Food As Real Medicine Rx Program (FARM Rx)
The FARM Rx Program promotes affordable access to fruits and vegetables and healthy eating in underserved communities through partnerships with local healthcare providers, community organizations and the Athens Farmers Market. The Athens Farmers Market partners with healthcare providers to provide prescriptions for fruits and vegetables to patients with chronic, diet-related illnesses; patients can redeem prescriptions at the Athens Farmers Markets. The FARM Rx Program is a proven, evidence-based model of preventative healthcare with a demonstrated impact, resulting in healthier communities, food systems, and local economies.
In its third year, the Athens Farmers Market is partnered with Envision Athens, St. Mary’s Hospital, Piedmont Athens Regional, SNAP Ed at UGA, the UGA Department of Crop and Soil Sciences, UGA College of Public Health and the UGA Office of Sustainability to provide fresh, locally-grown produce to people in our community who are struggling with diet-related illnesses.
Despite the various efforts to reduce food insecurity from national, state, and local levels one in five Clarke County residents, or 26,340 residents, are food insecure . Of those, an estimated 30% are not likely to receive nutrition assistance through SNAP because they make over the income eligibility threshold of 130% of the federal poverty line (Gundersen, A. Dewey, Crumbaugh, & Engelhard, 2018). Receiving SNAP benefits is often not enough for low-income or food insecure adults to consume federal recommendations for fruits and vegetables (Stewart, H. et al., 2016; USDA, 2018). Lower rates of consuming healthy foods such as fruits and vegetables can increase one’s risk for developing diet-related chronic conditions such as hypertension or diabetes (Bellavia, 2013). In 2017, it is estimated that diabetes cost $237 billion in direct health care expenditures and 43% of these costs are associated with medications (ADA, 2018). One solution to help reduce the incidence and burden of chronic diseases and food insecurity is to prescribe healthy food such as fruits and vegetables. This solution has been tested through an innovative program called the Fruit and Vegetable Prescription (FVRx) Program. This program is an innovative model that promotes affordable access to fruits and vegetables and healthy eating in underserved communities through partnerships with local healthcare providers, community organizations, and higher education institutions. Using a similar model, FARM Rx can help mitigate Athens’ dire food insecurity challenge by providing access to fresh, local produce while improving diet quality to help guard against future diet-related diseases.
The current FARM Rx program is based on the local partnerships formed during the 2017 and 2018 Athens FVRx Programs. These partners include the Athens Farmers Market, Athens Nurses Clinic, UGA SNAP-Ed, UGA Office of Sustainability, and UGA Crop and Soil Sciences. Wholesome Wave Georgia supported the development of the program and its implementation through funding each aspect of the pilot program. The FVRx program funded by Wholesome Wave Georgia is a proven evidence-based model of preventative healthcare with a demonstrated impact, resulting in healthier communities, food systems, and local economies. In 2017 alone, 219 households received produce prescriptions that put $47,376 into the hands of local farmers (Cook & Webb-Girard, 2018). Nearly 80% of those households reported an income less than $25,000 annually. One in three participants did not have any form of health insurance, with the majority receiving public health insurance such as Medicare or Medicaid.
The Athens FVRx program just finished its second year. In 2017, the Athens FVRx Program supported 22 households in Athens with incentives valued over $10,710 for fresh, local fruits and vegetables purchased at the Athens Farmers Market. Families were also provided access to 10 weeks of nutrition and physical activity lessons, as well as four monthly financial literacy classes. Nutrition education and physical activity classes were provided by SNAP-Ed, while UGA Cooperative Extension provided the financial literacy education, and both were taught in English and Spanish. Health measures such as height, weight, and blood pressure were tracked over the course of the program to highlight how an increase in fruit and vegetable consumption would impact participants’ health.
2017 Athens FVRx program results:
May 2018-November 2018
Food security*: Food security improved over the course of the program.
1 in 2 of participants cut the size of meals or skipped meals due to financial restraints at baseline. By the end of the program, only 1 in 3 cut or skipped their meals, a reduction of 38%.
More than 1 in 2 participants ate less than they felt they should due to financial restraints at baseline. By the end of the program, that statistic dropped to only 1 in 5, a reduction of 66%.
1 in 10 participants were hungry at baseline because there wasn’t enough money for food. By the end of the program, that number dropped to 0%. That’s a 100% reduction!
