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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) Gus Schumacher Nutrition Incentive Program (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 over 100 PPR grantees, most of whom are community-based organizations implementing local and regional Food is Medicine projects.

Project description

Administered by the USDA National Institute of Food and Agriculture (NIFA), 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). Clinic patients who have a limited income and have a diagnosis of or are at risk of developing a diet-related chronic disease are referred by their provider to receive a produce prescription. Prescriptions are either provided directly in the form of a produce box or as a voucher to be redeemed for FVs in farm direct settings (e.g., farmers markets) or brick and mortar food retailers (e.g., grocery stores, supermarkets).

Background and Analysis

The NTAE evaluation of GusNIP PPR projects uses core metric data collected from project participants and participating sites (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 sites are used to assess PPR project enrollment numbers and prescription redemption.

Overall findings

In our most recent impact findings report scheduled for release in December 2025, we found that:

• PPR projects enrolled an average of 1,804 participants per month for a total of 21,648 participants from September 2023 to August 2024.

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

• Over 9 out of 10 PPR participants (93%) report satisfaction with the program.

• PPR participants from a study of five GusNIP PPR projects experienced significant improvements in HbA1c and blood pressure, especially among those with poorly controlled diabetes or stage two hypertension.

Stay tuned for the release of the Year 5 Impact Findings, coming in late 2025! In the meantime, feel free to check out the Year 4 Impact Findings below.

Questions or comments? Send us an email.

American Heart Association Health Care by FoodTM - 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’s Health Care by FoodTM initiative, CNHI sought to identify key implementation factors in produce prescription (PPR) programs that lead to successful participant engagement.

Project description

This study augmented 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 collected new detailed data about PPR intervention characteristics and implementation strategies from over 100 GusNIP projects across the United States through a survey and interviews. We used these new data to identify project characteristics, strategies and contexts associated with high levels of participant engagement in PPR. This study leveraged GusNIP projects’ heterogeneity as a strength, moving beyond the assumption that simply offering free or subsidized healthy food will result in high levels of sustained participant engagement in PPR.

Background and Analysis

Through its GusNIP Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information (NTAE) Center, CNHI works with data on PPR incentive redemption from over 100 GusNIP PPR grantees. Connecting redemption data, participant outcomes data, and detailed survey data on PPR project characteristics, CNHI used quantitative analysis to identify intervention characteristics associated with PPR redemption and participant outcomes such as fruit and vegetable intake, food security status, and perceived health. CNHI also conducted interviews with GusNIP PPR project implementers to explore lessons learned by project staff as they implemented their PPR projects.

Qualitative analyses provided a practical understanding of implementation approaches that can facilitate high redemption, as well as potential pitfalls to avoid, and contextual factors that indicate a need for alternative implementation supports.

Overall findings

Findings from this work identified key decision points for PPR implementers to encourage participant engagement and positive outcomes. Findings were also used to develop a list of best practices for putting promising intervention approaches into practice. These findings are accessible from the following sources:

• Best Practices Report for Implementing a PPR 

• Participant Redemption and Engagement in Produce Prescription Programs: A Qualitative Analysis of Implementer Perspectives 

• Forthcoming publication presenting findings from quantitative analyses 

Collaboration with Partner

• American Heart Association (funder) 

• Erin Summerlee, Director, Rural Health Network of South Central New York (Advisory Committee Member) 

• Hilary Seligman, Professor of Medicine, University of California San Francisco (Advisory Committee Member) 

• Kofi D. Essel, Food as Medicine Program Director, Elevance Health (Advisory Committee Member) 

For questions or comments, email Dr. Christopher Long.

Development of a User-Centered Approach for Screening, Referral, and Enrollment of a Food is Medicine Program Among Adults

CNHI's role

In partnership with the University of Kentucky (UK), CNHI seeks to identify qualitative findings from a pilot study conducted by UK’s Food as Health Alliance program.

Project description

Recently, the American Heart Association launched the Health Care by Food™ program, which promotes a user-centered design approach. The University of Kentucky is leading a pilot study that utilizes this framework to develop a tailored FIM program using a screening decision tool to allocate patients to a FIM program based on their preferences and resource constraints, such as preferring to shop in-person or online and availability of transportation to the store.

The aims of this study are to:

1. Examine the use of a screening decision tool on measures of engagement, retention, and usage. 

2. Determine the effect of the FIM program on primary outcomes of blood pressure (systolic and diastolic) and on secondary outcomes of dietary intake, financial strain, and general self-reported health. 

3. Report on cost benefits of the program among participants. 

4. Report on the user experience among participants through qualitative feedback. 

 Background and Analysis

CNHI developed and oversaw the qualitative aim of the project, which was conducted using a series of semi-structured interviews. Interviews were conducted in two phases.  

