Promising Practices for Food is Medicine Interventions: Summary of Listening Sessions with Health Centers

Health centers have been a key part of the nation’s health care system for nearly 60 years. Health centers provide affordable, accessible, and high-quality primary health care to more than 31 million people in underserved communities at over 15,500 sites. About 90% of their patients have incomes less than 200% of the federal poverty level. They are in all U.S. states, territories, and the District of Columbia. You can find them in cities, rural areas, and everywhere in between. Health centers are partly funded by the Health Resources and Services Administration (HRSA). HRSA monitors health centers to ensure they meet high standards and help their patients achieve better health.

Health centers innovate to achieve good health outcomes. They have been champions for and leaders in employing Food Is Medicine (FIM) interventions for decades, and adoption continues to grow. As part of the U.S. Department of Health and Human Services (HHS) FIM initiative, HHS convened two listening sessions with health center leaders. This resource summarizes the feedback on advancing FIM in health centers shared during those sessions.

• Continuous education and training to care teams.
• Effective referral system and establish high-value partnerships.
• Dedicated time to establish and integrate FIM efforts.
• Availability of personnel, storage space, and wrap-around supports needed to support FIM efforts.
• Culturally relevant foods and support as needed for how to prepare foods provided.
• Ties between food interventions and other activities addressing health-related social needs (e.g., housing challenges).

According to health center representatives that participated in the listening sessions, decisions about FIM interventions should be informed by the community landscape.

• Screen patients for health-related social needs (HRSNs), including food insecurity, both to identify which patients might benefit from FIM interventions and to assess the scope of need in the community.
• Help patients apply for social services involving food and take note of those who do not qualify for benefits but who might still require support.
• Conduct a community “foodscape” analysis to better understand patients’ nutritional needs, food-availability, and cultural connection to food. Understanding the local population’s food environment – not just what and how people eat, but also their individual preferences and how they access food – is a key first step to plan FIM interventions that are realistic and sustainable.
• Partner with community-based organizations (e.g., food banks, food pantries, religious organizations, and local farms) to find local resources available to patients. Universities can be valuable partners as well. 

According to health center representatives that participated in the listening sessions, there are several key opportunities for health centers to support strong design, development, and sustained FIM interventions. 

• Foster discussion among health care providers, health center administrators, and local government officials about the communities’ food and nutritional needs and opportunities to support infrastructure for FIM interventions.
• Review clinical and administrative workflows to identify opportunities to integrate conversations about nutrition, taking into consideration the time constraints for visits with providers.
• Engage stakeholders with lived experience in both the health center and community over the course of intervention planning and implementation. In the community, support dialogue to demonstrate intervention effectiveness to cross-sector partners to spark partnership and support.
• Identify champions for FIM that possess key qualities, including:
  1. Know the need and want to help the community
  2. Hold established relationships to the community
  3. Focus on data-driven innovation and growth
  4. Will engage local policymakers
  5. Will share community stories
  6. Committed to leadership 

Health center representatives in the listening sessions identified key qualities, values, and practices that have supported successful FIM intervention implementation to date.

• Focus on healthy options: Prioritize access to good nutrition when providing access to food through such actions as including fruits and vegetables in meal kits and obtaining fresh foods from local farms and grocery stores.
• Easy access: Create multiple, convenient opportunities for individuals and communities to obtain foods through such approaches as drive-up services, on-site pantries, and meal delivery programs.
• Community education: Teach individuals and communities about how to prepare nutritious foods by providing recipes and holding virtual or in-person cooking classes.
• Emotional and social impacts: Recognize the emotional and social impacts of food and meal sharing. Incorporate foods from different cultures in FIM interventions.

According to health center representatives that participated in the listening sessions, it is important to ensure two-way engagement with all personnel, regardless of role, title, or tenure. 

• Practical education: Offer training and obtain lived experience perspectives from health center personnel about healthy lifestyles and nutrition. Consider a “Cook with a Doc” program or have chefs work with personnel as an integrated team supporting patient interventions. Move beyond lectures and impart applied medical understanding of food that can be used in professional and personal settings.
• Health provider motivation: Take a layered approach when explaining FIM’s benefits to providers by first noting benefits to immediate patient health — with connections to conditions such as diabetes and hypertension — and then addressing the larger community impact.
• Clinical workload: Emphasize FIM’s multiple points of engagement to keep clinic personnel from viewing FIM as overburdening. Ensure clinic staff that they don’t have to “boil the ocean,” but can help support targeted impact.
• Clinic morale: Connect screening directly to interventions so that identifying problems is directly connected with having next steps toward solutions.

According to health center representatives that participated in the listening sessions, aligning organizational structures and resources supports increasing and sustainable integration of FIM programs into clinical and community services.

• Time: Design reasonable timelines for all necessary steps of FIM implementation (e.g., creating referral systems, facilitating patient follow-up, recruiting staff or volunteers).
• Flexibility: Anticipate and prepare for unforeseen difficulties (e.g., scheduling conflicts, staffing shortages, inadequate storage space).
• Embedded Technical Assistance: Identify opportunities to help the clinic staff implement workflows at a granular level.
• Partnership: Build strong, stable relationships with FIM program partners (e.g., infrastructure providers, staff and volunteers, local government members) and understand what partners need.
• Leadership: To succeed in a conventional health care structure, consider whether the FIM program leader profile requires a certain role or credential. 

According to health center representatives that participated in the listening sessions, clinical measures are commonly used to evaluate FIM interventions because they are already collected for other purposes. Other signals are valuable, too.

• Evaluate process, patient engagement, health-related behaviors (e.g., dietary intake), utilization across the health care system, and health outcomes.
• Use community cues to determine whether a FIM intervention might be increasing community health, such as whether participating community members keep coming back, are consuming the food received, or are utilizing the resources to which they are referred.
• Gather stories from those participating in FIM activities and combine them with other data to help paint a more complete picture of results. 

Health centers with experience implementing FIM interventions identified additional helpful opportunities. 

• Medicaid 1115 demonstration projects can substantially contribute to FIM intervention sustainability.
• Technical assistance is useful in scaling beyond a single site but likely requires dedicated funding.
• Support for the “missing middle” of the food hub — the organizations that process, package, and deliver the food — must come from sources other than health centers.
• Local food systems and the built environment must be addressed to tackle upstream food challenges.