------- + -------

Food Is Medicine (FIM)

 

Project Description

Food is Medicine (FIM) programs integrate with the health care system to provide healthy food to prevent, manage or treat specific health conditions (Volpp et al., 2023). FIM programs support people’s health by making it easier for them to access and eat fruits, vegetables and other healthy foods. FIM programs are often prescribed by health care professionals to address chronic conditions like diabetes, heart disease, cancer or kidney disease. Two of the most common forms of FIM programs are produce prescriptions and medically tailored meals. Most FIM programs serve people who are experiencing specific health conditions, food insecurity and limited income.

The Center for Nutrition & Health Impact’s (CNHI) work with FIM programs aligns well with our mission to strengthen public health initiatives through rigorous research, program evaluation and collaborative partnerships. Many FIM programs share CNHI’s emphasis on supporting communities’ access to nourishing food and long, healthy lives. For these reasons, CNHI provides evaluation and technical assistance support to several FIM programs across the United States.

Our FIM work emphasizes approaches that center communities’ voices alongside data from health systems and food systems. CNHI’s portfolio of FIM evaluations incorporates patient interviews, electronic health records, insurance claims data and economic data. We lead rigorous evaluations that inform strategy to improve reimbursement of FIM programs. CNHI is working to advance knowledge about effective screening for nutrition security and other health-related needs. As described in [the project summaries below], we partner with large and small organizations to ensure quality implementation of their national, regional and local FIM programs.

 

Project Overviews

 

Gus Schumacher Nutrition Incentive Program (GusNIP) Produce Prescription (PPR) Projects

CNHI's role

CNHI leads the United States Department of Agriculture’s (USDA) GusNIP Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information (NTAE) Center. In this role, we provide evaluation and technical support to produce prescription (PPR) projects. We support 112 PPR grantees, most of whom are community-based organizations implementing local and regional Food is Medicine.

Project description

Administered by the USDA, GusNIP is a federal initiative that funds the implementation of nutrition incentive (NI) and PPR projects. A produce prescription is an incentive in the form of a prescription for fresh fruits and vegetables (FVs). Prescriptions are provided by the clinic to eligible participants and are redeemed for FVs at farmers markets, brick and mortar food retailers or clinics.

Background and Analysis

The NTAE evaluation of GusNIP PPR projects centers on using core metric data collected from project participants and participating firms (i.e., retailers and clinics). Key outcomes including fruit and vegetable intake, food security status are collected from surveys of PPR participants before and after participating in the program. Data from participating firms are used to assess PPR project enrollment numbers and prescription redemption.

Overall findings

In our most recent impact analysis, we found that:

  • PPR projects enrolled an average of 1,881 participants monthly

  • Participation in PPR projects was associated with higher fruit and vegetable intake and improved food security at follow-up assessment when compared to baseline.

  • After participating in GusNIP, PPR project participants reported higher fruit and vegetable intake (PPR = 2.79 cups/day) than the average U.S. adult (2.53 cups/day).

  • PPR participants reported high program satisfaction (94% of PPR participants felt satisfied)

Collaboration with partner (if applicable)

As the lead of the NTAE Center, in partnership with Fair Food Network and University of California San Francisco, CNHI collaborates on GusNIP PPR with the following core partners through the Nutrition Incentive Hub; Michigan Farmers Market Association, National Grocers Association Foundation and The Food Trust, among other researchers and consultants.

Questions or comments? Send us an email.

American Heart Association (AHA) Food is Medicine

Linking Programmatic and Contextual Factors with Improved Food is Medicine (FIM) Engagement Across the U.S.

CNHI's role

With support from the American Heart Association, CNHI seeks to identify the key implementation factors in produce prescription (PPR) programs that lead to successful participant engagement.

Project description

This study augments existing Gus Schumacher Nutrition Incentive Program (GusNIP) PPR national project-level and participant-level core metrics data with new quantitative and qualitative data. Specifically, CNHI is collecting new detailed data about PPR intervention characteristics and implementation strategies from over 100 GusNIP projects across the United States. We are using these new data to identify project characteristics, strategies and contexts associated with high levels of participant engagement. This study will leverage projects’ heterogeneity as a strength, moving beyond the assumption that simply offering free or subsidized healthy food will result in high levels of program uptake. American Heart Association funded this project.

Background and Analysis

As the GusNIP Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information (NTAE) Center, CNHI has access to data on PPR incentive redemption from over 100 GusNIP PPR grantees. Pairing redemption data with detailed survey data on PPR implementation characteristics (developed using the EPIS framework), CNHI is using multivariable statistics to identify intervention characteristics associated with high redemption rates as well as using generalized linear mixed models to assess relationships between combinations of intervention characteristics and redemption percentages.

CNHI is also conducting interviews with PPR project implementers to explore and characterize lessons learned by project staff in selecting, deploying and adapting engagement strategies. Using qualitative thematic analyses to describe implementation strategies, implementation determinants and lessons learned will provide a practical understanding of implementation approaches that can facilitate high redemption rates, as well as potential pitfalls to avoid and/or contextual factors that may indicate a need for additional/alternative implementation supports.

Overall findings forthcoming

Findings from this work will identify a set of characteristics that represent key real-world decision points for program implementers, describe drivers of participants’ satisfaction with interventions and inform best practices for putting promising intervention approaches into practice.

For questions or comments, email Elise Mitchell.