• The first round of interviews was conducted with patients soon after they enrolled in the FIM program to learn about the user experience of screening, referral, and enrollment systems. These interviews focused on the user experience related to the two Food Is Medicine screening and enrollment models (automated versus in-person), and were conducted in a brief, iterative format to obtain quick, actionable feedback to improve the systems. Input from users of the FIM screening and enrollment systems will be used to enhance the acceptability and usability of the automated screening and enrollment system.  

• The second round of semi-structured qualitative interviews were with patients shortly after they participated in the 3-month FIM program to obtain participant/user perspectives. These in-depth interviews asked patients about satisfaction with the Health Care by FoodTM program they were assigned to (MTM or Grocery Rx), barriers and facilitators to participating, perceived impacts of the program, and any recommended changes. 

For questions or comments, email Emily Dimond.

American Heart Association Health Care x Food Planning Grant

CNHI's role

The University of Kentucky Food as Health Alliance and CNHI received a planning grant funded by the American Heart Association through the Health Care by Food™ program. The CNHI team will use their expertise to help develop and plan for gathering qualitative user-perspectives to as part of the new proposal.

Project description

The study aims to develop a stepped-care model with nutrition and mental health counseling, including referral systems into federal nutrition programs for sustained clinical improvements. The randomized controlled trial (RCT) will be among adults with hypertension and low incomes residing in high-poverty rural and urban areas, recruited from three large healthcare systems across Kentucky. The study builds upon the University of Kentucky Food as Health Alliance’s three years of experience in building a statewide food is medicine system, including lessons learned from the FIM pilot study—Development of a User-Centered Approach for Screening, Referral, and Enrollment Food as Medicine Rural and Urban Adults (see above project)—related to screening, referral, enrollment, and engagement to test a full-powered RCT to determine the incremental effect of a more intensive food and nutrition support plus counseling service program, with a focus on the user experience.

Background and Analysis

The stepped care model allows testing the incremental effect of more intensive food, nutrition, and counseling services for participants who need extra support. The study will use this model to answer at what level of care and for whom these services are clinically meaningful and cost-effective.  

The study seeks to:

• Determine the effectiveness of a stepped care food is medicine intervention among adults with low income diagnosed with hypertension on the primary outcome of blood pressure (systolic and diastolic) and secondary outcomes of hemoglobin A1C, quality of life, food security, nutrition security, and family stress (anxiety, depression, and stress).  

• Examine the lived experience in the entire Health Care by Food system at key time points in screening, referral, enrollment, and engagement throughout the stepped care process to enhance scalability across multiple healthcare sectors. 

• Evaluate the cost-effectiveness of the interventions from a healthcare and societal perspective. 

For questions or comments, email Dr. Betsy Anderson Steeves.

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 enrolled participants in five regions across the United States by collaborating with clinics and community-based organizations that are implementing GusNIP PPR projects. Eligible study participants have been diagnosed with T2D and have limited income. Enrolled intervention participants received PPR benefits for four to six months.

Each of the five sites also enrolled a comparison group of participants who were eligible but did not receive PPR benefits. This allows PPPT2D to compare the intervention’s impacts between participants receiving the intervention versus a comparison group of participants receiving standard of care treatment for T2D.

Quantitative data are being collected to understand if participants receiving PPRs experience improvements in hemoglobin A1c (HbA1c), fruit and vegetable (FV) intake, food security and other measures compared to participants receiving standard of care (e.g., the control group). Qualitative data are also being collected to understand participant and clinic staff member experiences with the PPR.

Background and Analysis

The study is addressing:

• The impact of PPRs on participants’ HbA1c, FV intake, food security, body mass index, blood pressure, health care utilization and other outcomes as compared to participants receiving standard of care.  

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

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

Overall findings forthcoming

Collaboration with partners:

• American Diabetes Association (funder) 

• Chicago Botanic Garden with Lawndale Christian Health Center (Illinois)

• Market Umbrella with Crescent Care (Louisiana)

• Parkview Hospital (Indiana) 

• Presbyterian Healthcare Services with New Mexico Farmers Marketing Association (New Mexico)

• Virtua Health and The Food Trust (New Jersey)

For questions or comments, email Dr. Christopher Long.

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 was to document the evolving landscape of Food is Medicine (FIM) programs for pregnant women. The Center identified future directions of FIM programming for pregnant women in the form of six directions.

Be sure to also check out a more recent report developed by the Center, exploring perceptions of public health impacts of perinatal FIM programs from the perspectives of both program implementers and program supporters to enhance program adoption, implementation, and maintenance.

Implementation and Impact of Perinatal Food Is Medicine Programs: A Qualitative Research Study

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 is Medicine (FIM) 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, FIM 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 FIM interventions to document the evolving landscape of FIM 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. 

Mama's Kitchen

Evaluation of the shipped medically tailored meals pilot project 

CNHI's role:

In collaboration with Mama’s Kitchen, CNHI conducted a mixed methods evaluation of a pilot program of shipped medically tailored meals to residents outside of traditional service areas of Mama’s Kitchen. 

