is around $2,500, so it’s reasonable to assume that there’s an ROI that we would experience with that,” said Allison Hess, vice president of health and wellness at Geisinger. She’s hopeful that ROI will convince insurance companies “to potentially fund this as part of a benefit package.”
Similarly—albeit hypothetically—a recent simulation study of Medicare and Medicaid recipients predicted that providing a 30% subsidy on fruits and vegetables would prevent nearly 2 million cardiovascular events and save almost $40 billion in annual healthcare costs.