In Support of Senate Bill 2453: A Food and Health Pilot!

Originally published by FIMMA, Food is Medicine Massachusetts. 

On January 22, 2020, only half a year since the launch of the Massachusetts Food is Medicine State Plan the Joint Committee on Public Health gathered for the hearing on Senate Bill 2453, An Act Relative to Establishing and Implementing a Food and Health Pilot Program. A diverse group of stakeholders from food and health organizations across Massachusetts attended in the State House in order to convey their support for the Pilot Program.

An Act Relative to Establishing and Implementing a Food and Health Pilot Program was introduced to the Joint Committee on Public Health by Massachusetts Senator Julian Cyr and Representative Denise Garlick. If approved, the legislation will require the Executive Office of Health and Human Services (EOHHS) to establish the Food and Health Pilot Program with the necessary funding to connect MassHealth patients that are both at risk for or suffering from diet-related conditions to one of three Food is Medicine interventions: medically tailored meals, medically tailored food packages, and nutritious food referrals such as produce prescriptions.

Despite emerging evidence surrounding the efficacy Food is Medicine interventions to improve health and decrease health care costs, access remains limited across Massachusetts. The Massachusetts Food is Medicine State Plan,released in June 2019 by the Center for Health Law and Policy Innovation and Community Servings comprehensively evaluated the need for, current access to, and barriers associated with improving access to Food is Medicine interventions. The initiative found that while pioneering programs exist, structural and institutional barriers—lack of integration into health care referral systems, gaps in research, and lack of sustainable funding—have historically limited the ability of these programs to scale up to meet the growing need of communities across the state.

Implementing a Food and Health Pilot Program will test the ability of our food and health care systems to overcome these barriers, further cementing Massachusetts’s role as a leader in access to care. If enacted, Senate Bill 2453 will:

• Add to the body of evidence supporting Food is Medicine and provide valuable data on the impact of Food is Medicine interventions on health care costs and outcomes;

• Enhance the ability of the Massachusetts health care system to provide appropriate nutrition services based on patient need; and

• Expand access to Food is Medicine interventions in the state.

The legislative sponsor and co-author of the bill, Senator Julian Cyr, kicked off the hearing last Wednesday and spoke to the heart of the Pilot’s mission, insisting that “This program will make Massachusetts the first state in the nation to meet the nutritional needs of patients to survive, heal and thrive.” His heartfelt testimony was followed by a panel of three national leaders in the Food is Medicine space, the Katie Garfield form Center for Health Law and Policy, David Waters of Community Servings, and Dariush Mozaffarian, Dean of the Friedman School of Nutrition Science and Policy who set the stage highlighting the findings in the Massachusetts Food is Medicine State Plan, discussing the inextricable link between nutrition and health outcomes, and reviewing research illustrating the impact of these critical interventions. Fourteen stakeholders provided testimony throughout the hearing representing health care providers, community-based organizations, Food is Medicine consumers, and research centers, all in support of the legislation. 

Massachusetts has always been a national leader in health care policy, especially in state-wide efforts to address the social determinants of health. We have led the way in ensuring universal access to health insurance coverage, and we remain at the forefront of innovative reforms such as implementing value-based reimbursement. However, we continue to struggle with two issues that play a fundamental role in driving both poor health outcomes and health care costs: food insecurity and diet-related disease. During the hearing, Dean Mozaffarian pointed to nutrition as “the single biggest overlooked aspect of health.” He warned that the failure to include nutrition in health care will come at the expense of “American longevity,” and the first step to preventing a reality where “more Americans are sick than healthy” is treating diet-related conditions with better food. 

“This bill means something for all chronic diseases that are impacted by holistic approach to health. I haven’t been sick at all for the past seven months. I thank Community Servings for the work they do to keep me engaged and cared for.” -David Brown,  Community Servings Client

Food insecurity, or the lack of consistent access to enough food for an active, healthy life, impacts one out of every ten households in Massachusetts, and results in $1.9 billion in avoidable health care costs each year. For many households, improving basic access to nutritious foods through programs like SNAP may be sufficient to improve health. However, for individuals living with or at risk for serious health conditions affected by diet, these strategies fall short. These individuals not only need access to nutritious foods but also equitable access to Food is Medicine interventions — foods specifically tailored to address the impacts of their health conditions. 

