The Future of Pharmacy: Enhancing Chronic Disease Management With Food Is Medicine

A report from the Milken Institute shares insights and actionable recommendations for pharmacies integrating food is medicine (FIM), a medically led nutritional framework, emphasizing the opportunities for pharmacists in supporting chronic disease prevention, management, and treatment. According to a survey conducted by Wolters Kluwer, 58% of individuals in the United States are more likely to visit a local pharmacy for non-emergent medical care over a primary care physician, largely due to accessibility and timeliness of treatment.¹ The report, “Catalyzing Action for Pharmacist-Provided Food Is Medicine Care,” equips pharmacists with the tools to effectively implement FIM care into their practices and address the unmet needs of patients in their communities.

Centering FIM care in pharmacies provides patients with access to essential resources to enhance their overall health outcomes and improve their management of chronic diseases. Image Credit: © New Africa - stock.adobe.com

Nutrition and proper dietary habits have strong associations with overall health outcomes, and many chronic diseases, such as obesity, type 2 diabetes, hypertension, cardiovascular diseases (CVD), metabolic syndrome, as well as some cancers. In the United States, approximately 1 million individuals die every year from diet-related chronic illnesses, with nutrition and exercise being significant factors influencing health outcomes. Regular exercise paired with a high consumption of fruits, vegetables, legumes, and whole grains, and low consumption of ultra processed foods, is associated with decreased risk of chronic disease and premature death.^2-4

Despite widespread knowledge of the associations between chronic disease and nutrition, many individuals face significant barriers to obtaining adequate servings of crucial food groups, like fruits and vegetables. According to the American Heart Association, only 12% and 9% of adults meet the recommended daily intake of fruits and vegetables, respectively, in the United States. Lack of health literacy, geographical or financial access, lack of time, and lack of social support are all common driving factors for food insecurity and malnourishment.⁵

FIM is a dietary framework designed to utilize the nutritional benefits of food to prevent, manage, and treat diseases, recognizing the critical role diet plays in determining overall health outcomes. With the patient at the center, FIM interventions are uniquely designed to meet the critical needs of individuals through medically tailored meals, grocers, and food assistance.⁶

“FIM is not a one-size-fits-all solution, but rather, a tailored approach to ensuring that the patient is at the center of their care. FIM interventions span a continuum of options depending on an individual’s specific health condition and needs...” Holly Freishat, senior director of feeding change with the Milken Institute, said in an interview with Pharmacy Times. “[It] is not a stand-alone food service—it is embedded within other disease management and prevention practices that take a person's full care journey and lifestyle into perspective.”

In the report, the authors found that pharmacists can bring value to every stage of FIM care, from identifying patients for interventions to connecting patients to resources and following up on health outcomes. Due to their accessibility, frequency of patient visits, trust, and commitment to equity, pharmacies are crucial health care touchpoints for patients seeking a variety of health services.

The study authors from the Milken Institute employed a comprehensive approach including information from literature review, interviews, steering committee meetings, and roundtable discussions, to provide valuable insights into the significant role of pharmacists in expanding access to FIM care. It includes 3 key action steps to help pharmacists translate FIM from research to practice, comprising of 12 recommendations supported by 34 actions across payment pathways, workflow processes, and technology infrastructure.⁶

“However, in order for this to become a reality, [3] key components need to be transformed or established to successfully sustain and scale FIM in pharmacies: effective payment pathways to reimburse pharmacists for FIM care, seamless integration of FIM care into pharmacy workflows, and supportive technology infrastructure that supports interoperability and data sharing between FIM stakeholders,” said Freishat. “Together, these components can support pharmacy involvement in FIM and expand access to FIM for more patients”

Pharmacists are a central touch point of primary care for patients, but these are often underutilized resources. Due to their accessibility, frequency of visits, qualified care, and equitable health services, they are well-positioned to provide services connecting patients to foods that support their unique dietary needs.⁶

“Pharmacists play a key role in providing FIM care. Pharmacists are already embedded in a larger care team of providers and regularly interface with patients who may have diet-related chronic conditions when they visit the pharmacy to pick up their medications—many of whom may also be eligible for FIM services.” “Furthermore, in a shifting pharmacy landscape where pharmacists are taking on more clinical services (such as vaccines and point-of-care testing) and transitioning towards value-based care, pharmacists are well-positioned to facilitate the connection between individuals and FIM-related resources.”

The treatment landscape for pharmacists continues to evolve as the health care system at large transitions from a fee-for-service model to a value-based one, and the needs of patients battling chronic diseases grows.⁶ Centering FIM care in pharmacies provides patients with access to essential resources to enhance their overall health outcomes and improve their management of chronic diseases.

“While the public sector has been instrumental in driving forward the FIM agenda through Medicare and Medicaid, the private sector has an important role to play in sustaining and scaling the movement to improve the health of millions of individuals and provide not just food but also care,” said Freishat. “As FIM continues to gain traction in both the public and private sectors, pharmacists are well-positioned to support these efforts as crucial members of the FIM care team.

References

1. Survey: care expands beyond the clinic to the pharmacy. Wolters Kluwer. 2023. Accessed June 27, 2024. https://www.wolterskluwer.com/en/know/pharmacy-next

2. Gropper SS. The Role of Nutrition in Chronic Disease. National Library of Medicine. January 28, 2023. doi:10.3390/nu15030664

3. The role of the planetary health diet in combating chronic diseases, climate change. Pharmacy Times. June 19, 2024. Accessed June 27, 2024. https://www.pharmacytimes.com/view/the-role-of-the-planetary-health-diet-in-combating-chronic-diseases-climate-change

4. Matthews ED and Kurnat-Thoma EL (2024) U.S. food policy to address diet-related chronic disease. Front. Public Health. 12:1339859. doi: 10.3389/fpubh.2024.1339859

5. “Food is medicine” movement takes off. Pharmacy Times. March 12, 2024. Accessed June 27, 2024. https://www.pharmacytimes.com/view/-food-is-medicine-movement-takes-off

6. Freishtat H, Roesler A, Lin-Schweitzer A, et al. Catalyzing action for pharmacist-provided food is medicine care. Milken Institute. June 2024. Accessed June 26, 2024. https://milkeninstitute.org/sites/default/files/2024-06/Catalyzing%20Action%20for%20Pharmacist-Provided%20FIM%20Care%20240610.pdf