- Geisinger’s Fresh Food Farmacy program, which provides diabetic adults with access to free, nutritious food and comprehensive health behavioral services, has proven more effective and less costly than other methods of treatment.
The approach offers a promising alternative for the future of diabetes care, wrote a team of Geisinger leaders in an article for the Harvard Business Review.
Patients enrolled in the fresh food program for 12 months have seen their Hb1Ac levels drop more than two points, from an average of 9.6 to 7.5. In comparison, diabetic patients who simply add a second or third medication to their treatment usually see their Hb1Ac levels drop between 0.5 and 1.2 points.
The program has shown substantial financial benefits as well. Before the initiative started, the program patients’ care cost Geisinger between $8,000 and $12,000 per person per month. The program has reduced these costs by an average of two-thirds.
“Finding effective, less expensive treatments for diabetes is critical because of its enormous social and financial costs and its growing prevalence: One in 10 people currently has diabetes, and it is estimated that by 2050 the figure will rise to one in three,” said Andrea Feinberg, MD, Medical Director of Health and Wellness.
The Fresh Food Farmacy program supplies patients and their families with the food, menus and recipes needed to prepare two healthy meals five days per week.
In addition, to further ensure that patients achieve sustained lifestyle improvements, participants enroll in group classes on medication management, healthy eating habits, and goal setting. Each participant is also assigned a care team, consisting of a physician, pharmacist, dietician, pharmacist, and non-clinical staff, among others.
Geisinger implemented the program in a county that had particularly high rates of poverty and food insecurity, or limited access to nutritious food.
While food insecurity is a widespread issue, it is extremely prevalent in the counties Geisinger serves: 14 percent of their overall populations and 23 percent of children cannot reliably access healthy food. One in eight of these food-insecure people has diabetes.
Over the first nine months, the program grew from an initial six patients to 50 patients and their families. Now, over 80 patients and their families are actively enrolled, and approximately 250 people are given 10 meals per week.
“Our initiative has had a greater impact on diabetes control (albeit in a small population) than expensive medications that have significant side effects,” Feinberg stated. “We have also seen significant improvements in patients’ cholesterol, blood sugars, and triglycerides — improvements that can lower the chances of heart disease and other vascular complications.”
For organizations thinking about a program like the Farm Fresh Farmacy, Feinberg says it is critical to keep patient engagement in mind. Many patients experience transportation, housing, and family-care challenges that make it difficult to fully engage with the program.
To help patients navigate these issues, the program brought on community health assistants that would ensure all participants receive exceptional care.
Additionally, Feinberg says it is imperative that providers and staff on care teams practice at their highest level, as human resource costs account for most of the program’s expenses. Carefully distributing work among each care team keeps members from feeling overwhelmed and helps them perform to the best of their ability.
Going forward, Geisinger plans to expand the program by demonstrating its financial benefits so that large healthcare payers will support it.
They are also looking to improve their data-capture processes by creating an app that will enable patient communication, engagement, and real-time data exchange with a provider-facing clinical dashboard.
“Ultimately, we hope to extend this program to reach food-insecure children with diabetes as well as diabetics for whom food insecurity is not an issue,” Feinberg concluded. “If programs like ours can be scaled to a national level, they could improve the health of millions of people with diabetes, profoundly reduce costs, and even help decrease the prevalence of diabetes.”