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.
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 and death. By investing in upstream interventions, California can be better prepared for our current health crisis — and the next one.
But is San Francisco, and California generally, prepared to greatly expand access to these food-based interventions?
My sense is yes. SPUR — in collaboration with the UCSF Center for Vulnerable Populations, the Harvard Center for Health Law and Policy Innovation and the Food as Medicine Collaborative — recently published “Integrating Food into Health Care,” a report based on a survey of 145 organizations across the state. The research shows there is already a strong network of community-based organizations, government agencies and traditional health care providers offering — and poised to expand — food-based services. In San Francisco, more than a dozen organizations provide at least one medically supportive food and nutrition intervention. However, to build upon the existing network of providers, the Department of Health Care Services, which administers Medi-Cal, and health plans must address barriers to growth.
Nearly 70% of providers surveyed reported a lack of sustainable funding as a barrier to offering food and nutrition services. These interventions are primarily funded through philanthropy, hospital community benefit dollars and other external sources, rather than insurance. In other words, they lack long-term financial sustainability.
Yet researchers have estimated these interventions could save $40-$100 billion in health care costs nationwide. Transitioning these services from pilots to standard plan benefits would ensure their sustainability and enable more patients to improve their health while also reducing overall health care costs.
While some may argue that inadequate healthy food access is a problem to be solved by social services agencies, Dr. Kim Newell Green, former president of the San Francisco Marin Medical Association, explains, “If a new drug came to market that showed these health outcomes and no side effects, we would immediately prescribe it to patients.”
A future where we pay for the prevention — and not just the treatment — of chronic disease is within our grasp. The San Francisco Health Plan must take the lead by seizing this rare opportunity to improve care by providing medically supportive food and nutrition interventions.
“An apple a day keeps the doctor away” isn’t just a wise adage. It’s evidence-based medicine that health plans should embrace.
Katie Ettman is the food and agriculture policy manager at SPUR, a nonprofit public policy organization in the San Francisco Bay Area.