Nutrition knowledge and behaviors*: As a result of combining nutrition education with an FVRx, the participants significantly improved knowledge of:
How to prepare fresh fruits and vegetables
Where to buy affordable produce
Increased frequency of shopping for produce (avg. 1.4x/week increase)
The importance of fruits and vegetables in a family’s diet
Health outcomes: The FVRx program delivered measurable impacts on participant health.
Total vegetable consumption significantly increased by an average 5.3 cups per week, or about ¾ cups a day. That’s equivalent to 30% of the daily vegetable recommendation for women, 24% for men!
Waist circumference decreased by 8% at the Athens site from the first to last measure collected. The fat around the waist is largely “visceral fat”; reducing visceral fat is important because it is linked to higher LDL cholesterol, insulin resistance, and an increased risk for disease (Harvard Health Publishing, 2005).
Systolic blood pressure decreased by 8% and diastolic blood pressure decreased by 7%.
Click here for the full report on Athens’ FVRx program impact.
*Data was self-reported using monthly surveys.
The funding organization Wholesome Wave Georgia has recognized the potential of partnering with larger health organizations in order to increase the reach and build evidence to change the face of preventative healthcare. By taking the lessons learned over three years about supporting and piloting their program model in various Georgia communities, they are directing their resources to three healthcare sites that they have worked with in the past. This has allowed the Athens program partners to reflect and redefine ourselves.
Are we crazy? If we are, we’re not alone. Health insurance companies are beginning to realize the impact diet can have on health and have taken it into their own hands to improve their employee and beneficiaries’ diets.
South Africa’s largest private health insurance company, Discovery, created a nationwide health promotion program called “HealthyFood” in 2009. The program offered participants up to a 25% cash back on healthy food purchases (An, 2013). HealthyFood was associated with more consumption of fruit, vegetables, and whole-grain foods, and less consumption of unhealthy foods like those high in sugar and salt.
Humana, a Medicare Advantage healthcare organization, partnered with Discovery for its own HealthyFood program offered through their behavioral economics-based healthcare rewards program, Go365 (Humana). Through a partnership with Walmart, Humana members receive 5% savings on products that qualify for Walmart's “Great For You” icon, including fresh fruits, vegetables, and low-fat dairy(Humana).
New England insurance provider Harvard Pilgrim Health Care introduced EatRight Rewards for their 1,200 employees and employer health plans in 2014 (NutriSavings). The initiative was geared towards lowering health claims by encouraging healthy food choices. Partnering with large supermarket chains, participants’ grocery purchases were tracked through their grocery store loyalty cards. Participants received up to $20 a month in cash rewards for buying healthy foods at participating grocery stores.
Hospitals and health systems have joined the “Food is Medicine” movement as well.
The first hospital-based therapeutic food pantry in the country was the Preventative Food Pantry, housed in the basement of Boston Medical Center (Boston Medical Center). Since doors opened in 2001, over one million patients with conditions ranging from HIV/AIDS to heart disease have been served to promote physical health and prevent future ailments. Families visit the pantry a maximum of twice a month and receive three to four days of food, including fresh fruits and vegetables, for their household. The clinic also recently opened a teaching kitchen with cooking classes targeting specific health conditions, such as diabetes (Snook, 2016).
Pennsylvania-based Geisinger Health System opened their Fresh Food Farmacy in 2016 with the aim to optimize the treatment and management of type 2 diabetes and food insecurity (Feinberg, Slotkin, Hess, & Erskine, 2017). Patients who are identified as having HbA1C levels greater than 8 and as being food insecure are given a “prescription” or referral by their primary care physician for the Fresh Food Farmacy. Once enrolled, patients receive free food, including fresh fruits and vegetables, onsite at a clinic; 15 hours of diabetes education; cooking tools; and recipes. Each week, patients receive enough food to prepare healthy and nutritious meals for their whole family, twice a day for five days. Before the Farmacy program, participants’ care cost Geisinger Health Plan, Geisinger health insurance company, $8,000 to $12,000 average per person per month (though it is noted that the participants are a particularly complex set of patients). Payer-side claims data shows that payer costs decreased by two-thirds on average across the program since the Farmacy program was established.Program costs average about $2,200 per patient per year without taking into consideration clinical gains. Participants’ HbA1c levels have dropped more than two points, from an average of 9.6 before the Farmacy to 7.5. According to David Feinberg, the president and CEO of Geisinger Health System, the savings with this change are significant-- a decrease in HbA1C of 1 point saves Geisinger about $8,000 in healthcare costs. Significant improvements in patients’ cholesterol, blood sugars, and triglycerides have also occurred (Aubrey, 2017).
