Food is Medicine

Description of the video:

Katie Garfield (CHLPI): Food, insecure, Katie Garfield (CHLPI): diet related, and diet related disease also
disproportionately burden individuals from communities of color Katie Garfield (CHLPI): in response. I
think, as you've heard today, we're seeing a growing effort to better equip the Us. Health care system to
identify individuals who are struggling with food and security, um and diet related disease and connect them
to responsive services. Katie Garfield (CHLPI): And as a part of these efforts, food and health organizations
have developed a spectrum of food as medicine services, interventions that respond specifically that link
between nutrition and health. Katie Garfield (CHLPI): And today Bret and I are going to describe some
recent policy advancements related specifically to two of these interventions, um medically tailored meals
which provide home, delivered meals designed by a registered diet to nutritionist, to individuals who are
often too ill to shop and cook for themselves Katie Garfield (CHLPI): um, and produce prescriptions which
provide prescriptions for healthy produce for Andrew individuals living with, Uh, or at risk for diet, related
health conditions. Katie Garfield (CHLPI): And so, of course all good policy begins with consideration of the
evidence, and so I just wanted to highlight a couple of the really important pieces of evidence we know about
medically tailored meals and produce prescriptions. Katie Garfield (CHLPI): Uh, First and foremost, we
know that existing peer-reviewed literature on these interventions shows that they both are associated with
improvements in food and security and diet quality. And honestly, we should sort of pause and underline that.
Um! This is really a big deal. We know that changes in those two factors can have an enormous impact on
health. Katie Garfield (CHLPI): But uh, I want to note that we're also seeing research go beyond those two
core points and starting to look at more specific points around biometrics, healthcare utilization, and costs,
and some of the key findings are noted on this slide. Katie Garfield (CHLPI): So, for example, a two
thousand and nineteen study here in Massachusetts found that participation in a medically tailored meal
program was associated with forty-nine viewer inpatient admissions, seventy two your admissions to skilled
nursing facilities. And Katie Garfield (CHLPI): uh, an overall net reduction of sixteen percent in health care
costs, and that's including the cost of me. So that's an enormous enormous stat Katie Garfield (CHLPI): and
building on those findings Just this pack. October there was a new study that came out um authored by uh
Kurt Hager uh that noted that if we provided medically tailored meals to individuals with certain chronic
illnesses in Medicaid, Medicare and private insurance, Katie Garfield (CHLPI): we would see thirteen point
six billion dollars in net savings in the first year alone. So, again, really compelling evidence and research on
produce prescriptions is starting to so similar similarly promising results. For example, there was a twenty
twenty systematic review of produce prescription research. Katie Garfield (CHLPI): They found three of four
produce prescription studies, and the peer reviewed literature on a decrease in Hb. A. One, C and fewer, but
still some studies also found impact on important metrics like Bmi and blood pressure, Katie Garfield
(CHLPI): and we know that evidence is going to continue to grow. For example, we know there's a
forthcoming study that's going to highlight results from the largest produce prescription, study to date that
has really exciting results regarding produce prescriptions and their impact on diet, quality, Katie Garfield
(CHLPI): food and security. Hba, once the blood pressure and Bmi um. So again, the research is just really
exciting in this space. Katie Garfield (CHLPI): And in response to that growing research we're now seeing
growing momentum at the State and national levels for health care policy. As I said, i'm going to focus in on
some emerging state level policies, especially within the Medicaid program where we're seeing the most
activity. Um, Katie Garfield (CHLPI): And then i'll turn things over to Brent, who will pull our lens back to
some really exciting developments, the National level. Katie Garfield (CHLPI): So before we dive into
specific policies, I just want to go over sort of the visual on this slide, which kind of gives us summary of
where food is. Medicine is in the Us. Health care system from a policy perspective. Um, Katie Garfield
(CHLPI): we often say at our center. If you imagine the health care system of the house, food is medicine.
