Following the approval of $6 million in state funding, California is gearing up for a three-year “Food is Medicine” pilot program that stands to benefit hospitals as well as patients.
The program, set to begin in January, is aimed at patients enrolled in Medi-Cal, California's Medicaid program, who suffer from chronic diseases such as congestive heart failure, cancer and diabetes. Patients in San Francisco, Oakland, Los Angeles and several other areas will be provided with healthy food when they go home from the hospital.
The program will be led by San Francisco-based Project Open Hand, a nonprofit organization that cooks 2,500 meals and provides 200 bags of groceries to sick patients every day.
“We understand very clearly how nutrition and medical regimens work together to keep people healthier,” says Project Open Hand CEO Mark Ryle.
Ryle cites a University of California, San Francisco/Project Open Hand Food is Medicine research study that evaluated the impact of a medically tailored meal program for San Francisco and Alameda County residents with Type 2 diabetes, HIV or dual diagnosis. The results, published earlier this year in the Journal of Urban Health, demonstrated a 63 percent drop in hospitalizations, a 58 percent reduction in emergency department visits and a 50 percent increase in medication adherence.
The initiative will enable Project Open Hand and several other participating nonprofit groups to identify Medi-Cal patients who are readmitted to a hospital for preventable reasons within 30 days of discharge.
“Last year, the Medi-Cal system spent approximately $25 billion on preventable readmissions,” Ryle says. “That's the problem we're trying to solve.”
Rita Nguyen, M.D., assistant health officer with the San Francisco Department of Public Health and a hospitalist at Zuckerberg San Francisco General Hospital, says most chronic conditions are closely tied to diet and physical activity.
“And when you think about the cost of food, it’s nothing compared to one emergency room visit or overnight stay at a hospital,” says Nguyen, who previously served as medical director of ZSFG’s Healthy Food Initiatives program. “The research field has been doing more studies on this type of work to demonstrate that providing food can actually reduce health care use and ultimately save money for the health care system.”
The connection between healthy food, patient health and lower hospital costs also is voiced by Hilary Seligman, M.D., director of the Food Policy, Health and Hunger Program at the UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General.
“We're making the case that if hospitals can support food security, then utilization and costs will decline,” Seligman says.
Seligman says hospitals should realize that even patients who are covered by health insurance may lack sufficient food. “There are food-insecure patients in every hospital system,” she says.
Nguyen says distributing food to improve patient health supports the concept of accountable care organizations providing value-based care and maintaining population health.
Besides the fact that Medicare financially penalizes hospitals with high readmission rates, Nguyen says, readmission rates “are also something that hospitals track and compare amongst each other. For even a safety net hospital such as ours, we don’t want to be seen as near the bottom of that.”
Seligman says the ability of hospitals to participate in food programs “depends on whether there is leadership support. The opportunities are tremendous. It requires innovation and initial investment. Supporting food security is likely to pay off in the long run, but it’s not going to pay off in six months. That's why leadership investment in this issue is so important.”