Integrating produce prescriptions into healthcare: Lessons learned from vouchers 4 veggies

Background

Food is medicine (FIM) interventions, such as produce prescriptions (PPR), have gained traction as strategies to improve nutrition and health. Although these programs have demonstrated positive impact, widespread adoption remains limited. One pathway to broader implementation is through 1115 waivers, which enable Medicaid to cover services that address social determinants of health.

Objective

We will illustrate the successes and challenges faced during the adoption of community supports under California’s 1115 waiver, leveraging implementation experience and exploring the local and national policy landscape that allows community supports coverage under Medicaid.

Methods

We use Vouchers 4 Veggies (V4V), a San Francisco-based produce prescription program to highlight successes and challenges specific to healthcare integration and reimbursement pathways. V4V provides low-income individuals at risk for, or affected by, diet-related chronic diseases with vouchers for 6-9 months to purchase fruits and vegetables at participating vendors. Since 2015, the program has served 25,000+ households through a network of 150+ community-based organizations (CBOs) and clinics and has demonstrated positive impacts on food security, fruit and vegetable intake, and satisfaction. V4V’s healthcare integration efforts include city and state coalition building with clinic partners and other FIM providers, creating and iterating on referral, encounter, and billing workflows, and aligning with local and statewide health plans on PPR implementation best practices. 

Results

V4V’s deep ties to San Francisco’s Medicaid-eligible population and local partners, our ability to adapt to multiple different workflows, and existing infrastructure have contributed to successful implementation in multiple clinical settings. Despite these successes, we’ve identified key challenges unique to working with healthcare, including referral pathways, billing, and data infrastructure, which are informing our future healthcare integration efforts.                                                                                                    

Conclusion

CBOs, like V4V, aiming to expand their programs through 1115 waivers often face significant barriers. Successful implementation with Medicaid plans depends on an organization’s understanding of the unique aspects of contracting with health plans and its ability to adapt to the complexities of the healthcare setting. We aim to share insights and lessons learned so far during 1115 waiver implementation.

Presentation slides