Interventions are not yet coming in through the front door, Katie Garfield (CHLPI): and by that we mean
they're not a part of baseline coverage in any uh Federal health care program, So they're not a part of standard
benefits, and Medicaid Medicare um. They are, however, making it in through the windows in some really
important ways. Katie Garfield (CHLPI): Uh, for example, flexibilities in both Medicaid and Medicare are
creating opportunities for individual states and individual health plans to experiment with covering and
paying for Buddhist medicine services. So I want to consider how that's playing out in Indiana at the State
level Katie Garfield (CHLPI): with a real focus in on the Medicaid program. Katie Garfield (CHLPI): As a
reminder, Medicaid is our national safety net Public health insurance program serving individuals with low
income and Medicaid is operated as a State Federal partnership. Katie Garfield (CHLPI): The States, each
administering their own program within Federal guidelines. In many cases. States also contract with private
health plans to deliver benefits, and that's known as medicaid managed care Katie Garfield (CHLPI):
Currently, Buddhist medicine services are not covered as a part of baseline benefits standard benefits in the
Medicaid program. Instead, coverage is currently occurring through two main pathways, Katie Garfield
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(CHLPI): Medicaid waivers and managed care flexibilities, and we're starting to see growing momentum in
both of these areas. So let's consider each in turn. Katie Garfield (CHLPI): First let's start with waivers. As I
noted on my last slide. Medicaid is a State Federal partnerships uh with States designing their program within
Federal guidelines. Katie Garfield (CHLPI): But in some cases States want to experiment with stepping
outside of those guidelines providing services in a way that's technically not allowed under Federal rules
Katie Garfield (CHLPI): uh States that would like to go beyond the guidelines in this way can apply for
waivers, and there are several types of waivers that States can request each title by the section of the Social
Security Act that creates it. Katie Garfield (CHLPI): And recently States have used two types of waivers to
increase access to food as medicine services, nineteen, fifteen, c. Home and community based Service
waivers and Section eleven, fifteen demonstration Waivers Katie Garfield (CHLPI): section one thousand
nine hundred and fifteen. See Waivers allow States to provide additional home and community based services
to keep individuals in the community that would otherwise need an institutional level of care. So what
otherwise, perhaps need to be in a nursing home? Katie Garfield (CHLPI): Importantly, Cms. Has, uh for a
number of years allowed States to use these waivers to provide uh eligible populations with home delivered
meals. So this is one of the first ways we saw Buddhist medicine coming into the Medicaid program, and this
occurs in a lot of States. Um! And i'll know that Indiana is no exception here. Katie Garfield (CHLPI): As a
result, nineteen fifteen c. Waivers are an important opportunity to increase Access to food is medicine
services in the State. Indiana currently has two such waivers that include coverage of meals. Katie Garfield
(CHLPI): The Indiana, aged and disabled, waiver, and the Indiana traumatic brain injury waiver, and both of
those are described in more detail on this slide. But I'm going to sort of take us to our next type of waiver um
in interest of time, but one thousand nine hundred and fifty waivers current opportunity in Indiana. Katie
Garfield (CHLPI): In contrast. Section eleven fifteen demonstration waivers are a more flexible type of
Medicaid waiver. Katie Garfield (CHLPI): They allow States to experiment with a range of new ways to
design their medicaid programs by waving for provisions of the Medicaid statute, or by providing um
coverage for a wider array of non traditional services, because these waivers are meant to be experiments.
They're renewed every five years. Katie Garfield (CHLPI): Um! And importantly, a growing number of
States are using these waivers to pay for food as medicine services. So, for example, Massachusetts, Oregon,
North Carolina, Uh, and Arkansas, all have approved Section eleven, fifteen waivers that allow them to cover
some sorts of nutrition supports, Katie Garfield (CHLPI): and we know that even more States are waiting in
the wings. New Jersey, New York, Washington, for example, all have waiver proposals pending before Cms.
Katie Garfield (CHLPI): And while Indiana has two section eleven, fifteen waivers. Neither currently
provides coverage for Buddhist medicine services. But I want to highlight this as a potential future
opportunity, because this can change. Katie Garfield (CHLPI): These waivers have to be renewed and
updated periodically, and so we could, would describe eleven fifteen waivers as a future opportunity. See
where we could see these waivers add in coverage of this medicine services, Katie Garfield (CHLPI): and
then, lastly, um! I just want to note that they're not the Medicaid waivers aren't the only pathway to cover
food as medicine services and medicaid. We're also seeing a number of States using managed care flexibility
to increase access. Um Katie Garfield (CHLPI): Medicaid managed care. As I mentioned our private plans
contracting uh with the State deliver Medicaid services. Those plans generally must cover the State standard
services, but all school can offer additional services that go beyond that benefit package. Some states like
California are very deliberately leaning into these managed care authorities, Katie Garfield (CHLPI):
providing explicit approval and technical support to encourage plans to use them, Katie Garfield (CHLPI):
and they're but they're also gaining uh traction really across the country, even just at the plan Level um, And
that's true here in Indiana as well. For example, Indiana contracts with five Medicaid managed care plans,
and at least one of them Katie Garfield (CHLPI): uh anthem uses managed care, flexibility to cover meals as
part of its benefit package. So it's a current and future opportunity, some activity, but more could happen.
