Using food as medicine can transform patients' lives, but establishing models and payment pathways is key

On Saturday, experts gathered at the National Association of Chain Drug Stores' 2024 Total Store Expo to discuss the future of the “food as medicine” movement, which aims to integrate nutrition into the broader health care system. Though many questions remain about the different models and challenges, experts agreed that pharmacies will play a key role.

Darius Mozaffarian, M.D., director of the Food as Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University, said nutritional deficiencies are a systemic problem, not just a matter of individuals making unhealthy food choices. Food as medicine programs have recognized this and are beginning to take off around the country.

Patient and dietitian | Image courtesy: Kittiphan | stock.adobe.com

“Compared to five years ago, I would say there are at least 10 times as many food-as-medicine programs,” Mozaffarian says, “and now medical care is starting to get involved.”

Mozaffarian said some states are funding Medicaid food-for-drug programs, which is important because Medicaid recipients often suffer from food insecurity, and the Department of Health and Human Services has a working group focused on developing guidelines for food-for-drug programs.

Currently, there are different models for food-as-medicine programs. Most have a doctor who prescribes the treatment, at which point a pharmacist can get involved. Some programs provide patients with grocery cards, but Mozaffarian says this isn't ideal because patients can buy any food with the card, regardless of its nutritional value.

“I think what's really exciting right now is thinking about the role of the pharmacy: you get a prescription for a drug at the pharmacy, you pick it up at the pharmacy, and you fill it,” Mozaffarian said. “A lot of pharmacies have a section where they sell food on-site. That's really an innovation.”

Providing education should be a key component of any food-as-medicine program, and pharmacists are well positioned to meet that need. By aggregating OTC purchases, prescriptions and food data, pharmacists and dietitians can intervene directly with patients and provide personalized insights, says Lisa Smith, PharmD, MBA, senior director of clinical operations and strategy at Walmart Health and Wellness.

Many pharmacy chains and grocery pharmacies have nutritionists on staff. Hy-Vee has 63 retail nutritionists in its stores who work closely with pharmacies, says Aaron Weese, president of Hy-Vee. Grocery pharmacies, in particular, have a great opportunity to guide patients directly to the items they need, teach them how to read nutrition labels, and provide them with direct tools to make dietary changes.

While people with diabetes can especially benefit from these offerings, panelist Barbara Eichorst, MS, RD, CDCES, vice president of health care programs at the American Diabetes Association (ADA), said all consumers could benefit from food as medicine.

“Today, it's not just about diabetes because diabetes is a chronic cardiometabolic disease,” Eichorst says, “so there's a great need to educate clinicians, physicians, primary care providers, pharmacists and dietitians about effective nutrition and interventions.”

In addition to benefiting patients regardless of diagnosis, Mozaffarian added that using food as medicine can play a role in the nutrition and overall health of all Americans, regardless of race, ethnicity or socioeconomic status. But awareness of social determinants of health (SDOH) needs to be built into food-as-medicine programs, he said. He noted that while nutrition has improved for affluent, educated Americans in recent decades, the nutrition of others has stagnated or worsened.

“[Food as medicine] This is the first major innovation I can think of in my career in medicine that may actually improve health. and It improves health equity,” Mozaffarian said.

But payment models remain a major obstacle, and all panelists agreed that without establishing several key elements such as payment pathways, workflows and data interoperability, these programs will be limited.

“Think of food as medicine, and the momentum [it has]”It would be a shame if pharmacists were left out of these efforts,” Smith said. “Without a sustainable business model, you can't have a sustainable program.”

Panelist Darryl Rising, co-founder and president of Soda Health, highlighted the financial benefits of partnering with pharmacies in conversations with payers, which can lead to improved star ratings and increased revenue.

“If you want to make a difference, you have to get into retail because that's where consumers spend most of their time,” Rising said. “So I look at it from the perspective of convenience, cost and care itself.”

Rising emphasized that consumers shop for groceries around 80 times a year, compared to just five doctor visits, providing frequent opportunities to integrate nutrition and health care. Panelist Melanie Marcus, MBA, chief marketing and customer experience officer at Surescripts, added that there is a significant primary care shortage in the U.S., with roughly two-thirds of the country's counties having fewer than one primary care provider per 1,500 people. This further highlights the role of the much more accessible pharmacy.

Data interoperability is a challenge related to the broader implementation of the Food and Drug Program. Marcus said steps are being taken to improve this, but it will take time. The Trusted Exchange Framework and Common Agreement (TEFCA), first published in November 2023 and updated in April 2024, establishes a Qualified Health Information Network (QHIN) that can share data between participants. In July 2024, the Office of the National Coordinator for Health Information Technology confirmed that pharmacies can verify clinical information delivered through the QHIN, which was not clear previously.

While this new framework is a big step forward, Marcus said there is still much work to be done, highlighting two key questions in particular: what data does pharmacy need, and how do we get it into individual clinical systems?

As country partners work to answer these questions and implement broader food and drug programs, panelists said pharmacies are positioned to play an early and important role. A continued emphasis on pharmacy's accessibility and close relationships with patients can further this mission.

“At the end of the day, we believe community pharmacies can play a big role in health care because we've seen it,” said Lina Shah, PharmD, senior vice president of pharmacy growth at Walgreens Corp. “We saw the ability to make an impact with H1N1, we saw the impact with SDOH, which is a primary source of health care delivery in underserved areas, and we're seeing it during the COVID-19 outbreak.”

reference

Eichorst B, Freishtat H, Lindholz C, et al. NACDS Institute: Building Sustainable Models of Care. National Association of Chain Drug Stores Total Store Expo. August 17, 2024, Boston, MA.