During the hearing, Katie Garfield clearly laid out the three critical outcomes that the bill will achieve if enacted:

• Add to the body of evidence supporting Food is Medicine and fill the critical gaps in research on the impact of Food is Medicine interventions on health care costs and outcomes; 

• Enhance the ability of the Massachusetts health care system to provide appropriate nutrition services based on patient need; and 

• Expand access to Food is Medicine interventions in the state, addressing funding as a key barrier. 

While pioneering programs currently exist, structural and institutional barriers including lack of integration into health care referral systems, gaps in research, and lack of sustainable funding limit the ability of these programs to scale up and meet the growing needs of communities across the state. To that end, Kumara Sidhartha, the Medical Director of Cape Cod Healthcare, testified that this program’s transformative potential would be found in the “creation and evaluation of a comprehensive program as opposed to the piecemeal programs that exist.”

“We need resources to make this vital connection that would benefit from this pilot program. This helps to build the connection providers have to local sources, medical offices, and food markets so that communities can more readily streamline services to patients and offset bad effects of living in a food dessert. This is a great program because it helps to de-stigmatize the hunger conversation for optimal patient support.” -Representative Mindy Domb

Many of those that testified specifically emphasized the ways in which this program will be able to build upon the newly implemented Flexible Services program in Massachusetts. Under the program, MassHealth Accountable Care Organizations (ACOs) receive funding that can be used to meet the housing and/or nutrition needs of eligible patients. While this innovative program represents an incredible leap forward in Massachusetts’s ability to address the needs of some of its most vulnerable residents, it faces several limitations. The most notable deficiency being the specification that Flexible Services dollars are restricted to address the needs of individual patients; they cannot be used to provide broader support to the patient’s household. In hopes of amending the Food and Health Pilot to address the household level, testimonials stressed the need for expansive funds to optimize the impact of the program and ensure that patients need not choose between prioritizing their health status and feeding their family. Dean Mozaffarian asserted his confidence for this amendment to illustrate medical benefit, relieving legislature concerns in his testimony that, “it would be blind of us not to see that food will be shared” and eliminating the option for household funding poses the risk of diluting the effects of an otherwise successful intervention“when in fact a parent gives food to child or elderly couples share food.”

Senate Bill 2453 will create opportunities to improve access to Food is Medicine interventions in both the short and long-term. The allocation of concrete, direct funds will not only expand current programs to new populations and geographies under the Pilot but also provide critical data that can be used as the foundation for policies and partnerships to support expansion on a much broader scale. Rachel Weil of the Greater Boston Food Bank proudly said that this program will “foster better collaboration to improve the health and lives of the commonwealth population.” While there is much work to be done, this Senate hearing marked an incredible first step on the path to ensuring that Food is Medicine interventions become and are acknowledged as invaluable pieces of the Massachusetts healthcare system. 

Thank you to everyone who testified in support of the Food and Health Pilot Program, including: 

• Katie Garfield, Clinical Instructor, The Center for Health Law and Policy Innovation

• David Waters, CEO, Community Servings

• Dariush Mozaffarian, Dean of the Friedman School of Nutrition Science and Policy; Professor of Medicine, Tufts School of Medicine

• Kumara Sidhartha, Medical Director, Cape Cod Healthcare ACO

• Kim Prendergast, Director of Social Determinants of Health, Community Care Cooperative ACO

• Kim Reckert, Manager of Community Health Relations and Development, Community Benefits, UMass Memorial Medical Center

• David Brown, Community Servings Client

• Rachel Weil, Community Health and Research Associate, Greater Boston Food Bank

• Josh Trautwein, Co-founder/CEO, About Fresh

• Giuliana Cappucci, Education Director, Mill City Grows

• Sarah Grow, Advocacy and Development, The Open Door

• Alan, Greater Boston Food Bank Mobile Market Client

• Rich Sheward, Director of Innovative Partnerships, Children’s HealthWatch

• Hannah Sobel, Development and Policy Program Manager, Community Servings

• Kurt Hager, PhD Candidate, Friedman School of Nutrition Science and Policy

FULL WRITTEN TESTIMONY