Katie Garfield (CHLPI): Um! So that's a really brief insight into state level opportunity here in Indiana,
around for this mess and services, and now I want to uh hand it over to Brent to widen out our lens and talk
about the national landscape. Brent Ling, Wholesome Wave: Thanks so much, Katie. Um, I'm going to be
very brief. Um, Hi, everybody. I'm brentling. I'm Director of external affairs. A wholesome wave. Um, We
don't have a lot of time to talk, so i'm just gonna get into it. But um, we are a Connecticut based nonprofit,
and I'm based out of our Dc. Office. Um. Since we only have a few minutes, I figured I would start by getting
to my my four um take home messages right off the bat. Um One is that we have a national moment here to
innovate in healthcare um and policymakers. That's Brent Ling, Wholesome Wave: at least at the Federal
level, but also at the State level, are as willing as ever in my lifetime to consider new approaches to
government sponsor call plans. Um. This is rooted in all kinds of reasons that we don't have time to get into
here necessarily. Um. But the moment um particularly for food, is medicine is unprecedented. Um, and this
has been born out in pretty substantial amount of Federal policy changes um over the last five years or so that
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i'm going to get into Brent Ling, Wholesome Wave: um. The second I want to share is that policy work is
important. I'm not sure who all is in the audience today. I wish I could make it there myself. Um. But right
now, you know the way we operate. Food is medicine can be undignified. We we um offer food events and
programs. We do produce prescription programs all across the country, and when it happens we enroll
patients in a twelve month program that we and they know both Haven't been in date, and um, no matter how
well and how much good the program is doing. Um! The program is going to end for that Brent Ling,
Wholesome Wave: at some point, and that's due to grant funding and not anything that is within their control.
Um! So I apologize in advance for using so many sports metaphors. But this false start. Um is really can be at
best uncomfortable for families, and that works do real damage to help and well being of families. Brent
Ling, Wholesome Wave: Um! And then find our number Three point here is that no matter where what seat
you sit in, you have a role and an opportunity to make a difference in the policy making process if you're not
sure how to make a difference. But you want to. I I would really welcome a conversation. Um. Policy work is
very important, and policy engagement is very important, for when we are self governing people, but also we
know that there is a moment of change happening right now, Brent Ling, Wholesome Wave: and um if we're
not closely involved in by we I mean practitioners and patients. Um, if we're not closely involved with uh the
work here in the process. Here. We know the kind of policies that are most likely to be formed. Brent Ling,
Wholesome Wave: And so, um! We're working in a space where a home run is really just something that
doesn't uh make things worse for patients and providers. Let's go instead for a grand slam, and actually make
things a whole lot better for patients and providers in Indiana and across the country, Brent Ling, Wholesome
Wave: and then number four. This might be the most important one, as of this morning it is now without
question, and no longer in any kind of dial. That Indiana is a superior basketball state to North Carolina.
Brent Ling, Wholesome Wave: I hope someone in the audience is watching the users last night. Brent Ling,
Wholesome Wave: I'm gonna pull up my screen. My slides here, Brent Ling, Wholesome Wave: and I
mentioned some of this already. Um, that's who I am. And this is what also might as well some way does,
innovative but simple uh healthy food access programs across the country, and then we work to transform
those into policy. Brent Ling, Wholesome Wave: Um, Our motto here is, Everybody is well fed, and we strive
for the day that everybody has um fidelity, equity, and dignity in uh these types of services that we offer
Brent Ling, Wholesome Wave: one of our initiatives, and one of my jobs is to host the national produce
prescription collaborative. We are a coalition of several organizations that are practitioners of previous
prescriptions, as well as researchers like Harvard and Tufts, and others, as well as grocery partners,
healthcare um practitioners. And so on. And then we have gathered together to help advance probes,
prescription and the use of the produce prescription model in standard practice of care. Brent Ling,
Wholesome Wave: And this is the meat of the presentation here. These are some of the Federal policy
changes that have happened in the last few years. Um, that have gotten us to a place of pretty tremendous
opportunity. Um, I'm just going to go down them here in two thousand and fourteen. There is a uh usda
program in the farm bill that uh eventually funded some produce prescription programs for snap shoppers.
