From 3M Health Information Systems
Is there a role for health care in helping people make better food choices?
The link between poor food choices and disease is undeniable. Conditions such as diabetes, heart disease and most cancers have a direct link to the choices we make at the dinner table. Yet healthcare providers have not historically engaged patients to help them make healthy food choices. Apart from advising patients to lose weight, there is little instruction offered on what foods should be eaten and what should be avoided. In this era of accountable care, there is an opportunity for healthcare providers and payers to help patients and members make the right food choices.
Obesity and poor eating habits cannot be solely attributed to lack of individual willpower or indulgent behavior. The obesity rate of American adults did not double in the past 30 years simply because individuals were suddenly unable to control their food intake. They received help from both the government and the food industry.
Seven of the foods most heavily subsidized by the federal government – corn, soybeans, wheat, rice, sorghum, milk, and meat – are processed into foods that contribute to the obesity crisis, while only a fraction of subsidies support the production of fruits and vegetables. A plant-based diet that includes whole grains, greens, beans, seeds, nuts and fruit is most likely to contribute to the goals of the Triple Aim – better outcomes, better patient experience, and lower cost. However, the cost of calorie-dense, non-nutritious food is kept artificially low, and the plethora of fast food restaurants, convenience stores and grocery stores packed with aisles of processed food makes these foods easily accessible. The combination of low price and easy access has led to obesity rates that are highest in states with the lowest median income.
The obesity epidemic and the health issues related to overconsuming non-nutritious foods with high levels of sugar, salt, fat, and processed carbohydrates is best addressed at the state and federal policy level. However, there are also opportunities in this era of accountable care for providers and payers to make a positive contribution through their own policies and programs.
Hospitals and healthcare facilities that offer food services to their patients can use this as an opportunity to teach patients the basics of healthy eating. A health crisis is often a motivator for people to change behaviors, particularly those behaviors that contribute to their illness. Hospitals have an opportunity, as well as a captive audience, to use the food they serve patients as a teaching tool that models the type of diet patients should eat regularly to manage and potentially reverse their disease.
Even patients treated on an outpatient basis can be “prescribed” healthy food that begins with a stop at the cafeteria or restaurant within the healthcare facility. Montefiore Medical Center is an example of health system that actively promotes healthy food choices that benefit their staff as well as their patients. The largest healthcare provider in the Bronx has made such positive changes as eliminating sugary beverages, reducing salt, replacing a fried munchie bar with a whole grain and vegetable bar, and reducing portion sizes.
Healthcare providers that form accountable care organizations (ACOs) can also be encouraged by government and commercial payers to incorporate healthy food options, nutritional education and patient behavioral change into the quality metrics that they measure. Measuring the positive food choices of patients may be more challenging than calculating medication possession ratios, but the impact on reducing total cost of care can be even greater. Grocery stores already track purchases using rewards programs. Scoring foods based on their nutritional value and providing feedback to patients and providers is one option available to an ACO.
Wellmark Blue Cross Blue Shield is an example of a health plan that has made positive steps to reward members for healthy behaviors with their Blue Rewards health insurance option. By coordinating services with UnityPoint Health and Hy-Vee pharmacy, Wellmark encourages healthy behavior through health assessments, wellness screenings, nutrition counseling and healthy food options offered by Hy-Vee. Payers that support such programs will encourage ACOs and other provider organizations to come up with new ideas that encourage healthy eating and promote positive behaviors.
The healthcare industry has only begun to use their resources to influence positive food choices among their patients and members. As it becomes more obvious how healthy eating impacts all aspects of the Triple Aim the healthcare system will start to play a bigger role. It’s not a matter of adopting a new idea, but rather hearkening back to a maxim attributed to Hippocrates more than 2,500 years ago — “Let food be thy medicine, and medicine be thy food.”
Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.