It was so encouraging to read Associate Editor Heather Landi’s report on an exciting initiative at the Danville, Pennsylvania-based Geisinger Health System. As she noted in her report, under the headline, “Can a Prescription for Fresh Food Treat Diabetes? At Geisinger, an Informatics-Driven Project Is Showing Promising Results,” she noted that, “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 give away fresh, healthy food to diabetes 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.”
As Andrea Feinberg, M.D., medical director of Health and Wellness at Geisinger Health, and the clinical champion of the Fresh Food Farmacy, put it to Landi, “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.”
As Landi further noted, “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.”
Meanwhile, 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,” he told Landi, “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.”
So here’s what’s fantastic about all of this: first, the leaders at Geisinger are approaching this issue broadly and strategically. Focusing on food and nutrition in aiming to improve the health status of their diabetic patients, is exactly the right kind of thing to do. The reality, as Geisinger’s leaders know, is that most of what makes the difference for diabetics, in controlling their blood sugar levels in their day-to-day lives, is not connected with the purely medical, but rather, is connected with nutrition and exercise—the so-called “lifestyle” factors (though really, to be honest, nutrition is so much more fundamental than being about “lifestyle”—but there, the English language fails us to some extent, I would say).
What’s more, this is absolutely an area in which leveraging information technology not only makes sense, but really is a critical success factor. As Landi noted in her report, “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.” As Dr. Feinberg told her, “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.”
The third major element here has to do with leadership, management, and process. In the past, what used to be called “disease management” programs tended not only to be very limited in size and scope—they also tended to lack c-suite support, and tended to be run as “one-off” efforts disconnected from overall operations in patient care organizations. I remember interviewing the clinician leaders of a CHF (congestive heart failure) disease management program at a Southern California hospital way back in 1997. A time-pressed cardiologist and two very harried cardiac nurses were attempting to run the entire program, and, in visiting them in their facility, it was clear that they were overwhelmed on a practical level. Their initiative was great, at least in theory; but making it work was just so difficult, given their limited resources.
This Geisinger program clearly has support from the top of the organization, and, importantly, the resources—human and financial—to make it work—as well as the commitment to pursue it across time.