Managing patients’ chronic conditions requires addressing food insecurity

Arti Masturzo, MD

Food insecurity affects more than 10% of American households. That’s approximately 41 million children, adults, and elderly individuals who frequently experience limited availability of nutritionally adequate and safe food items.

People with diabetes are among those with the highest rates of food insecurity. Recent research indicates that 16% of people with diabetes are food insecure—and the numbers are even higher for people with complications from diabetes, including those who are taking insulin (19%) and those with eye or kidney complications (22%).

These are people for whom diet is even more critical to good health than the general population. The single most important thing a patient can do to successfully manage their diabetes is to regulate what they eat, yet they are struggling the most with consistent access to nutritious food options.

The health care system must do more to collaboratively and proactively support patients with chronic conditions experiencing food insecurity and other issues related to social determinants of health (SDOH). We can start by creating space to ask the right questions, implementing effective strategies for utilizing those insights, and integrating technologies to establish a holistic framework for overall wellness.

Making room for conversations about SDOH issues

Food insecurity can be a difficult topic to broach in clinical settings, especially when health systems do not employ a consistent methodology for collecting information about SDOH concerns. Technology and workflow issues are part of the problem, but even more important are the lack of time and the challenges of fostering trust and a sense of psychological safety between provider and patient.

Even in settings with standardized procedures, like the hospital outpatient department where I see patients and routinely conduct screenings, patients often feel embarrassed to be honest about their challenges, or hopeless that the health care system can help solve their concerns.

We must give providers and patients the space to develop the trust and personal connections required to have stigma-free conversations about food insecurity and other socioeconomic issues that have a direct impact on a patient’s health and medical spending. Health care providers will also need up-to-date education and training on how to have meaningful conversations.

We can do this by adopting team-based care best practices that enable clinicians to build strong relationships, adjusting reimbursement policies to support and incentivize providers who engage in SDOH conversations, and investing in data-driven workflows to make it easier to generate actionable insights from SDOH information.

Using insights from patients to make a difference in their lives

Once we have the right information, we have to do something with it. Fortunately, momentum is building throughout the health care community toward a whole-person approach to care.

Personalized coaching and guidance must be critical components of this evolving ecosystem.

Prioritizing patient engagement through targeted, disease-specific education and coaching improves outcomes and helps reduce the total cost of care. We must work to ensure that people with diabetes understand how to use their medical devices and feel confident with employing proven strategies to manage their conditions through nutrition, activity, and other good health habits.

It's also encouraging to see federal and state policymakers embrace the idea of food as medicine. For example, the White House has established partnerships with public and private entities, including DoorDash and Instacart, to improve access to healthier options for people experiencing food insecurity.

Meanwhile, more than half a dozen state Medicaid agencies have applied for federal Section 1115 waivers to take advantage of funding for nutrition support as a benefit. New Mexico, Washington, New York, New Jersey, Delaware, and Maine already have waivers pending.

Also, Massachusetts, Arkansas, and Oregon are already experimenting with augmenting current Supplemental Nutrition Assistance Program benefits with Medicaid resources. Qualifying beneficiaries can access nutrition education, medically tailored meals, access to pantry staples, and prescriptions for fruits and vegetables.

This is a promising approach to expanding access to nutritious food for people with complex health needs and socioeconomic challenges. However, this approach may not be effective unless health care providers, social workers, and care coordinators have the tools and time at the point of care to connect eligible people with available resources.

Technology’s role in enabling whole-person care

Technology is playing an increasingly important role in stratifying individuals by risk, extending the bandwidth of clinicians, and keeping patients connected with their care, even among elderly populations who traditionally have been viewed as less able to engage with digital tools. With the right education and support, older adults are just as willing and able to use health technologies as other groups, and they may benefit significantly from home-based devices and personal monitoring technologies.

But technology alone isn’t always enough. Giving a patient a device without addressing their underlying food security—or their transportation issues, social isolation, low health literacy, or mistrust of the health system—isn’t necessarily going to improve their ability to manage their diabetes and other needs.

We must view technology as just one component (albeit an important one) of a broader person-first approach to care. Matching digital tools with trusted patient-provider relationships and policy-driven resources for taking action against food insecurity will be vital for success.

As a practicing clinician and entrepreneur, my biggest hope is that the health care industry will be able to use this multipronged approach to place SDOH at the center of patient care. I am a firm believer that in just a few short years, SDOH screening will be considered equivalent to a traditional “vital sign.” Only then will we truly make headway in addressing food insecurity across all populations.

Arti Masturzo, MD, is chief medical officer at CCS, a leading provider of clinical solutions and home-delivered medical supplies for people with diabetes and other chronic conditions.