How Congress can write a new prescription in health care: Food

Last year, the Biden administration hosted the secondin-50-years White House Conference on Hunger, Nutrition and Health to end hunger by 2030, increase healthy eating, and increase physical exercise. One year later, many of us who worked at that conference are wondering: now what?

Don’t get us wrong; things are happening. But we need to do more.

One place ripe for advancement is the Food Is Medicine (FIM) policy, moving us away from punitive strategies often suggested for nutrition programs like SNAP and toward a pro-health, pro-patient approach.

Everyone has heard the adage “an apple a day keeps the doctor away.” At the heart of discussions about improving nutrition security in America is the notion that we all deserve access to healthful foods at affordable prices. The Agriculture Department is focusing on this crucial question.

For Food Is Medicine, the question is a little narrower. Here, the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and other health care leaders must determine when an apple stops being an apple and starts being part of a medical intervention for the care of a patient with a diet-related disease.

Why does this matter? Hunger and chronic disease continue to grow, which is bad news for individuals, health plans and taxpayers. A 2021 estimate from the Centers for Medicare & Medicaid Services found that 26.7% of Americans have diabetes and 57.2% suffer from hypertension. According to the Agriculture Department, a strong connection exists between hunger and chronic diseases like high blood pressure, heart disease and diabetes. Chronic disease rates continue to grow, and the Centers for Disease Control and Prevention estimates that 90% of all health care costs in the United States go toward treating chronic disease and mental health — about $3.7 trillion a year.

Food Is Medicine policies address these challenges by promoting partnerships between health care providers, community-based organizations like food banks, agriculture leaders like farmers markets and farmers, and promising startups. Working together, they create medically tailored meals and produce prescriptions to onsite food pantries at medical centers. Many of these programs target those who are food insecure. Some deploy medical interventions like medical nutrition therapy to improve patient outcomes in treating diseases and reduce costs to providers or health plans.

All this is to say that innovation using food as health care is happening nationwide. Impressive studies are showing results for patients and health systems. Only Washington remains behind the curve. The good news is that there are three things Congress can do today to jumpstart Food Is Medicine policies.

First, Congress can help push the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to act by requiring data collection and reporting on what FIM programs are out there and how they work.

HHS and CMS are greenlighting FIM programs through Medicare Advantage and Medicaid state plans. Unfortunately, CMS doesn’t seem to require these plans to collect and report data to the agency about impact, efficacy or cost. CMS could be missing a treasure trove of data that might help the agency determine where FIM fits in reimbursable patient care.

Second, Congress must pass targeted FIM demonstration programs like the medically tailored meals demonstration program bill.

In the land of mandatory health programs, CMS must be reasonably confident that something works before a full rollout. This is where demonstration proposals from Congress can help: set up a narrow, targeted, time-limited, capped program to test what works and what doesn’t. From there, let the data drive the conversation.

Third, Congress must expand coverage opportunities for dietitians and nutritionists by passing bills like the Medical Nutrition Therapy Act.

The thing that turns food into health care and actually powers FIM programs is the addition of medical nutrition therapy. These services are provided by a licensed dietitian or nutritionist and are already reimbursed by Medicare for diabetes and renal disease. So, let’s do more of that right now by passing the Medical Nutrition Therapy Act and collecting data on why these innovations are working.

These three small steps will advance FIM programs by leaps and bounds in the health care space while positively addressing food and nutrition insecurity. And for doubters, these programs will face the proverbial music as CMS does an intense review. That’s how good policy gets made, and it’s time federal health care policy leaders did so with FIM programs.