ALL IN’s Recipe4Health (formerly known as Food as Medicine) initiative is an integrative model for healthcare that addresses the social determinants of health (specifically food insecurity and social isolation) and chronic disease. This model advances health and racial equity by transforming the healthcare system’s capacity to increase access to and utilization of affordable, nutrient-rich, whole medically supportive food and to provide ongoing behavioral change support to improve the overall health of communities. Recipe4Health focuses on using medically supportive food from farms that use regenerative practices that improve soil health, human health, and planetary health with an equity lens.
Clinically Integrated Recipe4Health Model
What is medically supportive food and nutrition services?
- A spectrum of interventions that provide nutrient rich whole food used for prevention, reversal, and/or treatment of certain health conditions
- Includes any fruit, vegetable, legume, nut, seed, whole grain, low mercury/high omega-3 fatty acid seafood, and/or lean animal protein
- Includes behavioral and nutritional coaching and education to amplify the effect of medically supportive food
Recipe4Health promotes the use of medically supportive food in healthcare clinics. And we know that urban farmers who use regenerative practices, like Dig Deep Farms, will play an increasingly important role as the demand for medically supportive food grows.
Through clinically integrated sites, Recipe4Health works to address food security and treat, prevent, and reverse chronic disease, which can also reduce ER visits, hospitalizations, and medication usage. The clinically integrated model builds three important pieces of innovative infrastructure with clinics:
1. Food Farmacy:
Patients are prescribed fresh produce by their healthcare team which is filled by Dig Deep Farms, an urban farm utilizing regenerative practices to fortify the soil and grow nutrient-dense food that is pesticide-free, seasonal, and local. Food prescriptions include 16 weeks of vegetables fulfilled by “Food Farmacies,” currently implemented as delivery to patients’ doorsteps. Dig Deep Farms creates green economy jobs for formerly incarcerated or returning citizens to work as farmacists, farmers, and delivery drivers.
2. Behavioral Pharmacy:
Group Medical Visits bring together patients with various medical conditions to “move, nourish, connect, and be” through weekly visits that include physical activity, healthy food, social connection, and stress reduction. The behavioral group support, provided by Open Source Wellness, is currently delivered virtually and occurs weekly.
3. Provider Training:
Providers and healthcare staff receive state-of-the-art trainings on how to use “food as medicine” to treat, prevent, and reverse chronic disease. ALL IN trains clinical teams at primary care clinics on the latest science and develops their confidence to implement nutrition interventions in the exam room with diverse patients. Staff also receive training on implementing universal food insecurity screening, optimizing CalFresh referrals, and referring to the Food Farmacy and/or the Behavioral Pharmacy.
With support from Measure A, the Recipe4Health initiative also maintains food farmacies at Roots Community Clinic, La Clinica de la Raza, and West Oakland Health Council. Measure A raised the sales tax by one-half cent to provide financial support for medical and public health services for Alameda County residents in need. Each month these clinics combine a food farmacy with other services (e.g., CalFresh enrollment, health education, dental and optometry stands, etc.).
Policy Work on Medically Supportive Foods and Nutrition Services
In partnership with Alameda County’s local, public managed care plan, Alameda Alliance for Health, ALL IN is working to identify sustainable funding mechanisms and recommend policy changes to make food prescriptions, other medically supportive food interventions, and nutrition services paid for by Medi-Cal just like other medications and medical treatments.
ALL IN is pursuing two policy pathways to make medically supportive food and nutrition services a covered benefit at the state-level:
1. Administrative pathway via the proposed California Advancing and Innovating Medi-Cal Waiver:
Alameda County is part of the statewide Medically Supportive Food and Nutrition steering committee, which brought together over 100 organizations to sign a position paper to support inclusion of “Medically Supportive Foods and Nutrition Services” into California’s Medi-Cal waiver, California Advancing and Innovating Medi-Cal (CalAIM). In early 2021, the Department of Healthcare Services included this in the CalAIM optional services initiative, which will allow health plans to offer medically supportive food and medically tailored meals to their members.
2. Legislative pathway via AB 368 (2021) and the 2021 California State Budget Act:
Assembly member Rob Bonta introduced legislation, Assembly Bill 368 (2021), to address racial and ethnic health disparities by establishing food prescription pilot programs in three counties, including Alameda County, to provide food prescriptions to Medi-Cal Managed Care members who are food insecure and have diet-related, chronic health conditions. The California Department of Health Care Services would implement and evaluate the pilot in partnership with managed care plans to build the evidence base demonstrating how food prescriptions can manage, prevent, and reverse chronic conditions, reduce food and nutrition insecurity, and eliminate racial health disparities.
Research and Evaluation
Stanford University, the University of California San Francisco, the Community Health Center Network, Alameda Alliance for Health, and the Gretchen Swanson Center for Nutrition are working together to evaluate and research Recipe4Health’s impact on health outcomes, healthcare utilization, patient reported outcomes, health related behaviors, and food insecurity.
Open Source Wellness, in partnership with the Alameda Health System, published an analysis of the effectiveness of a clinic-based group medical visit integration of the behavioral pharmacy model in a federally qualified health center in Hayward, California. They demonstrated significant increases in daily servings of fruits and vegetables and exercise.
Resources for Healthcare Teams
“Rooting Food as Medicine in Healthcare:” This toolkit is for primary care clinics and other healthcare settings that want to incorporate “food as medicine” initiatives into their practice and workflow. Because every health center has a different culture, it includes suggested templates and timelines that can be adapted for their needs.
Key Highlight: Rooting Food as Medicine in Healthcare includes several worksheets to guide your planning.
- Worksheet 1: Readiness Assessment: This self-assessment helps healthcare organizations think through what needs to happen in order to successfully integrate food as medicine into a clinical setting.
- Worksheet 2: Models of Intervention: This worksheet provides an overview of best practices, logistics, and roles for those interested in implementing pop-up food farmacies, CSA boxes, or clinic-based voucher programs.