Many health plans have members in institutional settings with co-morbid physical and behavioral health conditions. With the right support, health plans know that many of those members could achieve better health, better quality of life, and more independence – at lower overall cost. But providing that support effectively is not easy because those members’ health needs and life circumstances vary so widely. Food-as-medicine programs can play a powerful role in helping members manage and sustain their transition to less restrictive or fully independent living situations. Not only can such programs improve the health of members with chronic illness but they can also help members stay connected to their health plan while growing their self-confidence, developing independence, improving mood and outlook, and reducing stress. Together, these interventions can meaningfully impact mental health as well as physical health and reduce barriers to independence and overall health and wellness. North-Carolina-based Alliance Health Plan recently engaged with NourishedRx to lead a food-as-medicine program with a complex member population it wants to help transition to less restrictive living situations. Alliance Health specifically works with Medicaid beneficiaries who have mental health illnesses, substance use disorders, and intellectual and developmental difficulties.

In the Spring of 2024, NourishedRx began its program by providing 6 weeks of prepared nutritious meal deliveries to Alliance Health members, followed by 10 weeks of healthy groceries. These members were diagnosed with a behavioral health disorder and are also smokers, many with some form of chronic disease. The goal of the program is to foster their independence and keep them housed.This population requires care management from interdisciplinary teams, so Alliance Health wanted to find interventions that offered holistic support and resources. Our data on the broader benefits of food-as-medicine programs demonstrated the kinds of outcomes they sought. Success will be measured by the number of people who maintain their housing and independence, but the impact is already being felt.

As Lori Caviness, Director of Community Health Strategy and Social Impact, Community Health and Well-Being, Alliance Health Plan, puts it: “We are so encouraged by the early results of this program to improve food and nutrition security for people enrolled in ourTransitions to Community Living (TCL) Program. Members have shared that the program has helped boost their energy levels and has made it easier for them to stay in housing and live independently.” In initial surveys, program participants talk about feeling happier and more energetic and report losing weight because of their dietary changes.In our work with food insecure and chronically ill populations, we’ve observed a robust relationship between healthier diet and improved mental health. 81% of our members reported improvement in how diet impacts their health and well-being, and 57% reported a decrease in the number of their unhealthy mental days (in the past 30 days). 59% reported an increase in social interactions with family and friends.The following are some areas where food-as-medicine provides holistic support to not only affect physical health but also enhances mental health and fosters personal agency and independence

1. Reducing the impact of ultra-processed, junk and fast foods

People who are food insecure may not lack access to food so much as they lack access to healthy food. This is a problem for many who are chronically ill, lacking transportation or support, and struggling to afford quality food. Fast food, junk food, and ultra-processed food may be the easiest, cheapest food available to them in nearby convenience stores, gas stations, drug stores and fast-food restaurants.Eating this food affects physical and mental health. The link between healthy diet and better health outcomes for people with chronic illnesses like obesity, diabetes, cardiovascular disease and kidney disease is well established. According to a recent Harvard study published in JAMA, ultra-processed foods are also linked to an increased risk of depression. Indeed, people who eat9 or more servings daily are 50% more likely than those who have fewer than 4 servings to develop depression. Other studies have shown that diets high in added sugar, artificial sweeteners, refined carbohydrates, trans fat and high sodium food are also associated with increased risk of mood swings and depression.A balanced, healthy, consistent diet is powerful medicine for reducing that risk of depression. It creates a foundation for better health.

2. Reducing the stress of food insecurity

People whose cupboards and refrigerators are empty, who do not know where their next meal will come from, who struggle on a daily basis to afford or obtain the food they need for themselves and their families are under tremendous stress which leads to a higher risk of anxiety (257%) and depression (253%). Food insecure people are more likely to use mental health services and to seek care in emergency departments. Some people also experience shame and a sense of helplessness that exacerbates feelings of depression, loneliness, and anxiety. Food insecurity makes it harder to manage mental health problems which can exacerbate a negative health cycle. For some, it can become harder to take positive steps by seeking help, changing circumstances or behaviors, or finding resources or employment.Providing healthy nutritious food, educating people on healthy alternatives, and instilling new habits and behaviors can have a tremendous impact on health, quality of life and mental wellbeing. In our programs, 53% of our members reported reduced risk of food insecurity and 61%reported reduced risk of nutrition insecurity. And reducing that mental health load helps members better manage their physical health, too. For our diabetes patients, specifically, 66%of our members reported feeling less overwhelmed by the demands of living with their disease, and 68% reported improvement in complying with their diabetes therapy regimen.

3. Supporting seniors, mothers, and children

Food insecurity can affect anyone’s mental health but it can be particularly challenging for mothers, children, and seniors.Food insecure mothers are over twice as likely to have depression and trauma. In children, hunger relates to increased risk of depression and suicidal ideation through early adulthood. Food insecurity leads to challenges in school, in social situations, and with disorders like ADHD. It can also impact development and lifelong health.Food insecurity in seniors is often masked due to isolation, changes in eating habits, and the need to adopt new diets to address chronic illness. Lack of access to healthy food can increase stress and anxiety, intensify isolation, disrupt medication management, increase cognitive decline, and lead to health problems that further exacerbate depression. For the senior moving from a skilled nursing facility to the home, accessing food, knowing what to eat to help with physical conditions like diabetes, and even feeling motivated to cook are barriers that food-as-medicine programs help overcome. Similarly, for mothers with newborns that face economic difficulties, challenges getting and cooking food, combined with any postpartum fatigue, overwhelm and depression and any pregnancy related health challenges, improving access to healthy food and nutrition can help entire families thrive.

Improving Resilience and IndependenceAcross our food-as-medicine programs, 97% of members report that their experience with the program improved their knowledge and confidence in eating healthy foods, while 98%reported their experience with the program will positively affect their ongoing food choices.55% of members have reported reduced concern about stable housing.This level of holistic impact is hard for traditional healthcare interventions to achieve. Food-as-medicine programs may be uniquely positioned to do so. Not only is food and food security fundamental to physical and mental health but the programs themselves offer care and support that goes beyond food deliveries. Our program, for example, also serves as a de facto screening mechanism to identify physical and mental health issues that the health plan should know about so that they can address the social health barriers that may be impeding overall health and wellness.When participants exit such a program, they have received the education, guidance, and motivational support to sustain new eating, shopping, and cooking behaviors that further bolster health and well-being. Food as medicine programs help members feel less isolated, more cared for, and more supported in adopting healthier lifestyles and behaviors. This canlead to more resilience, self-confidence, hope, and optimism, which are fundamental to independence and drive meaningful and sustained change.