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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) 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.

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

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

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

For questions or comments, email Elise Mitchell.

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 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 Healthcare 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 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 Medicaid adults with hypertension 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 Medicaid adults 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 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:

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

• Market Umbrella with Crescent Care and CareSouth Medical and Dental (Louisiana)

• Parkview Hospital (Indiana) 

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

• Virtua Health and The Food Trust (New Jersey)

• American Diabetes Association (funder)

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.

Food is Medicine to Feed the Family

Subaward for Humana.

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.

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.