HEALTH CARE PLANS MUST EMBRACE FOOD AND NUTRITION-BASED MEDICAL INTERVENTIONS How healthy eating can become part of S.F.’s health care strategy Katie Ettman Introduction by SFMMS Past-President and Pediatrician Kimberly Newell Green, MD: In 2019 I was asked to be a Champion Provider Fellow. CPF is a statewide two-year fellowship with the goal of training healthcare providers to engage in policy, systems and environmental (PSE) change activities around obesity, and dental and chronic disease prevention. The goal of the fellowship is to give providers the skills and support needed to partner with their local health department to affect policy change in their communities and throughout California. Recognizing that this process could arm me with skills to magnify the health advocacy work that I was doing through SFMMS and CMA, I jumped at the chance. Along with trained chef and San Francisco fellow Emma Steinberg, MD, I partnered with Dr Rita Nguyen, the lead of San Francisco Department of Public Health’s Food as Medicine Collaborative and her colleagues Priti Rani and Erin Franey. This powerful trio of health advocates steered us to join a coalition doing work to find tangible ways for health systems to think about food insecurity and to treat it as a medical issue. Through work with an incredibly passionate coalition of advocates from many organizations including leaders from SFDPH, SPUR and several community-based organizations including food providers and advocates, we focused much of our work on the CalAIM process. After months of advocacy and efforts, facilitated in part by SFMMS’ relationships with state legislators and DHCS leaders, we were thrilled to have an important success. The words “medically-supportive food and nutrition” were inserted into the CalAim legislation. With these 5 words, a universe of food supports became possible for patients who need them. Now, when the treatment for your patient’s diabetes, cardiac disease, or renal disease is food, condition appropriate healthy food can be covered by Medicaid. The food supports come in many forms, including direct prescriptions to hospital-based food pharmacies, medically-tailored meals, and “vouchers for veggies” which can be brought to local markets. The legislation also supports counseling to promote nutritional behavior change. But the work has only begun. As health plans begin to implement the complex and comprehensive new approach to care delivery encapsulated in CalAIM, they will need to build the infrastructure and systems to support this work. And so the work continues. The OpEd that we reprint here by my partner and colleague Katie Ettman begins to outline the work to be done. Please join us in the vital work towards moving the healthcare system to provide the appropriate, cost-effective and high quality treatment for many chronic diseases that cause so much suffering and death: food. – Kimberly Newell Green, MD
At the end of 2021, the federal agency that oversees Medicare and Medicaid made a big decision that made little news. With all the fanfare of papers getting a stamp of approval, California received permission to pilot new approaches to providing healthcare to the more than 13 million Californians who rely on Medi-Cal. With that approval, the onus is now on local health plans, including the San Francisco Health Plan, to implement strategies that could profoundly improve people’s health and lives. One cutting-edge aspect of the reforms is Community Supports, of which there are 14 designed to address social drivers of health, such as lack of access to food. 28
SAN FRANCISCO MARIN MEDICINE APRIL/MAY/JUNE 2022
But these are optional services, meaning individual health plans must opt into providing them. To prevent, treat and reverse chronic conditions, the San Francisco Health Plan and health plans across California should opt into providing medically supportive food and nutrition, one of the 14 Community Supports. Medically supportive food and nutrition interventions include produce prescriptions, food pharmacies, healthy groceries and medically tailored meals. Evidence strongly suggests that this spectrum of interventions can help reduce average blood sugar in those with diabetes, blood pressure and preterm birth. Many of these conditions put individuals at greater risk for COVID-19 hospitalization WWW.SFMMS.ORG