Brent Ling, Wholesome Wave: Um in two thousand and sixteen uh was the first. I was made aware of the
Cdc. Funding a program in Ohio for produce prescriptions. Um cmi uh. And I allowed um to basically design
coverages Brent Ling, Wholesome Wave: for uh, that coverage models that covered food as medicine for
particular patients, and they started doing that in two thousand and seventeen for patients who were enrolled
in A. V. B. Cmi demonstration project. Brent Ling, Wholesome Wave: Um. The Usda produce prescription
program was created in two thousand and eighteen, and then in two thousand and twenty. Cms. Opened the
door for food as a so special supplemental benefit for the chronically ill and medicare advantage, and that
happened as recently as twenty-two um allowing plans to offer produce prescriptions and the meals and other
types of food services. Brent Ling, Wholesome Wave: Um and twenty twenty one. The house appropriated
funding for pilots demonstration projects at the Indian Health Service and Veterans Health Administration,
and then in two thousand and twenty-two, we saw right before the White House Conference a Bill Hr. Fiftythree, seventy, which is a medically together. Meal Demonstration project in traditional medicare, and that
bill has now fifty-two co-sponsors in the house. Um! So making a lot of great traction here so far, in just the
few first few weeks of being introduced, Brent Ling, Wholesome Wave: um pilots of the Vha. And Indian
Health Service were launched or announced at the twenty twenty-two White House Conference, which Katie
mentioned um. And then, of course, there's the States that have, and are awaiting approval for their Medicaid
demonstration projects in two thousand and twenty-two. All those are Federal policy actions. Um! There are
probably more than i'm not thinking of here. But um, I hope you can see the momentum that is happening at
the Federal level in the interest. Brent Ling, Wholesome Wave: Um, these are the things that we work on at
the national produce prescription, collaborative. Um. They are all things that I kind of listed already, but it's
Medicaid, Medicare traditional Medicare, as well as Medicare Advantage Veterans Health Administration and
Indian Health Service. We work on quality metrics. Um. We work to find Federal research. We work on the
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community benefit, reporting standard to improve hospitals, ability to to issue these programs and meet the
needs of their communities Brent Ling, Wholesome Wave: and a health care. Coding infrastructure is
incredibly important as well as the produce prescription program at the Usda Brent Ling, Wholesome Wave:
for immediate next steps. Um, Brent Ling, Wholesome Wave: One is really to advance the policies around
the White House Conference that we're in house already. Um. And when it comes to the demonstrations
there, as well as in Medicaid and various states. Um! Those demonstrations must be informative to
policymakers, and we're working really hard to make sure that happens, we're working to make sure that
these projects are able to be scaled through the coding data and payment processing technologies and
framework. Brent Ling, Wholesome Wave: Um, We are looking to direct that uh philanthropic funds that are
dedicated to our research to really fund projects that are equivalent to an Fda Level Clinical demonstration
project with randomized control groups and so on. Um, We are working to support the eleven fifteen Waiver
implementation and examine Brent Ling, Wholesome Wave: and publicize the details about Medicare
Advantage utilization of who does medicine. Brent Ling, Wholesome Wave: Um. Further, we really need to
move the policy discussion. For years health care, policy, discussion in this country has been about how
many people are covered, and how many people are not covered. Um! And the parameters under that are in
constant public debate. Um! We very rarely talk about. What does it mean to be covered? And in an era
where right now we have more a higher percentage of our patients covered, or of our citizens covered in this
country than we ever have before. We still have twenty percent of people who are really struggling with
medical debt. Brent Ling, Wholesome Wave: Um! And that's just the tip of the iceberg in terms of the
problems associated with the health care system. So um, we need to talk about what it means to be covered.
And I think these conversations and these policy changes recently have opened up that door, and I look
forward to um more of those conversations, and that being increasingly important part of the conversation in
two thousand and twenty and beyond. Brent Ling, Wholesome Wave: Thank you. Brent Ling, Wholesome
Wave: I hope we have time for questions. Barb Morris: Sorry you missed the applause. There, Barb Morris:
Do we have any questions for um other Katie or Brent, Barb Morris: Hey, Brent, Hey, Katie? It's Nima.
