Hospitals and health systems across the country are feeling the pressure to improve the outcomes of their patients while managing rising costs. According to the Centers for Disease Control and Prevention, chronic and mental health conditions represent 90 percent of the nation’s $3.3 trillion annual health care expenditures. We’ve all experienced the financial strain that comes when these conditions are poorly managed and less than optimal patient outcomes are achieved. Diabetes is one of the most prevalent and costly chronic conditions to manage, with the CDC reporting that the over 29 million Americans living with diabetes costs $245 billion annually.
These are staggering numbers. At Geisinger we recognized that we primarily serve a rural population with higher than average rates of diabetes, food insecurity, poverty and unemployment. Diabetes has a tremendous impact on our patient population and the financial health of our organization. We spent significant time and effort reviewing published data, as well as our own data, and identified a correlation between our uncontrolled type 2 diabetes patients and food insecurity. We were also able to pinpoint areas in our footprint where we had high rates of both food insecurity and uncontrolled type 2 diabetes. This information challenged us to ask ourselves what we could do differently to ensure food insecurity would no longer be a roadblock to achieving positive outcomes for our patients.
We decided to implement a “food as medicine” approach and started the Fresh Food Farmacy in 2016. With help from the Central Pennsylvania Food Bank, we set out to provide fresh, healthy food to patients with type 2 diabetes who indicated they struggled to obtain enough food in the last 12 months. Our goal was to see if providing free, fresh healthy food, along with a robust diabetes educational curriculum, could improve health as well as clinical outcomes. Patients in the program are provided ingredients and recipes for 10 healthy, nutritious meals per week that will feed them and their families. Along with receiving food, patients are required to participate in 15 hours of diabetes self-management education and to actively engage with their care team. The care team includes a program coordinator, nurse, primary care physician, registered dietician, pharmacist, health coach, community health assistant and nonclinical administrative support personnel.
The preliminary results of the program have been extremely encouraging. The hemoglobin A1C levels among program participants have, on average, dropped two points. This is better than what we typically see from diabetes medications alone. We’ve also seen a drop in emergency department visits among program participants in addition to increased engagement in other aspects of health maintenance. As our patients have seen the results of positively managing their diabetes, we’ve found they are more motivated to pursue other healthy habits like tobacco cessation or additional programs for weight management and exercise.
We anticipate that the average medical costs for those with type 2 diabetes and food insecurity will drop significantly as patients require less direct medical care to manage their diabetes.
The most important thing we’ve learned from the Fresh Food Farmacy program is that while care delivery within the four walls of the hospital is important, what happens with our patients and how we support them in their daily lives is equally, if not, more important. As the health care industry is moving toward connecting reimbursements to outcomes, health care leaders will need to look more closely at the drivers of poor outcomes and how they can be addressed.
The average medical expenditures for people diagnosed with diabetes are about $13,700 per year, with about $7,900 of that attributed directly to diabetes, according to the CDC. It costs us approximately $2,500 to $3,000 per year to provide food and support to a participant in the program. The return on investment we’ve seen in terms of patient outcomes has exceeded our expectations.
Solving for chronic conditions like diabetes will continue to be a challenge for patients and health care providers alike. Strategically addressing the social determinants that lead to and exacerbate these chronic conditions can produce real results if organizations are willing to be creative in how they address these challenges.