The intersection of nutrition and health has been known for a long time. But recently, a major trend - the "food as medicine" movement - has developed. As societies grapple with rising healthcare costs and gain a growing understanding of the impact of nutrition on well-being, healthcare organizations are embracing the idea that food can be a powerful form of medicine.
While companies like Kaiser Permanente, Highmark Health and other healthcare organizations have devoted resources to improving the nutrition of the communities they serve, Elevance Health appears to be going one step further.
Last June, Indianapolis, Indiana-based insurer appointed Dr. Kofi Essel to its inaugural food director as medicine director. After six months on the job, he recently explained to MedCity News why Elevance hired him.
"I think the opportunity to bring in a nutritionist as medicine director was a realization of, 'Hey, if we're going to take this seriously, we want to bring in some more substantive expertise,'" Essel said in an interview. "They had to more or less engage externally to bring that in, to really increase the efforts internally."
Before joining Elevance, Essel was a pediatrician at Children's National Hospital in Washington, DC, and director of Culinary Medicine Program of the George Washington University School of Medicine and Health Sciences. He has also done extensive teaching and research in the areas of community health and food and nutrition. In other words, he has long seen a clear, clinical connection with what we put into our bodies and how healthy we are.
At Elevance, Essel is focused on implementing food as medicine in "every industry," whether that's Medicaid, Medicare or commercial insurance. The insurer has more than 47 million members. While food insecurity and nutrition-related diseases impact people covered by a variety of insurance policies, not all food-as-medicine strategies work for everyone.
"Every industry is looking for something different and we adapt to what they need to improve health outcomes for their members, whether it's an age issue, whether it's an issue around disability, whether it's an issue around which resources and the access they have," Essel said. "When designing interventions, we have to think about all those components."
Some strategies Elevance is exploring include partnering with the Supplemental Nutrition Assistance Program (SNAP), deploying medically tailored meals and prescriptions, and improving nutrition education. SNAP is a federal government program that provides food benefits to low-income people. Essel said the insurer is using a combination of these approaches in several pilots across its business, but declined to provide additional information.
An integrated health care system without a specific food-as-medicine position was more forthcoming about its efforts.
Pamela Schwartz is the executive director of community health at Kaiser Permanente, based in Oakland, California. Schwartz leads Kaiser's food and nutrition strategies, but also focuses on other social determinants of health, such as housing. She has a team specifically focused on food and teams focused on other social determinants.
Kaiser serves approximately 12.6 million members. Among them, one in four struggles with food and nutrition security, Schwartz said. Among Medicaid members, half struggle with food and nutrition security. Having a dedicated team focused on food as medicine "increases" the organization's ability to "lean in" to the problem, she said.
"It allows us to create a comprehensive portfolio of efforts specifically aimed at addressing this and improving these outcomes for people," she said.
Some of his efforts include a Commitment of $50 million to food and nutrition security, the organization announced in 2022. Also Kaiser Permanente in October launched a study that will measure the effects of providing Instacart Health Fresh Funds to Medi-Cal members with diet-related illnesses. This builds on a previous study where curated food boxes were sent to members. From that research, Kaiser learned that members want choice in their food. The study with Instacart gives members compensation to buy healthy food themselves.
Such as Kaiser Permanente, Highmark Health, based in Pittsburgh, Pennsylvania, also brings food as medicine efforts under the Social Determinants of Health (SDOH) banner. The organization has approximately 7 million members.
Nebeyou Abebe, senior vice president of SDOH, said he has appointed Austin Price, director of stakeholder engagement and impact for SDOH, to work with the SDOH team and external community stakeholders on food as medicine strategies and initiatives .
Abebe added that creating a specific role for food as medicine is not something he would do at Highmark. Food insecurity is just one part of SDOH. Social isolation, transportation barriers, intimate partner violence and other factors also impact health.
"There are a whole range of social needs and social issues that our members are going through," Abebe said. "So I would never have a director for each of those SDOH domains. But I do have a dedicated resource within the company's SDOH team - Price - who helps coordinate and collaborate with key stakeholders across the company to drive our food-as-medicine strategy."
Highmark Health has done that too launched several food initiatives, including the Healthy Neighborhood pilot in West Virginia in partnership with Vandalia Health Network, Marshall Health, Mountain Health Network, InComm Healthcare and Dollar General. It offers eligible West Virginia residents debit cards that they can use exclusively at Dollar General stores to purchase nutritious food. The company recently expanded the program to include West Virginia University Health System.
While Elevance, Kaiser Permanente, and Highmark Health all have slightly different ways of addressing food as medicine within their organizations, they have similar ambitions: to have a meaningful impact on food and nutrition security and on diet-related diseases.
Schwartz added that she wants to see more collaboration between health care organizations to further develop food and nutrition security.
"I don't think where we do this and how we do this should be a competitive thing," she said. "I think it should be this: How can we treat and prevent diet-related diseases in the most impactful way? Healthcare must come together around the table to learn what is most effective here."
It is no surprise that payers are increasingly considering food insecurity and the availability of nutritious food as a core capability. In fact, recent research shows that even reimbursing medically tailored meals could save payers $13.6 billion annually.
Filling a specific role for food as medicine - as Elevance has done - is not the only route payers and healthcare organizations are taking, explains Dr. Jay Bhatt, a practicing physician and director of the Center for Health Solutions and Health Equity Institute. at Deloitte. Other strategies include creating a food security task force, integrating food insecurity into existing roles, partnering with outside organizations, training their physician network, and working with employers.
Whatever strategy the payer chooses, one thing is clear:
" Organizations can lead an individual, but the work in this area must be embedded in the overall healthcare equity strategy, operations, measurements and financial priorities within the enterprise," Bhatt said. "Food equality should not be an afterthought."
Photo: vgajic, Getty Images
