By Stacy Bates, MS, RDN, SPAN Health Strategies
Health systems and health plans increasingly agree that food affects health outcomes. Fewer agree on how to deliver food-based care at scale, pay for it and prove it works. That gap is where most Food as Medicine programs struggle.
I've worked on both sides of this. I started as a dietitian and certified diabetes educator in an endocrinology clinic. Then I spent 12 years building retail nutrition programs at H-E-B, including a dietitian practice that billed medical nutrition therapy. I'm also an Aspen Institute Food fellow.
The patchwork problem
Today's Food as Medicine landscape is a patchwork. Eligibility rules, funding sources, food access and reporting differ by program, plan and state. A member may qualify for produce prescriptions through one program and nutrition counseling through another, with no connection between them.
Programs that work reduce that friction for funders, members and for the care team.
Choose the right intervention for the population
Food as Medicine is not one program. Common models include:
Medically tailored meals are fully prepared meals designed for a specific health condition. They fit members with serious illness or those who can't shop or cook for themselves.
Medically tailored groceries give members the ingredients and guidance to prepare condition-appropriate meals at home. They work well for people who can cook but need help knowing what to buy.
Produce prescriptions provide funds or vouchers for fruits and vegetables. They're best for members managing diet-related conditions who also face food insecurity.
Medical nutrition therapy is individualized care from a registered dietitian. It fits members who need a personal plan and ongoing support, and it can be billed to insurance for covered conditions.
Nutrition education reaches broad populations through classes, store tours and digital content. It's best suited to prevention and early intervention.
The strongest programs combine more than one. For example, produce prescriptions paired with dietitian counseling.
Partner with where people already shop
Grocery stores reach members every week. Retail partners can provide food access, redemption, pharmacy connections and dietitian support. Most health care teams underestimate how much these partnerships need on both sides: shared goals, data agreements and clear roles.
Plan payment and measurement from day one
Grant-funded pilots often end before they show results. Before launch, answer:
Who pays after the pilot, and under what billing or contract model?
What outcome will you measure, such as A1C, utilization or member engagement?
How will food purchases or redemptions be tracked and reported?
What does the member experience look like from referral to checkout?
Where to get help
SPAN Health Strategies helps health systems and health plans design Food as Medicine programs that connect clinical care, retail partners and measurable results. Contact us to talk through your program.