Healthy Eating Rx: Improving Nutrition Through Health Care

Most Americans have poor diets, which contribute to preventable illnesses and many of the leading causes of death—such as cardiovascular disease, cancer, COVID-19, and Type 2 diabetes. Poor diet and diet-related health conditions are also very costly. Cardiometabolic disease caused by poor diet costs an estimated $50 billion per year, while government spending to treat cardiovascular disease, cancer, and diabetes accounted for more than half of the $383.6 billion spent on diet-related diseases in 2018.

A Food is Medicine (FIM) Approach

Recognizing the potential of food-based interventions to improve health outcomes, Food is Medicine (FIM) integrates food-based programs and interventions at multiple levels of health care to address the specific health needs of certain populations. For the purposes of this report, FIM refers to interventions at the intersection of nutrition and health care (including the provision of nutritious foods), and those that are particularly focused on treating diet-related illnesses. Interventions discussed here include medically tailored meals (MTMs), medically tailored food packages, and produce prescription programs, all of which have been shown to improve health outcomes.

Scaling FIM Interventions

Despite evidence showing the value of FIM interventions, public and private payers and purchasers of care cover them to only a limited degree. Medicare fee-for-service does not cover them; some Medicare Advantage plans and value-based models do. Certain state Medicaid plans cover MTM and other FIM interventions using Section 1115 waivers and in lieu of other Medicaid services options. Implementing MTMs nationally for people with diet-related conditions and activity limitations could prevent about 1.6 million hospitalizations and collectively save Medicare, Medicaid, and private payers $13.6 billion annually.

Barriers to FIM Interventions

A major—and long-standing—barrier to improving nutrition security and access to FIM interventions is the lack of health care provider education about nutrition. Nutrition education is generally limited during health care providers’ training; for example, the typical medical student receives less than 20 hours over four years of medical school, much of it in basic science classes during the first year. Other barriers to nutrition security and FIM interventions include inconsistent coverage and payment, as well as inadequate coordination between the health care system and community-based organizations that provide food.

Congressional Action

In the 117th Congress (2021-2022), Reps. James McGovern (D-MA) and Michael Burgess (R-TX) proposed a House resolution calling on medical schools as well as residency and fellowship programs to strengthen nutrition education for physicians. Although the resolution did not impose a mandate on medical education, it signaled congressional interest in nutrition education. In the 118th (or current) Congress, Reps. McGovern and Tracey Mann (R-KS) relaunched the House Hunger Caucus, which was established in 2007 and focused on access to FIM interventions.

Administration Action

In September 2022, the Biden administration convened the first White House Conference on Hunger, Nutrition, and Health in more than 50 years and released its National Strategy on Hunger, Nutrition, and Health, providing a whole-of-government and private-sector road map for ending hunger and reducing diet-related diseases by 2030. One of five key pillars focused on integrating nutrition and health, namely by testing and expanding coverage of FIM interventions through public insurance programs – including Medicare, Medicaid, the Indian Health Service, and the Department of Veterans Affairs (VA). The strategy urges the private sector action to complement federal commitments, and a significant portion of the $8 billion-plus in private commitments as of August 2023 supports the integration of nutrition in health care.

BPC Activity

The Bipartisan Policy Center convened a Food is Medicine Working Group in March 2023, co-chaired by former Senate Majority Leader Bill Frist, former Agriculture Secretaries Dan Glickman and Ann Veneman, and former Health and Human Services (HHS) Secretary Donna Shalala. The working group includes diverse stakeholders, such as health systems, hospitals, insurers, patient advocacy organizations, health care providers, and food retailers. This report, which makes 10 recommendations to improve nutrition education and to scale evidence based FIM interventions, is a product of the co-chairs and reflects input from working group members and relevant stakeholders.

Food is Medicine Working Group Members

• Beatrice Abiero, Senior Manager of Policy Research, Instacart
• Dr. Shantanu Agrawal, Chief Health Officer, Elevance Health
• Akin Demehin, Senior Director for Quality and Safety Policy, American Hospital Association
• Matt Eyles, President and CEO, America’s Health Insurance Plans
• Holly Freishtat, Senior Director of Feeding Change, Milken Institute
• Dr. Pritesh Gandhi, Chief Community Health Officer, Walmart Health
• Dr. John Lumpkin, Executive Strategic Counselor, Corporate Social Responsibility and Drivers of Health, Blue Cross Blue Shield North Carolina
• Dr. Suja Mathew, Regent, American College of Physicians; Chief Clinical Officer, Atlantic Health System
• Dr. Dariush Mozaffarian, Dean for Policy and Jean Mayer Professor of Nutrition at the Friedman School of Nutrition Science and Policy, Tufts University
• Karen Murphy, Executive Vice President, Geisinger
• Taylor Newman, Director of Nutrition, Kroger
• Pam Schwartz, Executive Director for Community Health, Kaiser Permanente
• Dr. Kevin Volpp, Mark V. Pauly President’s Distinguished Professor, Perelman School of Medicine and the Wharton School, University of Pennsylvania; Scientific Lead, American Heart Association Food is Medicine Initiative
• Lauri Wright, President-Elect, Academy of Nutrition and Dietetics