Thank you guys so much for agreeing to participate today. Um, I have kind of a two part question for really
either of you. Um. The first is that you know, thinking about motivating the people that are in this room to
kind of engage in policy advocacy. Um, Barb Morris: that can feel pretty discouraging at this moment of
time, and not in this political environment. Um, Barb Morris: it feels to me like there is um a good amount of
bipartisan momentum um behind these initiatives. Um! Can you either correct me if i'm wrong on that, or
talk a little bit more about that? About why, specifically, in this moment we should feel a little bit more
optimistic about the possibility of some of these policies actually moving forward. Barb Morris: Um! And
then the second piece of that I think more for Brent from your standpoint. Um, because you know Indiana
Well, he went to the best Indiana college, you know Indiana well, and you know other states. Well, why do
you think there's that? This is a really exciting moment for Indiana to really engage in this? Brent Ling,
Wholesome Wave: I'll. I'll go ahead and take a swing at that. Um. The reason I am optimistic is because of
Brent Ling, Wholesome Wave: um, you know, Brent Ling, Wholesome Wave: before before it looks like, and
even in the few years after it. You kind of touch healthcare policy. Brent Ling, Wholesome Wave: Um, it
would just it wouldn't even be up for discussion. Um! And the Aca. Uh advanced that discussion um quite a
bit, and has opened up the opportunity to experiment with health care policy. Um! So just the policy window
is is open in a way that I haven't seen before as a kind of reference in my beginning comments: Brent Ling,
Wholesome Wave: Um, and yeah, I understand the discouraging part as um when it comes to any kind of
Congressional discussion. It can become very partisan very quickly. Brent Ling, Wholesome Wave: Um! And
we I can't sit here and guarantee that we can make sure health care is not a part of an issue. There's just no
chance of that. Um. But it is important to engage in those discussions. Um, because that's how things become
unpartisan um. The Affordable Care Act is no longer such a partisan topic, because um Conservative States
are now accepting it, and there's there's an article today about the the about face on the in the Republican
party about the Aca. Um, there's so Brent Ling, Wholesome Wave: partisanship as ugly as it is. It isn't
necessarily bad thing. It isn't, it is important to engage. But further, there's so much that can be done aside
from part in politics, within administrations within Medicaid agencies within Cms um that are not part of an
agencies they just want to make sure people are taken care of. And right now it is not a part of an issue to
necessarily say that we need to take care of people Better um increase health outcomes while saving money.
Brent Ling, Wholesome Wave: Um, and I think everyone can agree on that. Um, there's certainly bipartisan
consensus there. One of the reasons why I think Indiana is a special place. Um, for obvious reasons. Um.
Another one is just the innovation in hip. I opened up the doors. You guys have experience with trying new
things. Um trying innovative things, and there's a lot of expertise in the state um on on that process. And so I
think that that's a good opportunity. Um. Further, there's been very innovative States in I am in your office
and other places where um Brent Ling, Wholesome Wave: uh innovation in the food access space is as um.
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Brent Ling, Wholesome Wave: The The infrastructure in the State has certainly developed. And so, if
Medicaid starts reimbursing for certain services. Um, there's now the ability to actually deliver um, and and
that's emerging. It's not certainly one hundred percent there yet. But it's as good as it's been in a long time.
Um! So I think that that's also a promising um Brent Ling, Wholesome Wave: um at least to a processing on
it. And say, Katie Garfield (CHLPI): I think I couldn't have said it better. So i'm just gonna say ditto. I think
that was a great answer on that Barb Morris: right? Well, thank you so much for the both of you for joining us
today. Um, I think we've all continued to learn a lot from you both. I can tell you that? Um Speaking on
behalf of Eskinazi health, we Barb Morris: um our medically tailored meal producer. We've been doing that
for about five years now. Um! And we are excited to see the growth and the movement um in this, in this part
of um in in legislation, and and then things that the insurance companies and Medicare Medicaid are looking
at um, and Barb Morris: hopefully get some opportunities to continue to talk to you all further. Um, as we
move forward with that, so Thank you so much for joining us today. Brent Ling, Wholesome Wave: Thanks
for having me in it. Thank you. This is great.