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WASHINGTON -- Giving patients with type 2 diabetes access to healthy food at no charge can result in large improvements in their disease and overall quality of life, Allison Hess said here.

"We're seeing on average a two-point reduction [in HbA1c] across the board -- and we don't have any side effects," Hess, who is associate vice president for health and wellness at Geisinger Health System, in Benton, Pennsylvania, said at the World Health Care Congress. "And in fact we have people coming off of their medications."

Geisinger's journey with food as medicine began after the health system looked at its results for treating type 2 diabetes patients. "Despite all the resources and all the effort, we still didn't feel like we were moving the needle quite as much as we had hoped," said Hess. "We also looked at the cost and we were concerned with our growing spend" on these patients.

So the health system began looking at social determinants of health as a possible reason for why so little progress was being made; they zeroed in on diet and exercise, particularly diet. To find out whether patients were food insecure, the plan embedded two food insecurity statements into their type 2 patients' medical record to get patients' responses while they were being roomed:

• Within the past 12 months, we worried whether our food would run out before we got money to buy more (Yes or No)
• Within the past 12 months, the food bought just didn't last and we didn't have money to get more (Yes or No)

If any patient answered "yes" to either question and met other criteria, they were referred to a Geisinger program called "." The program, which began in July 2016, provides patients with two meals' worth of food per day, 5 days per week, to the entire household for as long as is needed. The food is available at a 3,000-square-foot facility on a Geisinger hospital campus in Coal Township, Pennsylvania. The Farmacy, which looks much like a supermarket, also includes a food warehouse and a classroom for offering nutrition classes.

At the beginning of the program, participants are limited mostly to food that allows them to prepare certain specific healthy recipes, but after a while they can have free choice among the foods offered, Hess said. The selection mostly includes "diabetes appropriate" food such as fresh fruits and vegetables; "we try to limit canned food." Almost all of the foods are sourced from local food banks, and those that aren't come from "vendor partners" of the health system.

The partnership with the food banks makes the food very inexpensive -- the cost is about $1,200 per year to feed a family of four, said Hess. "We couldn't do it without them as our partner."

Criteria for being referred to the program include:

• Ages ≥18

• Diagnosis of type 2 diabetes
• HbA1c of ≥8%

• Food insecurity
• Patient of Geisinger specialty or primary care

Patients who express interest in the program are encouraged to come to a "welcome class" at which they also meet their care team: an RN health manager, a pharmacist, a dietitian, a wellness associate, and a community health associate. "What's interesting is all of the care team members were already available, but because we put it into a program and added a food component, all of a sudden they're taking advantage of things they always had access to but may not have realized," said Hess. Patients who decide to enroll must meet again with the care team and enroll in a diabetes self-management class.

Each team member plays a specific role in taking care of the patient's needs, she continued. For example, the community health worker can address transportation and other non-medical needs. "We found out there were other social determinants of health -- [some people] had housing issues, and there were also people struggling to pay their heating bill in the winter."

"We're catching people at the point where they're kind of giving up," she added. "They have very high A1cs -- 10%, 11%, 12%, 13% -- and they're frustrated. Every time they go to the doctor, they [hear] they need to [change their diet] but they can't afford it." One patient in the program actually cuts up fruits and vegetables at his regular job, but he couldn't afford to buy them.

The program, which is currently funded through foundation grants, is also saving money for the health system. Rita, age 55, is one of the patients in the program. She is raising three grandchildren, and caring for a husband on dialysis. She weighed 181 lbs and had an HbA1c of 13.8%. When she came into the program in January 2017, she had "given up on herself completely," said Hess.

Nine months later, her HbA1c stood at 5.8% and her weight was down to 155; she is now a champion of the program. With Geisinger experiencing an average $8,000-$12,000 cost savings for each percentage point reduction in HbA1c, there were "huge" cost savings in Rita's case, Hess said.

Another patient who joined the program started with costs of more than $200,000 annually; that cost is now down to $40,000, according to Hess. In addition to the blood glucose changes, patients frequently experience decreases in cholesterol and blood pressure, and some early results are also showing decreases in emergency department visits, she added.

Geisinger doesn't promote its program as being for weight loss. "We do that very intentionally," said Hess. "We wanted this to be a nutrition program. [But] the byproduct is that they ask, 'What do you have for weight loss?' So we have put other programs in place that now have people continuing to lose weight."

Geisinger is hoping to eventually expand the program outside the health system campus, and to structure the program as a long-term covered benefit, she said.

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