Consumer / Employer, Payers, Social Determinants

‘Food Equity Can’t Be a Side Gig’: How Food as Medicine is Becoming A Core Team Capability

As the food as medicine movement grows, some payers and healthcare organizations are carving out specific roles and teams dedicated to food and nutrition. Doing so can be beneficial considering the significant impact diet can have on health outcomes.

The intersection of food and health has long been known. But recently, a major trend — the “food as medicine” movement — has picked up steam. As societies wrestle with rising healthcare costs and gain a growing understanding of the effect of diet 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 taking it a step further.

Last June, the Indianapolis, Indiana-based insurer appointed Dr. Kofi Essel as its inaugural food as medicine director. After six months on the job, he recently explained to MedCity News why Elevance hired him.

“I think the opportunity of bringing in a food as medicine director was a realization that, ‘Hey if we want to take this seriously, we want to bring in some more subject matter expertise,’” Essel said in an interview. “They sort of needed to pull externally to bring that in to really raise up the efforts internally as well.”

Before joining Elevance, Essel was a pediatrician at Children’s National Hospital in Washington, D.C., and the director of George Washington University School of Medicine and Health Sciences Culinary Medicine Program. He has also done a lot of teaching and research on community health and food and nutrition. In other words, he has long seen a clear, clinical link to what we put in our bodies and how healthy we are.

At Elevance, Essel is focused on implementing food as medicine across “every line of business,” whether that’s Medicaid, Medicare or commercial insurance. The insurer has more than 47 million members. While food insecurity and diet-related diseases impact people covered by all kinds of insurance, not all food-as-medicine strategies work for everyone. 

“Every line of business is looking for something slightly different and we’re kind of adapting to what they need to improve health outcomes for their members, whether it’s an age thing, whether it’s an issue around disabilities, whether it’s an issue around what resources and access they have,” Essel said. “We have to think about all those pieces when designing interventions.”

Some strategies Elevance is exploring include working with the Supplemental Nutrition Assistance Program (SNAP), leveraging medically-tailored meals and produce 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 various pilots across its business lines, but declined to provide additional information about them.

An integrated health delivery system without a dedicated 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 that works specifically on food and teams that work on other social determinants.

Kaiser serves about 12.6 million members. Among them, one in four is struggling with food and nutrition security, Schwartz said. Among its Medicaid members, half are struggling with food and nutrition security. Having a dedicated team focused on food as medicine “elevates” the organization’s ability “to lean” into the problem, she said.

“It allows us to create a comprehensive portfolio of efforts that are aimed specifically at addressing this and improving these outcomes for people,” she said.

Some of its efforts include a $50 million commitment to food and nutrition security that the organization announced in 2022. In October, Kaiser Permanente also launched a study that will measure the effects of providing Instacart Health Fresh Funds to Medi-Cal members with diet-related diseases. This builds on a previous study that sent curated food boxes to members. From that study, Kaiser learned that members want choice in their food. The study with Instacart gives members a stipend to shop for their own healthy food.

Like Kaiser Permanente, Highmark Health, based in Pittsburgh, Pennsylvania, also brings food as medicine efforts under the banner of social determinants of health (SDOH). The organization has about 7 million members.

Nebeyou Abebe, senior vice president of SDOH, said he has assigned Austin Price, director of stakeholder engagement and impact for SDOH, to work with the SDOH team and outside community stakeholders on food as medicine strategies and initiatives. 

Abebe added that creating a specific role dedicated to food as medicine is not something that 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 one’s health.

“There are a whole host 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 enterprise SDOH team — Price — that is helping to coordinate and collaborate with key stakeholders across the enterprise to drive our food as medicine strategy.”

Highmark Health has also 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 provides eligible West Virginia residents with debit cards that they can use exclusively at Dollar General stores to purchase nutritious foods. The company recently expanded the program with West Virginia University Health System.

While Elevance, Kaiser Permanente and Highmark Health all have slightly different ways of addressing food as medicine within their organization, they have similar aspirations: to have a meaningful impact on food and nutrition security and diet-related disease.

Schwartz added that she wants to see more collaboration between healthcare organizations to move the needle on 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, how do we treat and prevent diet-related disease in the most impactful way? Healthcare should come to the table together to learn what is most effective here.”

It comes as no surprise that payers are increasingly targeting food insecurity and availability to nutritious food as a core capability. Indeed, recent research shows that even just covering medically-tailored meals can save payers $13.6 billion annually.

Carving out a dedicated role for food as medicine — as Elevance has done — isn’t the only route payers and healthcare organizations are taking, explained Dr. Jay Bhatt, a practicing physician and managing 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 in existing roles, collaborating with external organizations, educating their clinician network and collaborating with employers.

However, no matter the strategy the payer chooses, one thing is clear:

Organizations can have an individual provide leadership but the work on this issue has to be embedded into overall health equity strategy, operations, measurement, and financial priorities through the enterprise,” Bhatt declared. “Food equity can’t be a side gig.”

Photo: vgajic, Getty Images