Statewide Food Program Launches in CA

A pilot program to feed low-income people with chronic illnesses after they have been discharged from the hospital is launching statewide this month in California. Proponents of the new initiative hope to prove it can keep those who are enrolled from being readmitted to the hospital, as well as save the state money on the cost of providing health care to the individuals.

The San Francisco-based Project Open Hand is acting as the lead agency on the new "Food is Medicine" initiative and has teamed up with other nonprofit providers of meal programs throughout the state. The coalition includes Ceres Community Project and Food For Thought in the North Bay, the San Jose-based Health Trust, and several organizations in Southern California.

"This is our next coming out party," said Project Open Hand CEO Mark Ryle. "The state recognized our model is the right model for people with conditions such as diabetes and congestive heart failure all around California."

State lawmakers last summer approved $6 million to launch the pilot program. The money will target 1,000 Medi-Cal patients, mainly in urban areas of the state, who have chronic diseases such as HIV/AIDS, cancer, and diabetes.

"We had to go small at first because we want to get it right," said Ryle. "This is a first-in-the-nation project. There has never been something like this before."

Paul Hepfer, the senior vice president of programs for the Health Trust, expects to sign up 150 people in Santa Clara County over the coming months for the pilot program. The agencies involved and the state Department of Health Care Services have created specific enrollment criteria for who is eligible to participate, and referrals will come from hospitals and other health care providers.

The pilot is an extension of the food programs the Health Trust has provided for 25 years, said Hepfer. The agency helps feed 700 low-income South Bay residents through its Meals on Wheels program and the Jerry Larson Food Basket it runs.

"The years of providing these services to people with HIV and AIDS really helped us hone our skills and competency for what it takes to provide food and for using food as a medical intervention to help people be healthier," said Hepfer. "It is not just to deal with food insecurity, it is helping people improve their health through good food nutrition."

Richard Ayoub, a gay man who is the executive director of Project Angel Food in Los Angeles, expects his agency to enroll between 50 to 60 people per year into the pilot program. The preventative approach, he predicted, will keep people out of the hospital longer, keep them healthy longer, and result in saving money for the entire health care system.

"We are so thrilled and so excited about it," said Ayoub. "It is going to be groundbreaking research. All eyes will be on California because we are leading the way with this type of research project. We have a very progressive, smart government that really wants us to help heal people."

The program is officially known as the Medi-Cal Medically Tailored Meal Pilot Project. Those enrolled will receive three meals a day for three months, as well as consult with a dietician to ensure the meals are providing them the right nutritional support.

"When you get medically tailored meals, they actually help heal you because food is medicine," said Ayoub.

The California pilot is modeled after efforts by the organization Manna in Philadelphia, whose own pilot project demonstrated that delivering three medically tailored meals each day for six months to 65 patients with chronic diseases reduced their health care costs from $38,937 a month to $28,183 a month.

"People who are food insecure or malnourished spend more time in the hospital and are more frequently hospitalized because they often don't recover at home," said Ron Karp, executive director of Food for Thought in Sonoma. "All those factors add a huge cost to their treatment, whereas food intervention is relatively inexpensive."

As the Bay Area Reporter noted in a story last July when the funding for the California pilot program was approved, a key factor in winning support from state lawmakers was findings from the UCSF/Project Open Hand "Food Is Medicine" research study that examined the impact of a medically tailored meal program for San Francisco and Alameda County residents who had HIV, Type 2 diabetes, and/or dual diagnosis.

In early 2017, the Journal of Urban Health published the results, which demonstrated a 63 percent reduction in hospitalization, a 58 percent decrease in emergency room visits, and a 50 percent increase in medication adherence.

"It is not rocket science. Of course it does reduce health care costs. We have been saying this for years, but finally we got the science behind it," said Ryle.

Project Open Hand Executive Chef Adrian Barrow, a gay man who has worked for the agency for nearly a decade, has been coordinating with his counterparts at the other agencies involved in the pilot project to tweak recipes for the meals they will be providing.

"We have been the leaders in trying to decide what the food and menus will look like," said Barrow. "We have been sharing that information with the other agencies to make sure we are providing the same nutrition innovation in the study."

One of the biggest changes in how Barrow and the other chefs decide what food to cook for the pilot is they have been closely consulting with dieticians to ensure each meal is medically tailored to meet the different health needs of each person in the program.

"We are following very strict guidelines," said Barrow. "We are providing a certain amount of calories and nutrients beneficial to each client. These are not just meals that look and taste good. We are literally following guidelines useful to them."

Should it prove to be successful, as the participating agencies expect it will, the program will be expanded to include agencies serving cities in the state's Central Valley region. The state has agreed to increase the financing for the program to $35 million if the three-year pilot trial works.

"I don't think the general population really understands the cost savings effective nutrition can provide in overall health costs. Poor nutrition is one of the biggest reasons why people are readmitted to the hospital within the first 30 days of being discharged," said Hepfer with the Health Trust. "If they return home to little or no healthy food, often it is harder for them to maintain their medication regime, or take their medication, or have the strength to rehab properly. This is a low-cost intervention with a really high upside."

The success of the California program could also prompt other states to follow suit, argued Hepfer, and take the model nationwide to not only reduce health care costs but also improve the health outcomes of their citizens.

"There just hasn't been a robust enough research project with high enough numbers for us to really take this to payers like Medi-Cal and Medicaid and say here is the evidence behind this concept. Most studies to date have been slightly smaller than what we are doing," said Hepfer. "With any intervention that becomes a covered benefit, you have to have proof. We are hoping this larger project will kind of be the final proof that this really works, we know that, and let's invest in it and save a lot of money and help people be healthier."

Most of the agencies involved were launched in the 1980s and 1990s to care for those living with HIV and AIDS. Once again, they are pioneering a new model to provide heath care to people in need.

"We are the little engine that could," said Ayoub.