Food As Medicine Can Change Patient Lives, But Establishing Models, Payment Pathways Is Critical

Experts gathered in a session on Saturday 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. Although there are many lingering questions about various models and challenges, the experts all agreed that pharmacies will play a crucial role.

Lack of nutrition is a systemic problem, as opposed to simply individuals making unhealthy food choices, said Dariush Mozaffarian,MD, DrPH, director of the Food as Medicine Institute in the Friedman School of Nutrition Science and Policy at Tufts University. Food as medicine programs are recognizing this and have taken off across the country.

Nutritionist with a patient | Image credit: Kittiphan | stock.adobe.com

“Compared to 5 years ago, I would say there’s been at least a 10-fold explosion of food as medicine programs,” Mozaffarian said. “Health care is getting involved now.”

In some states, Mozaffarian said Medicaid is paying for food as medicine programs, which is important because individuals on Medicaid often have food insecurity challenges. Additionally, the Department of Health and Human Services has an active working group focused on creating guidelines for food as medicine programs.

Currently, there are many different models for food as medicine programs. Most models have a physician who prescribes the treatment, at which point pharmacists can get involved. Some programs provide the patient with a grocery card, although Mozaffarian said this is not ideal because patients can still purchase any foods with that card, regardless of nutritional value.

“I think what’s really exciting now is to think about the role of the pharmacy, where you can get a prescription for a drug, if you get a prescription for food in a pharmacy, and then you fill it,” Mozaffarian said. “Many pharmacies have retail settings for food right there, so that would really be an innovation.”

Providing education must be an important piece of any food as medicine program, and pharmacists are well positioned to fill that need. Lisa Smith, PharmD, MBA, senior director of clinical operations and strategy at Walmart Health and Wellness, said aggregating OTC purchases, prescriptions, and food data can allow pharmacists and dietitians to directly intervene with patients and provide personalized insights.

Many pharmacy chains and grocery pharmacies are including dietitians. Aaron Wiese, president of Hy-Vee, said their stores have 63 retail dietitians who work closely with the pharmacies. Specifically, Wiese said there are fantastic opportunities in grocery pharmacies to walk a patient directly to the item they need, show them how to read a nutrition label, and give them direct tools to change their diets.

Although patients with diabetes can particularly benefit from these services, panelist Barbara Eichorst, MS, RD, CDCES, vice president of health care programs at the American Diabetes Assocition (ADA) said food as medicine can benefit all consumers.

“It’s not just about diabetes these days because diabetes is a cardiometabolic chronic condition,” Eichorst said. “So there is a huge need to educate clinicians, physicians, primary care providers, pharmacists, and dietitians in terms of effective nutrition and intervention.”

Mozaffarian added that in addition to benefiting patients regardless of diagnoses, food as medicine can play a role in the nutrition and holistic health of all Americans—regardless of race, ethnicity, or socioeconomic status. However, he said awareness of social determinants of health (SDOH) must be incorporated into food as medicine programs. He noted that nutrition has improved among wealthy and educated Americans in recent decades but has stagnated or worsened among others.

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

However, payment models still represent a huge hurdle. Without establishing several key elements—payment pathways, workflow, and data interoperability—the panelists all agreed that these programs will be limited.

“When I think about food as medicine and the momentum [it has], what a shame it would be if pharmacists are left behind with these initiatives, Smith said. “You can’t have a sustainable program without a sustainable business model.”

In his conversations with payers, panelist Daryl Risinger, co-founder and president of Soda Health, Inc, said he has emphasized the economic benefits of partnering with pharmacies, highlighting that this can improve star ratings and boost revenue.

“If you want to move the needle, you need to be in retail because retail is where consumers are spending most of their time,” Risinger said. “So, I look at it from the standpoint of convenience, from the standpoint of cost, and the standpoint of the care itself.”

Risinger added that compared with seeing a physician maybe 5 times per year, consumers shop for groceries an estimated 80 times per year, highlighting the 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 huge primary care shortage in the US, with approximately two-thirds of counties in the country with less than 1 primary care provider per 1500 population. This further highlights the role for pharmacies, which are much more accessible.

Data interoperability is a related challenge for wider implementation of food is medicine programs. Marcus said there are steps being taken to improve this, although it will take time. The Trusted Exchange Framework and Common Agreement (TEFCA), which was first published in November 2023 and updated in April 2024, establishes qualified health information networks (QHINs), which will be able to share data among participants. In July 2024, the Office of the National Coordinator for Health Information Technology confirmed that pharmacies can see the clinical information delivered via QHINs, which was not previously clear.

This new framework is a huge step forward, but Marcus said there is still much work to be done. In particular, she highlighted 2 significant questions: which data do pharmacies need, and how can it be ingested into the individual clinical systems?

As national partners all work toward solving these questions and implementing more widespread food as medicine programming, the panelists said pharmacies have positioned themselves early to play a key role. Continuing to highlight their accessibility and close relationships with patients can further this mission.

“Ultimately, the reason why I feel confident that community pharmacy can play a tremendous role in health care is because we’ve seen it,” said Rina Shah, PharmD, senior vice president of pharmacy growth at Walgreen Co. “We’ve seen our ability to impact H1N1 when that hit. We’ve seen the impact in SDOH, where we’re in underserved communities and are the primary source of care. And we saw it during COVID-19.”

Reference

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