Project description 

Mama’s Kitchen is a community-based organization in San Diego, California that provides medically tailored meals and registered dietitian services to populations vulnerable to malnutrition due to critical and chronic illnesses. In their traditional delivery model, volunteer drivers deliver meals to client’s households within urban areas of San Diego. In an effort to expand services, Mama’s Kitchen implemented a pilot program to ship medically tailored meals to areas outside of the traditional model.

The objectives of the evaluation of the shipped medically tailored meal pilot program were to: 

1. Assess the number and characteristics of the clients.

2. Determine the pilot program’s impact over time on clients’ health and behaviors.

3. Understand Mama’s Kitchen staff perceptions of organizational-level, economic, and environmental factors that may influence program sustainability. 

Background and analysis 

CNHI provided technical assistance to Mama’s Kitchen to develop a pre-post intervention survey for clients. Mama’s Kitchen developed new partnerships with referral organizations, recruited clients, and conducted surveys. Mama’s Kitchen met their goal of enrolling over 50 clients, as a total of 55 clients were enrolled. CNHI analyzed the pre-post intervention data from the surveys.  

CNHI recruited, conducted, and qualitatively analyzed interviews with seven staff members involved with the pilot program.  

Overall findings 

The pilot program showed positive nutrition-related behaviors among clients. Studies with larger sample sizes and a control group are needed. Among staff, the Program Sustainability Assessment Tool domains of environmental support, partnerships, and program evaluation had the greatest support. Organizational capacity, communications, funding stability, strategic planning, and program adaptations all needed additional support for sustainability.

For questions or comments, email Shelly Palmer. 

Feeding America: Food As Medicine 3

Food as Medicine (FAM3) Evaluation

CNHI's role:

In partnership with Feeding America, CNHI leads the nationwide evaluation of Food Is Medicine (FIM) programs. All 21 Food banks and over 30 health care partners have a unique, participant-centered model tailored to their communities, offering valuable insight into both local needs and national trends. 

Project description 

Feeding America 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 regional food banks 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.

Prior multi-site FIM studies of this size have not assessed impact longitudinally in combination with exploring 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. 
 
For more on the progress to date, see the Year 2 FAM3 report below highlighting participant health improvements, food bank and health care perspectives, and more. 

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 

• Barriers and facilitators to implementing Food is Medicine programs: Evidence from 21 food bank–healthcare partnerships 

• 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.

Food is Medicine to Feed the Family

CNHI's role:

CNHI staff are supporting partners at the University of Kentucky Food as Health Alliance and the University of Louisville Health to conduct this research funded by the Humana Foundation.

Project description 

Food and nutrition insecurity can impact the whole family. This project evaluates the effectiveness of a nutrition security intervention that provides mental health supports, and various types of food benefits to the whole household rather than a single household member. This study will work to provide evidence supporting key policies on reimbursement of health-related social needs, like the provision of healthy food, as a medically covered benefit. This study is taking a user-centered approach to examine how to engage the whole family in FIM programming in the short term, while creating a sustainable model for clinic and community partnerships to use in the long term.

Background and Analysis 

This study aims to answer the question “How can a food as medicine model with tailored “doses”, or amount of food provided, improve health outcomes across the family?”. To do this, the study team is working with partners at the University of Louisville Hospital to conduct a pragmatic randomized control trial (pRCT) with families who participate in Medicaid, have children between the ages of 5-18 years, and nutrition-related chronic disease.

For questions or comments, email Dr. Betsy Anderson Steeves.

Community Servings Food is Medicine+ Case Study 

CNHI's role: 

CNHI is serving as the evaluation partner on a Rockefeller Foundation Food Is Medicine+ (FIM+) grant led by Community Servings, a Medically Tailored Meals (MTM) provider serving Massachusetts and Rhode Island. 

Project description  

Community Servings received funding from Rockefeller Foundation in 2024 to lead a case study in collaboration with the Center for Nutrition & Health Impact, the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI), and Johnson & Wales University. Community Servings is developing a report and supporting evaluation and educational tools documenting Community Servings’ practices of sourcing foods from local farms, fisheries, and other producers. CNHI is supporting this project as the evaluation partner in collaboration with Johnson & Wales University and the Food Law and Policy Clinic, Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School. The CNHI team supports the design and implementation of the evaluation methodology, analysis of impacts, and write-up of case study materials.  

Background and analysis  

This project uses literature reviews, vendor interviews, procurement data, and client survey data to address the following evaluation questions of interest: 

• What does existing research tell us about best practices for measuring the economic impact of local food sourcing? 

• To what extent does CS sourcing align with Good Food Sourcing practices?  

• To what extent are CS sourcing practices impacting the local economy?  

• To what extent are CS sourcing practices impacting clients’ experience? 

• To what extent are CS sourcing practices impacting climate outcomes?  

For questions or comments, email Emily Dimond.