Two food pharmacies were established by ProMedica (Sensenig & Miller, 2016), a nonprofit health system that serves 28 counties in northwest Ohio and southern Michigan (Epic, 2016). Their physicians “prescribe” patients identified as food insecure to visit one of their food pharmacies once a month for up to six months, receiving two to three days’ worth of food per visit. After six months, patients can return to their physician for another referral. Patients also receive healthy food, recipes, and nutrition coaching. Since opening in April 2015, more than 2,000 households have been assisted. Of the 4,000 Medicaid patients with food pharmacy referrals, there has been a 3% reduction in emergency department use, 53% reduction in readmission rates, and 4% increase in primary care visit rates (Petee & Cihon, 2017).
These programs show that providing patients with access to a healthy diet is not only the right thing to do, it’s the smart thing to do. The Athens FARM Rx program is looking to join these programs and more closely integrate food and medicine in 2019.
American Diabetes Association. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917-928. doi:10.2337/dci18-0007
An, R. (2013). Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Health Nutr, 16(7), 1215-1228. doi:10.1017/s1368980012004715
Aubrey, A. (2017). Fresh Food By Prescription: This Health Care Firm Is Trimming Costs — And Waistlines. Retrieved from https://www.npr.org/sections/thesalt/2017/05/08/526952657/fresh-food-by-prescription-this-health-care-firm-is-trimming-costs-and-waistline
Bellavia, A., Larsson, S.C., Bottai, M., Wolk, A., Orsini, N., Fruit and vegetable consumption and all-cause mortality: a dose-response analysis. American Journal of Clinical Nutrition, 2013. 98(2): p. 454-459.
Boston Medical Center. Preventative Food Pantry. Retrieved from https://www.bmc.org/nourishing-our-community/preventive-food-pantry
Cook, M., & Webb-Girard, A. (2018). Fruit and Vegetable Prescription® Program 2017 Evaluation Reports: Athens, Georgia Site. Retrieved from Atlanta, GA: https://static1.squarespace.com/static/54e3786ae4b0c344d00446b1/t/5ac59295575d1ffe219f2181/1522897559878/FVRx_Athens_05.pdf
Epic. (2016). Food Prescriptions Reduce Readmissions 53% at ProMedica. Retrieved from https://www.epic.com/epic/post/2498
Feinberg, A. T., Slotkin, J. R., Hess, A., & Erskine, A. R. (2017). How Geisinger Treats Diabetes by Giving Away Free, Healthy Food. Retrieved from https://hbr.org/2017/10/how-geisinger-treats-diabetes-by-giving-away-free-healthy-food
Gundersen, C., A. Dewey, A., Crumbaugh, M. K., & Engelhard, E. (2018). Map the Meal Gap 2018: A Report on County and Congressional District Food Insecurity and County Food Cost in the United States in 2016
Harvard Health Publishing. (2005) Abdominal fat and what to do about it: Visceral fat more of a health concern than subcutaneous fat. Retrieved from https://www.health.harvard.edu/staying-healthy/abdominal-fat-and-what-to-do-about-it
Humana. Go365—A personalized wellness and rewards program. Retrieved from https://www.humana.com/go365/
Humana. What happens to my HumanaVitality® account on January 1st, 2017? Retrieved from http://www.mcdean.com/go365/docs/Member%20FAQ.pdf
NutriSavings. Harvard Pilgrim’s EatRight Rewards Promotes Wellness. Retrieved from https://www.harvardpilgrim.org/portal/page?_pageid=253,7314016&_dad=portal&_schema=PORTAL
Petee, B., & Cihon, S. (2017). Food Insecurity and the Role of Hospitals. Retrieved from http://www.hpoe.org/HPOE_Live_Webinars/07-06-17%20webinar%20slides.pdf
Sensenig, J., & Miller, M. (2016). How Prescribing Food is Changing Patient Health. Retrieved from https://promedicahealthconnect.org/news-and-community/how-prescribing-food-is-changing-patient-health/
Snook, E. (2016). Medical Center Increases Access to Healthy Food with Opening of Expanded Preventive Food Pantry and Teaching Kitchen. Retrieved from https://www.bmc.org/about-us/news/2016/06/28/boston-medical-center-increases-access-healthy-food-opening-expanded
Stewart, H., et al., The Cost of Satisfying Fruit and Vegetable Recommendations in the Dietary Guidelines. 2016.
USDA, Supplemental Nutrition Assistance Program (SNAP): National and/or State Level Monthly and/or Annual Data. 2018: https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap.