Research
Patients Win!
Florida has more elderly and disabled than most states. These two groups make up 20% of the pool of Medicaid enrollees yet use 60% of the funding. With a new treatment program proven by research, experience in nine other states, and a clinical trial to save on costs, people heal and get well. The new treatment is Food is Medicine programs: medically tailored meals, medically tailored groceries, and produce prescriptions. People learn to eat to beat their disease, recover, and need less emergency services and unexpected hospitalizations as vitality is restored. Win!
Businesses Win!!
What if Florida takes the greatest Medicaid liability – our large pool of seniors and people with diabilties– and turn them into our greatest asset?
A whole new FiM supply chain can be brought to life with local businesses, hospitals, clinics, physicians and food growers, meal makers. All will be profited by the $1.6Billion in new revenue streaming into Florida over the next decade with $2 out of $3 coming from the Federal Government. Win!
Florida Wins!!!
Florida stands to gain a massive benefit of 3X the value of each Florida $ invested. Florida funds only 1/3 of the cost per patient < $1,000, while sharing in 50% of the $6,000 savings generated for each high need patient on Food is Medicine programs. Without Medicaid Waiver 1115, Florida is leaving $868 million on the table it could be adding back into its own bottom line. Respsonsible, reasonable leadership is working on this now.
This $1.6 Billion Business winfall in 10 years is a
Win, Win, Win!
Literature Review
Abbott's Healthy Food Rx Results – 12 Months - HbA1C's drop 0.8 points for diabetic enrollees
There are many ways to fund food-as-medicine interventions. Massachusetts, Oregon, and other states including North Carolina and Arkansas are using a specific mechanism in Medicaid called an 1115 waiver, a tool that has long been available to states. These 1115 waivers allow states to use federal funds to test programs that wouldn’t normally be included under Medicaid.
This report was written by the following staff and students at the Center for Health Law and Policy Innovation of Harvard Law School: Erika Hanson, Sara Raza, Katie Garfield, Erin Mizraki, Hannah Rahim,
Jessica Samuels, Carmel Shachar, and Emily Broad Leib.
Additional authors from the Food is Medicine Coalition include: Alissa Wassung and Cate Hensley
“Food Is Medicine” Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review
Conclusions: The rapid growth in understanding, implementation, and evaluation of FIM interventions has been remarkable, with programs and policy changes now underway across the country. The United States leads globally in this arena, with FIM projects only starting to be piloted in other nations.97 In the face of large health, economic, and equity impacts of poor nutrition and food insecurity, FIM programs represent a compelling health care innovation to help address these burdens. Renewed attention on MNE in undergraduate, graduate, and continuing medical education is occurring and will be relevant for success and scaling...Much of the initial programmatic focus and evidence has been on cardiometabolic health, making it important for clinicians in this area to understand the current landscape and coming directions. Experiences to date are promising, but current FIM programming reflects a patchwork of approaches, geographies, and payer coverage. Broader integration of FIM into health care to reach patients in need will require additional multiparty collaboration—among researchers, payers, clinicians, health care systems, patient advocates, community-based organizations, the private sector, research funders, and policy makers—to assess, optimize, and scale the interventions with greatest effects on nutrition, health, health disparities, and corresponding economic and societal burdens.
Tufts University Study Complete on Healthy Food Prescription Results – 0.8 points HbA1C drop for diabetic clients in 6-months.
West Palm Beach, FL and Boston, MA, October 5, 2024— A research study evaluation completed by Tufts University researchers on the Healthy Food Prescription, a food is medicine program and health intervention. The study population included participants of two 24-week medically tailored grocery programs administered by Living Hungry, a charity organization dedicated to addressing food insecurity in Florida’s high-risk communities. The programs provided a healthy grocery bundle every two weeks during the intervention period, containing an estimated 28 meals worth of produce, whole grains, legumes, proteins, and healthy fats for diabetic patients based on research-based reference levels (15,16)
At the end of the program, HbA1c significantly declined by -.60 percentage points (95% CI: -1.16, -0.04), however changes in BMI (<0.01 kg/m2 95%CI: -0.88, 0.88) and total cholesterol (10.14 95% CI: -27.38, 7.09) were not significant. The results of the sensitivity analysis including only participants with HbA1C >=8.0% were similar to the overall analysis. Among participants with HbA1c>=8.0%, HbA1c declined by -.80 percentage points (95% CI: 1.50,-0.10).
View the video presentation by the Research Team:
Dr. Kurt Hager, UMass Chan Medical School, Maura Plante, Living Hungry, and Elsa Konieczynski, Tufts University, Friedman School of Nutrition Science and Policy
True Cost of Food: Food is Medicine Case Study. The first case study, Medically Tailored Meals: Hospitalizations and Health Care Expenditures, is a health and economic evaluation of MTMs nationally. The second case study, Produce Prescription Programs: Health and Economic Impacts, is a health and economic evaluation of the true cost of expanding produce prescriptions nationally for adults with diabetes and food insecurity. Food is Medicine Institute at Tufts University & The Rockefeller Foundation, September 26, 2023.
The True Cost of Food: FiM Case Study Report highlights the findings from two “True Cost of Food” case studies that evaluated the health and economic impacts of scaling medically tailored meals and produce prescriptions nationally. The case study on medically tailored meals found that national implementation could result in 1.6 million averted hospitalizations and a net cost savings of $13.6 billion annually. The case study on produce prescriptions found that national implementation for patients with diabetes and food insecurity could result in 292,000 averted cardiovascular events, with high value cost effectiveness compared to other well-established medical interventions from the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University, and The Rockefeller Foundation.
Produce Presciptions impact on diet and heart health published in Circulation: Cardiovascular Quality and Outcomes and featured in the Washington Post. Authors found that receiving produce prescriptions for an average of 6 months was associated with improvements in blood pressure, blood sugar control, and weight among adults with hypertension, diabetes, and obesity. Authors also observed improvements in fruit and vegetable intake and food insecurity, including among children, which could lay an important foundation for child development. Wholesome Wave operated the produce prescription programs in 12 US states, serving nearly 4,000 people that we included in the analyses. This is the largest produce prescription study to date to assess health outcomes, pooling data across 22 program locations in the United States. These findings provide important new evidence from a diverse set of programs for meaningful benefits of produce prescriptions, highlighting the need for clinical, pol
Source:
Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States, Kurt Hager, Mengxi Du, Zhongyu Li, Dariush Mozaffarian, Kenneth Chui, Peilin Shi, Brent Ling, Sean B. Cash, Sara C. Folta and Fang Fang Zhang
Originally published 29 Aug 2023 Circulation: Cardiovascular Quality and Outcomes. 2023;16 https://doi.org/10.1161/CIRCOUTCOMES.122.009520
August 29, 2023: Fruit and vegetable ‘prescriptions’ may lead to better heart health by Teddy Amenabar, Washington Post
Healthy & Economic Impacts Produce Prescription Programs for Diabetes in the United STates, A Microsimulation Study, July 11, 2023 // An apple a day not only keeps the doctor away, it also could save the United States at least $40 billion in medical bills, report Friedman School of Nutrition Science and Policy researchers in a new study published July 7 in the Journal of the American Heart Association. Their modeled implementation of a nationwide produce prescription program—which would provide free or discounted fruits and vegetables to eligible Americans living with diabetes —projected extensive reductions in national rates of cardiovascular disease and associated health care costs.
Source:
Lu Wang PhD lu.wang@tufts.edu , Brianna N. Lauren MS , Kurt Hager PhD , Fang Fang Zhang MD, PhD , John B. Wong MD , David D. Kim PhD , and Dariush Mozaffarian MD, DrPH.
Mainstreaming Produce Prescriptions in Medicaid Managed Care: A Policy Toolkit and Resource Library, is the third report in a series exploring policy pathways to increase access to Produce Prescriptions (PRx) through the U.S. health care and food systems.
PRx are medical treatments or preventive services that provide access to healthy fruits and vegetables for patients with diet-related health risks or conditions who are food insecure or face documented challenges in accessing nutritious foods.
The first report in the series, Mainstreaming Produce Prescriptions: A Policy Scan, provides a high-level overview of current opportunities to sustain and scale PRx via U.S. health care and food policies. Mainstreaming Produce Prescriptions: A Policy Strategy Report then builds on this framework by providing policy recommendations addressing five core challenges limiting access to these vital programs: Funding, Research, Patient Data and Privacy, Infrastructure, and Advancing the Field.
Source:
Kristin Sukys, Erika Hanson, Katie Garfield & Emily Broad Leib, Center for Health Law and Policy Innovation, Mainstreaming Produce Prescriptions in Medicaid Managed Care: A Policy Toolkit and Resource Library (June 2023).
JAMA Open Network, Hager et Al, 10/2022
Source: 2022 Hager K et al. JAMA Network Open Supplement tables JAMA, Association of National Expansion of Insurance Coverage of Medically Tailored Meals With Estimated Hospitalizations and Health Care Expenditures in the US. Kurt Hager, MS; Frederick P. Cudhea, PhD; John B. Wong, MD; Seth A. Berkowitz, MD, MPH; Sarah Downer, JD; Brianna N. Lauren, BS; Dariush Mozaffarian, MD, DrPH, published 10/2022
Center for Health Law and Policy Innovation at Harvard Law School & The Aspen Institute's FiM Research Action Plan Foundation
This one report from the Center for Health Law and Policy Innovation is the foundation to all Florida Health & Nutrition Coalition members work and research. Food and Society at the Aspen Institute’s Food is Medicine Initiative aims to expand access to proven interventions through research. The Food is Medicine Research Action Plan publishes a comprehensive set of recommendations for creating an evidence base that will advance health care integration, build a holistic understanding of effectiveness, and engage communities, providers, and researchers. Food and Society, working with its expert Food is Medicine Advisory Board,to establish concrete steps to build on existing efforts and engage new actors, advancing research across the full spectrum of interventions, from prevention to treatment. The Research Action Plan serves as both a catalyst and framework for government and philanthropic investment in the field. In our view this is a must-read for all FiM Researchers.
NIH Nutrition Research Report 2020-2021
The NIH Nutrition Research Report 2020-2021 summarizes nutrition research activities supported and conducted by NIH ICOs in Fiscal Years 2020 and 2021. This report and an accompanying Executive Summary are now available. These documents detail FY19-FY21 funding levels for NIH-supported nutrition research and training, as well as providing highlights of selected accomplishments, gaps and opportunities, and future directions for nutrition.
Food is Medicine More Research Links
- National Strategy on Health, Hunger & Nutrition Policy Documents from National Conference, 9/2023
- $8 Billion in investments into FIM from National Conference under Susan Rice leadership.
- 2022 Hager K et al. JAMA Network Open Supplement tables
- The most recent medically tailored meal randomized controlled trial presented at the American Public Health Association meeting in Boston this fall found that hospitalizations were cut in half among participants receiving meals.
- A pilot randomized controlled trial, Andrea Pedroza-Tobias1, Rita Nguyen2, Edward Frongillo3, Aron O'Donnell4, Cady Smith5, Lizet Campos4, Binh An Phan6, Sheri Weiser4, Kartika Palar41Institute for Global Health Sciences, University of California San Francisco, 2California Department of Public Health, 3Arnold School of Public Health, University of South Carolina, 4Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California San Francisco , 5University of California Davis, 6Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California San Francisco.
- ClinicalTrials.Gov Listing
- MASSACHUSETTS 1115 ACTUAL SAVINGS: $11,309 reduction in total cost of carefor members that received Flexible Services nutrition supports in CY2020 (n = 839). page 58, Section 1115 Demonstration Project Extension Request.
Florida Medicaid Research Links
- NEW! CMS issues Guidance on Food is Medicine paid by Medicaid: Read the CHLPI Harvard Law Analysis
- Florida Medicaid Facts & : Disproportionate Share Analysis
- https://files.kff.org/attachment/fact-sheet-medicaid-state-FL
- https://www.kff.org/medicaid/issue-brief/medicaid-financing-the-basics/
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html4
- For complete list of approved & pending 1115 Waivers: https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/)
- Budget Waiver Facts
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html
- 9 State have Waivers 1115 funding Food
- https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/)
- https://www.healthinsurance.org/medicaid/florida/
- CMS on Medicaid Waivers 1115 & 2023 FL Medicaid Budget Amount
- Expense line items and implementation parameters for max spend of Medicaid dollars by State
- All State Medicaid CHIP Call with States December 6, 2022
- Harvard Law & Policy analysis of CMS Guidance Presentation
- Florida Waivers History/Timeline
- https://ahca.myflorida.com/Medicaid/Policy_and_Quality/Policy/federal_authorities/federal_waivers/index.shtml
- Business Case Analysis $1.6 Billion New Revenue Splits by Role in FIM Ecosystem