Once a month, patients line up early at La Clínica de la Raza’s San Antonio Neighborhood Health Center in East Oakland. They arrive with grocery bags and $10 vouchers written by their physicians for the most basic — and yet surprising — type of medicine: healthful food.

Since 2018, La Clínica has been running “food pharmacies” to help patients obtain fresh, locally sourced produce. The food pharmacy program is part of ALL IN Alameda County, the county’s multipronged initiative to end poverty, launched in 2014 by County Supervisor Wilma Chan. “Unfolding in the backyard of the local food movement, these pharmacies are part of a new push to bring produce into primary care,” Erica Hellerstein wrote in CalMatters. “The goal is to stave off poor health outcomes and reduce nutrition-related diseases like diabetes and hypertension.”

According to the Urban Institute and the Alameda County Community Food Bank, approximately 20% of households in Alameda County are food insecure. Nationally, 39% of families frequently or occasionally experience stress over meeting their food needs, according to a social needs survey conducted by Kaiser Permanente.

The prevalence of food access issues and other social barriers to health in communities across the country has driven the health care system to take an increasingly holistic approach to addressing patients’ health. “If the past few years are any indication of what to expect, then 2020 will likely see an increased focus on the relationship between traditional health care service providers and the nonmedical needs that influence a patient’s health outcomes,” Steven Porter predicted in HealthLeaders.

Here’s a look at some of the national initiatives to address patients’ unmet social needs like food insecurity and lack of transportation.

Health Solutions Beyond the Provider Community

In Alameda County, La Clínica is not the only health care provider to offer healthy food to patients. Last year, Oakland-based Kaiser Permanente launched Food for Life, an initiative to help Kaiser members get groceries and, in some cases, medically tailored meals. Though the initiative will eventually be scaled nationwide, it began with a texting campaign in California that helps eligible Kaiser members apply for benefits from CalFresh, California’s Supplemental Nutrition Assistance Program. Kaiser also started designing and assessing medically tailored meal delivery services, which can help patients manage allergies or conditions like cancer and diabetes. Kaiser plans to expand Food for Life to members and communities across the country after piloting it in California.

The Blue Cross Blue Shield Institute (a subsidiary of the Blue Cross Blue Shield Association dedicated to addressing social determinants of health) has also developed a meal services delivery model to help residents of Chicago and Dallas improve their diets for long-term health. The pilot program, foodQ, delivers nutritionally balanced, low-cost prepared meals to people living in 25 zip codes in Chicago and 15 in Dallas. Health Care Service Corporation (HCSC), which operates Blue Cross Blue Shield in five states, runs the project. Consumers do not have to be Blue Cross members to use the service.

“For us, it’s really part of our effort to address root causes of an expensive health care system,” Manika Turnbull, vice president and community health and economic impact officer at HCSC, told Bruce Japsen in Forbes.

Public health nutrition is also getting a bump from the technology sector. “Other organizations not traditionally associated with the medical industry are also becoming involved in the food access problem,” reported Jill Sheridan for WFYI Indianapolis.

Ride-sharing company Lyft launched the Lyft Grocery Access Program early in 2019 to provide families with low incomes in selected cities with $2.50 shared rides to grocery stores. The program started with a six-month pilot program in Washington, DC, and has since expanded to serve residents in Baltimore, Chicago, and New York City, Marc DeAngelis reported in Engadget. “So far, the company has provided over 18,000 discounted rides across the US and Canada to those with inadequate access to full-service grocery stores and farmers markets,” DeAngelis wrote.

Do these nutrition programs actually help patients stay healthy and control diet-related chronic conditions? Listen to episode four of the Tradeoffs podcast to learn about the evidence behind these types of interventions.

Transportation Often a Barrier to Care

A medical appointment is useless if you can’t get to it. That’s why Arizona last fall became the first state to relax its regulations to make it easier for ride-sharing companies like Uber and Lyft to provide transportation services to Medicaid enrollees. Other states have followed suit.

“As they seek to lower costs and improve care, Medicaid and other insurers have begun to examine the transportation needs of patients,” wrote Phil Galewitz for Kaiser Health News. He noted that in 2017, more than two million Medicaid enrollees under age 65 delayed care because they lacked transportation.

Allowing ride-sharing companies to participate in Arizona’s Medicaid nonemergency transportation benefit “seemed like an obvious solution,” Jami Snyder, director of the Arizona Health Care Cost Containment System, told Galewitz. “So far, our anecdotal reports have been very positive.”

Galewitz reported that Lyft currently has a lead in the Medicaid market — it is working with about 35 state Medicaid programs, while Uber is working with Arizona’s Medicaid program.

But both ride-sharing companies have partnered with health care systems as well. In an 18-month period, more than 1,000 health care systems signed on with Uber Health for “nonemergency medical transportation,” Paula Span reported for the New York Times. And Lyft has a partnership with Brookdale Senior Living, the nation’s largest chain of senior living communities, to provide transportation for residents.

A study published in JAMA Internal Medicine in 2018 found that complimentary ride-sharing services to Medicaid enrollees in West Philadelphia did not decrease missed primary care appointments. However, Krisda Chaiyachati, MD, MPH, MSHP, coauthor of the study and an assistant professor of medicine at the University of Pennsylvania, said this finding may reflect the multiple logistical barriers to medical appointments that people on Medicaid face. Ride-sharing services “may not solve the transportation needs for everybody, but it’s certainly an answer for many,” Chaiyachati told Galewitz.

The Importance of Assessing Social Needs

The push for health care to do a better job of recognizing and addressing social needs has gained momentum over recent years, and provider organizations are facing technology challenges as they figure out the best way to integrate social determinants of health into hospital workflows.

“The first step is, how are we capturing information about identification of people’s social care needs?” said Jacob Reider, MD, CEO of Alliance for Better Health, in an interview with Healthcare IT News. “We don’t have a very good consistent, predictable, repeatable mechanism for expressing that somebody has food insecurity needs.”

That’s where technology companies like Unite Us come in. Unite Us provides a digital platform that links social service organizations and the providers whose patients need their services. Using the platform, clinical and social service providers can act on social needs screening information, communicate with each other in real time, and track referrals and their outcomes in detail.

Recently, Kaiser, CommonSpirit Health, and Blue Shield of California signed on to use Unite Us in their hospital networks. Additionally, the CHCF Innovation Fund invested $1 million in Unite Us to help mobilize the support of California partners at the county level, beginning in Kern, Los Angeles, Merced, and San Joaquin Counties. Along with this program-related investment, CHCF will fund an independent evaluation of the Unite Us approach.

What else is the health care system doing to address patients’ unmet social needs? Tweet at me with #EssentialCoverage or email me.

Xenia Shih Bion

Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. She is the founding author of the “Essential Coverage” column in The CHCF Blog. Read More

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