Hospitals and health systems across the U.S. are all feeling the impact of the growing problem of chronic disease, and diabetes is one of the most pervasive and costly chronic diseases. An estimated 30.3 million people in the U.S. have diabetes, or one in 10 adults, and at a cost to healthcare of $245 billion per year, according to the Centers for Disease Control and Prevention (CDC).
The CDC estimates that, if current trends continue, the number of U.S. adults with diabetes could rise to one in five, or even one in three, by 2050.
At the same time, food insecurity also is a widespread problem across many communities, and many healthcare leaders note that studies have shown a correlation between low food security and poor diabetes self-management. In central Pennsylvania, food insecurity is particularly serious in many of the communities that the Danville, Pa.-based Geisinger Health System serves, according to health system executives. While 12.7 percent of the U.S. population and 18 percent of children are food-insecure, in many of the counties Geisinger serves, those numbers are even worse: 14 percent of the overall population and 23 percent of children. One in eight of these food-insecure people has diabetes, according to Geisinger executive leaders in an article published in Harvard Business Review.
With the aim of addressing food insecurity, as a significant social factor impacting health, and to improve patients’ diabetes management, Geisinger launched an IT- and data analytics-driven Fresh Food Farmacy initiative to provide fresh, healthy food to diabetes patients, at no cost to the patients. The health system initially launched the program in July 2016 as a pilot project at Geisinger Shamokin Area Community Hospital in Coal Township, in Northumberland County, which has the second-highest rate of long-term diabetes complications in central Pennsylvania.
“Geisinger is very focused on approaching medical conditions from a population health perspective—we not only want to take care of each person that’s in front of us and provide them with the best state-of-the art care that we can, but we also look at our patients in their communities and see how we can improve the overall health of those that we serve,” says Andrea Feinberg, M.D., medical director of Health and Wellness at Geisinger Health, and the clinical champion of the Fresh Food Farmacy.
Andrea Feinberg, M.D.
While Geisinger healthcare leaders are using an old approach, essentially “food as medicine,” to tackle medical conditions, the Fresh Food Farmacy initiative is an informatics-driven project that relies heavily on data integration, analytics and mobile technology to do everything from tracking clinical outcomes to managing the food supply chain.
Jonathan Slotkin, M.D., director of spinal surgery in the Geisinger Health System Neurosciences Institute, also serves as medical director of Geisinger in Motion, a department focusing on digital engagement and patient- and provider-facing mobile device technologies, within the division of informatics at the health system. Slotkin helps lead the informatics work that underlies the Fresh Food Farmacy project.
“For me, it’s fascinating from an informatics standpoint because it brings together traditional clinical care, which we’ve all gotten pretty good at, but it also brings in the harder issues around data and the transactional level of social determinants of health, costing, supply chain and distribution, things that most medical systems are not yet optimized for. I think as we all endeavor to manage and help our populations with social determinants of health, we are going to be faced with these challenges more and more,” he says.
An IT-Driven Effort to Provide Healthy Food
The Fresh Food Farmacy pilot began two years ago with just six patients, all diagnosed with Type 2 diabetes. To start the program, Feinberg says the project team first queried the health system’s electronic health record (EHR) to identify adult patients in selected zip codes who had a diagnosis of type 2 diabetes and hemoglobin A1C levels over 8.0, indicating that their disease was not controlled. Well-controlled diabetic patients typically have A1C levels under 7.0, Feinberg says. The program also targeted patients who received primary care through Geisinger physicians to enable the team to study and track clinical outcomes.
The project team also leveraged the MyGeisinger patient portal tool, which links to the health system’s Epic EHR, to screen patients for food insecurity. Care managers also called patients to screen them for food insecurity. “Our hypothesis was, and still is, that if you have unmet social needs and if you are faced with food insecurity and you cannot afford to pay for healthy, nutritious food, then your diabetes cannot be well controlled,” Feinberg says.
Slotkin notes, “This is an interesting informatics question because it is a large population health problem and we are approaching it that way, but at the same time, it very much affects individuals and individual families. We have a nice span of human touch and human interaction combined with the use of our EHR and our patient portal to leverage the enrollment to this program.”