Health system combats diabetes with ‘Farmacy’ that dispenses healthy food

A team of researchers from Geisinger Health System in Pennsylvania are attempting to curb diabetes among their patient population with a program that treats healthy food like a prescription drug—and it has delivered strong early results.

The program enrolled patients with uncontrolled diabetes who were deemed “food insecure”—meaning they often turned to inexpensive and easily accessible food for financial reasons. The problem is this food is often rich in calories but not nutrients, which can cause or worsen diabetes, the authors wrote in NEJM Catalyst.

Participants in Geisinger’s “Fresh Food Farmacy” attend 15 hours of educational courses on diabetes and are given enough fruits, vegetables, whole grains and lean proteins to feed their households 10 meals per week. After 18 months in the program, the first wave of enrollees demonstrated a drop in hemoglobin A1c levels from an average of 9.6 percent to 7.5 percent.

“To put this change in perspective, diabetes patients who take two or three medications can expect their HbA1c to drop between 0.5 and 1.2 percentage points,” wrote Andrea T. Feinberg, MD, the medical director of health and wellness at Geisinger Health, and colleagues. “The average 2.1 percentage point drop in HbA1c levels is a better outcome and corresponds to a more than 40 percent decrease in their risk of death or serious complications.”

Thirty-seven of those initial patients were insured by Geisinger, allowing the researchers to access their claims data. Mean healthcare costs dropped 80 percent after enrollment in the program, from $240,000 per member per year to $48,000 per member per year.  

The authors acknowledged case managers may have been most dogged in encouraging the sickest patients to enroll in the program, which might skew the population toward higher initial costs. However, they still believe there is tremendous value to this approach.

The cost of food—they described it as the “specialty drug”—is only $6 a week per patient, or 60 cents per meal. They acquire 60 percent of the food through a local food bank and 40 percent through retail providers for fresh fruits, vegetables and fish.

“If a new diabetes drug became available that could double the effectiveness of glucose control, it would likely be priced considerably higher than $6 per week (and if it wasn’t, the pharmaceutical firm’s stockholders would be in revolt),” the researchers pointed out.

Feinberg et al. couldn’t identify which part of the program was most effective, the free healthy food or the education and case management that came along with it. But they believe both components of the intervention are crucial.

“Some might call the Fresh Food Farmacy a nontraditional approach to diabetes, but if one considers fresh healthy food to be the equivalent of a drug covered by insurance and provided by the health care system, then this is essentially a disease management program—just more successful than most,” they wrote. “And, without systems for its appropriate, effective, and efficient use, fresh healthy food is no better than any medication. Our experience suggests that by detecting the patients most likely to benefit from the program and meeting their needs, we can reduce hunger in our communities while improving the health of our patients.”