From 3M Health Information Systems
Would you like a side of vegetables with your medication prescription?
Vegetables are a highly rated, though a vastly underutilized resource for addressing diet-related health conditions. The same is true for fruit, whole grains and legumes. If the regular consumption of nutritious whole foods promotes overall health and well-being, shouldn’t we expect health care providers to consider food as medicine? The answer is yes, and there is a growing trend for health care practitioners to adapt the medical model to address food insecurity and nutritional deficits in their patient population.
One in 20 American adults are currently diagnosed with heart disease, one in 10 with diabetes, 38 percent with prediabetes, 40 percent with high cholesterol, 42 percent with obesity and nearly half with hypertension. These are all diet-related conditions that can be treated or prevented with a whole foods, and a plant-based (WFBP) diet, particularly among higher-risk populations.
There are three primary reasons that the health care system has not focused on improving patient health through diet. First, nutrition is not widely covered in medical training. A survey of internal medicine interns revealed that 94 percent thought it was their obligation to discuss nutrition with patients, but only 14 percent felt adequately trained in nutrition counseling. Second, there is a high rate of recidivism among those that try to make changes to their diet, thereby frustrating providers who must rely on patient behavior change to get desired results. Finally, and most importantly, no one is making money when patients choose healthier food, except perhaps the local grocer or farmstand. Paradoxically, patients usually spend more money and time buying and preparing healthier food compared to consuming a steady diet of fast food, factory-farmed meat and mass-produced refined carbohydrate-based meals.
Given the clear link between diet and health, the medical community is beginning to take notice. Furthermore, they are finding ways to fit nutritious food into the medical model of health care delivery. It even has a name – produce prescriptions (PRx), as well as a national collaborative to promote its integration into standard clinical practice. PRx programs allow health care providers or payers to offer free or discounted produce “prescriptions” based on a patient’s eligibility criteria.
Produce prescriptions may soon become as prevalent as medication prescriptions given the potential to reduce health care costs among those with diet-related illnesses and food insecurity. According to a July 2023 article a national produce prescription program for 40 to 79-year-olds with diabetes and food insecurity could save $39.6 billion in health care spending and $4.8 billion in costs of lost productivity annually.
As the popularity of Medicare Advantage grows, a greater proportion of American seniors can also receive meal benefits offered to certain subgroups of beneficiaries. Half of all Medicare beneficiaries are enrolled in a Medicare Advantage plan and 71 percent of those plans offer a meal benefit. One such program featured in a June 2023 JAMA article resulted in lower 30-day mortality and readmission rates for heart failure patients that received posthospitalization home-delivered meals.
Produce prescriptions send a clear signal to the patient population that a healthy diet is an important part of addressing their diet-related conditions and overall health. A well-funded PRx program allows economically disadvantaged and food insecure populations to access food that they otherwise would not be able to afford. State Medicaid programs offer an ideal environment for designing, implementing and evaluating PRx programs since many recipients experience resource constraints and food insecurity. Medicaid program stakeholders interviewed in a recent study viewed PRx programs positively and highlighted the potential to improve patients’ diets, food security, disease management and financial security.
There are currently more than 100 U.S. Food and Drug Administration (USDA)-funded PRx programs operating in 36 states. Program participants not only report an increase in fruit and vegetable intake, but their intake is now higher than the average U.S. adult. The next step is to measure health improvements and health care cost reductions. As the evidence base grows, it may become increasingly more common for patients to leave their health care provider with an apple rather than a statin.
Steve Delaronde is senior manager of product, population and payment solutions at 3M Health Information Systems.