Health systems approaches for advancing implementation and policy for Food is Medicine

IMPORTANCE: Poor nutrition remains the leading modifiable risk factor for cardiovascular disease and its major risk factors, contributing to substantial morbidity, early disability, mortality, economic burdens, and health disparities in the US. Food is Medicine (FIM) is a growing movement that integrates food-based nutrition interventions into health care delivery to prevent, manage, and treat diet-related chronic diseases. Early research has indicated that FIM interventions including produce prescriptions, medically tailored groceries, and medically tailored meal are promising as cost-effective approaches to improve cardiovascular disease and associated health outcomes. Delivered in coordination with health care systems, FIM interventions are increasingly supported by federal and state legislative efforts, the latter via Medicaid Section 1115 waivers and in lieu of service pathways, as well as some private payers. 

OBSERVATIONS: Although coverage and policy pathways for FIM remain fragmented, cardiovascular specialists and other clinicians have an opportunity to play pivotal roles in operationalizing FIM in health systems through systematic screening for nutrition insecurity, risk stratification, closed-loop referral workflows, quality improvement through outcome measurement and monitoring, and patient education, as supported by electronic health record integration and multidisciplinary teams. Implementation science can assist clinicians in optimizing FIM delivery and scalability by standardizing eligibility criteria, intervention dose, duration of benefits, culturally tailored patient education, and clinician awareness. Clinician-initiated research, policy engagement, and health system leadership will also help to advance FIM, especially as a foundational component of value-based care delivery and health equity. 

CONCLUSIONS AND RELEVANCE: FIM policies and clinical integration potentially offer an opportunity to address the root causes of cardiometabolic disease, better manage health care costs, and promote health equity. Continued research, policy reform, and clinician engagement are needed to realize the full potential of FIM in 21st century medical practice.