American Diabetes Association (ADA) Produce Prescriptions (PPRs)

Pathway for Produce Prescriptions in Diabetes Management (PPPT2D)

CNHI's role

With support from the American Diabetes Association, CNHI seeks to evaluate the impact of Gus Schumacher Nutrition Incentive Program (GusNIP) produce prescription (PPR) projects on participants diagnosed with Type 2 diabetes (T2D), establish the cost-effectiveness of PPR projects through a program cost analysis, and examine reach, dose, and fidelity of PPR projects to determine feasibility and best practices.

Project description

PPPT2D is enrolling participants in five regions across the United States. Eligible participants have been diagnosed with type 2 diabetes (T2D) and have limited income. In each region, PPPT2D engages clinics and community-based organizations that are implementing GusNIP PPR projects. Enrolled participants in these intervention sites will receive PPRs for four to six months.

From each of the five regions, a control group of participants are also enrolled. This allows PPPT2D to compare the intervention’s impacts between participants receiving the intervention versus control group participants receiving standard of care (i.e., not receiving PPRs).

Quantitative and qualitative data will be collected to understand if participants receiving PPRs experience improvements in HbA1c, fruit and vegetable (FV) intake, food security and BMI, compared to participants receiving standard of care (e.g., the control group).

Background and Analysis

Little is known about the influence of PPRs on patients with T2D. The study seeks to address:

  • The impact of PPRs on participants’ HbA1c, FV intake, food security, height, weight, blood pressure, health care utilization and other outcomes as compared to control group participants.

  • Costs to implement a PPR project and cost effectiveness for improving outcomes among patients with T2D.

  • Best practices to improve program capacity and participant satisfaction when implementing PPRs.

Overall findings forthcoming

Collaboration with partners:

For questions or comments, email Elise Mitchell.

Share Our Strength Landscape Analysis

Food is Medicine for Pregnant Women
A landscape analysis to inform future work

CNHI's role:
The goal of the collaboration between Share Our Strength and the Center for Nutrition & Health Impact is to document the evolving landscape of Food as Medicine (FAM) programs for pregnant women. The Center identified future directions of FAM programming for pregnant women in the form of six directions.

Background and Analysis
One population at risk of adverse health outcomes due to food insecurity is pregnant women. Many risk factors related to food insecurity during pregnancy can impact maternal and fetal health outcomes.

Food as Medicine (FAM) interventions have emerged as a solution to improve food security. These interventions include:

  • Medically tailored meals

  • Medically tailored groceries

  • Produce prescriptions.

While researchers continue to evaluate the effectiveness of these interventions, FAM initiatives prioritizing pregnant women have largely gone unstudied.

Therefore, the purpose of this study was to provide Share Our Strength’s No Kid Hungry Campaign with a landscape analysis of FAM interventions to document the evolving landscape of FAM programs for pregnant women and identify six future directions detailed below.

Overall Findings

  1. Program Reached Multiple Populations
    Programs reached diverse populations of pregnant women; however, engaging individuals experiencing health disparities in program design is needed.

  2. Program Effectiveness Measures Varied
    FAM programs for pregnant women used varied measures and metrics to gauge effectiveness.

  3. Multiple Factors Led to Program Adoption
    External and internal influences led to the adoption of FAM programs for pregnant women.

  4. Program Components Varied Widely
    Free or reduced cost food, support services, and community partnerships varied across FAM programs for pregnant women.

  5. Key Factors Could Lead to Sustainable Programs
    Building evidence and partnerships may lead to policy changes and sustained funding.

For questions or comments, email Shelly Palmer. 

Food As Medicine 3

Food as Medicine (FAM3) Evaluation

CNHI's role:
In partnership with Feeding America National Organization (FANO), CNHI leads nationwide evaluation of Food Is Medicine (FIM) programs. All 21 Food banks and over 37 health care partners have a unique participants centered.  

Project description 
FANO and the Elevance Health Foundation (Elevance) are implementing the third iteration of their Food as Medicine (FAM3) initiative with 21 grantees consisting of dyadic partnerships between Feeding America network members and partner health care systems. Food and nutrition security are key social determinants of health, particularly for people experiencing or at risk for chronic disease, indicating a need for FIM interventions. Each FAM3 partnership has developed in its own intervention, including diverse ways of accessing food, providing nutrition education, and offering support for enrollment in programs like SNAP. While FAM3 is not the first evaluation of interventions like these, prior multi-site FIM studies of this size have not assessed impact longitudinally or explored key factors that determine successful implementation of FIM interventions. There are critical knowledge gaps regarding the impact of the FIM interventions and best practices for implementation. An in-depth evaluation of FIM impacts and processes across multiple sites and multiple types of intervention activities is warranted.  

Background and Analysis 

  • The evaluation key areas:

    • Building a space for grantee growth and learning via a learning collaborative. 

    • Electronic health records from select health care partners. 

    • Insurance claim information from participating Elevance Health Plan members. 

    • Baseline and follow-up survey collection of participants’ demographic, health care utilization, quality of life and nutrition security. 

    • In-depth longitudinal interviews with participants to understand their  experiences of the FIM interventions. 

    • FAM3 program implementation including barriers and facilitators for the various program models. 

Overall findings

  • Current Reach Data: FAM3 Grantee Reach Dashboard_Q4.xlsx (sharepoint.com) Only cumulative results may be shared at this time 

  • This study is ongoing, results expected July 2026. 

    • Collaboration with partner (if applicable) Elevance Health Foundation, Feeding America National Organization  

    • Downloadable files (e.g., report, companion pieces, resources, etc.) 

For questions or comments, email Ashleigh Floyd Clark.