Health care institutions, nonprofits team up to battle hunger and the pandemic

During the pandemic surge in the spring, Dr. Amy Smith, a family medicine physician at Cambridge Health Alliance, received a desperate phone call from one of her colleagues.

The respiratory clinician on the line was about to release a COVID-19 patient to recover at home, but the individual didn’t have enough money to buy food for their family. The clinician was crying on the phone, worried that the patient would expose themselves or others to the virus if they waited in line at a food pantry.

“I looked and said, This is a solvable problem,” Smith said. And then she solved it.

At the end of April, Smith and her team at Cambridge Health Alliance began screening their COVID-19 patients for food insecurity and created a grocery referral program. Over the last several months, they’ve been partnering with community-based organizations like Food For Free, the Malden YMCA, and Maverick Landing Community Services to deliver groceries to over 670 COVID-19 patients in Chelsea, Lynn, East Boston, Everett, and other hard-hit areas.

The food deliveries, which reached as many as 2,400 household members, have meant these vulnerable patients can recover safely at home, Smith said. This in turn can help stop the spread of the disease in high-risk populations, many of whom may be undocumented and therefore unable to access federal benefits such as SNAP, the Supplemental Nutrition Assistance Program.

Smith is now co-leading the hospital’s strategy around food insecurity, and is one of many health care practitioners stepping up their efforts to incorporate emergency food assistance into their care as a result of the pandemic.

Health care workers have long been able to draw a straight line between access to nutritious food and health outcomes: Unhealthy diets, after all, are often the root cause of chronic diseases. But as COVID-19 has wreaked havoc on at-risk populations, its economic fallout has also exacerbated the need for emergency food services throughout the state that serve those populations.

“We recognize that it’s important for us to have partnerships beyond our four walls; hospitals can’t do everything alone,” said Dr. Thea James, vice president of mission and associate chief medical officer at Boston Medical Center. BMC, which was the first hospital in the country to have a food pantry, recently began partnering with the local nonprofit About Fresh to coordinate over 1,000 door-step grocery deliveries to 200 of its patients.

“The partnership has been amazing for us during the pandemic,” James said.

As a result of the crisis, “a variety of nutrition services have suddenly become more accessible as a care system to patients,” said Kristin Sukys, a policy analyst at the Center for Health Law & Policy Innovation at Harvard Law School, and one of the leaders of the Food as Medicine Massachusetts coalition. “When COVID-19 struck, the community-based organizations that had partnerships with health care providers became a main lifeline to address emergency food need.”

Among the most robust efforts have stemmed from MassHealth’s new Flexible Services initiative, which aims to reduce health care costs and improve health outcomes and began rolling out statewide at the start of this year. The nutrition component of the pilot program lets health care providers screen Medicaid patients for food insecurity, and then refer them directly to community-based organizations that can help them apply for SNAP or WIC benefits, or get access to food pantries, meal or grocery deliveries, or even supermarket gift cards.

Jean Terranova, the director of food and health policy at Community Servings, a Jamaica Plain-based nonprofit that delivers medically tailored meals to patients, has been on the front lines of the Food as Medicine movement for years. But the pandemic escalated the need overnight, she said.

“With COVID it was right in your face…. It was an accelerant for this to take off,” she said. Community Servings had just finished a massive $21 million expansion, tripling the size of its kitchen and expanding the program statewide, when the pandemic hit. The organization has received 300 referrals from health care providers since March, and is on track to deliver 800,000 meals this year, a 40 percent increase over 2019. The referrals, Terranova said, have been coming “fast and furious.”

A few years ago, Project Bread ran a successful pilot program with Cambridge Health Alliance, working directly with its clinics to help sign patients up for SNAP and WIC benefits. The organization had planned to expand the program under the new MassHealth initiative to 13 health centers in Eastern Massachusetts and Worcester in July of this year. But at the outset of the pandemic, they leapt into action, and have since received 657 referrals from their partner clinics over the last several months.

“The need is so much greater than any of us ever anticipated,” and is critically important now that the additional $600 weekly unemployment benefits have run out, said Erin McAleer, the organization’s executive director. Project Bread is now offering trainings for health care workers in clinics throughout Boston to help them sign up patients for SNAP and WIC benefits.

“We want to make sure that more health care workers know what SNAP is and are comfortable talking with their patients about it,” McAleer said.

These new partnerships are creating a “transformation of how health care has invested in the social determinants of health,” said Josh Trautwein, chief executive officer of About Fresh, which runs the Fresh Truck mobile grocery store, and has been partnering with Boston Medical Center and other health systems to coordinate over 21,000 grocery deliveries to high-risk patients.

Through the MassHealth initiative, he is also beginning to roll out the Fresh Connect food purchasing program, a prepaid debit card that health systems can give patients to buy healthy food at existing restaurants and retailers. The nonprofit has a $3 million contract with a half-dozen area health care providers to give the cards to at-risk patients.

And Sukys, the policy analyst, said that for every formal state-supported MassHealth partnership, there are dozens more across the state, like Smith’s, that have emerged from the crisis out of sheer need. She and others hope that these emergency partnerships will result in stronger connections among social safety net programs.

The coordination of health providers and community-based food programs creates a “perfect scenario,” said Eric Rimm, an epidemiologist at Harvard University who studies the health effects of diet and lifestyle. Patients get more comprehensive support while bringing down the overall cost of health care, he said.

And for now, these links are providing a lifeline.

“Our patients’ lives are chaotic even when they haven’t lost their jobs and suddenly fallen ill,” said Dr. Leah Zallman, who co-heads the Social Determinants of Health Steering Committee at the Cambridge Health Alliance, and worked with Smith to create the grocery referral program. “You’re taking patients who are disenfranchised in every possible way and you add a COVID layer of burden. There’s no slack in the system.”