Editor's note: This story is part of Southwest Michigan Second Wave's On the Ground Battle Creek series.

A pharmacy at Grace Health is dispensing a different prescription to patients who have been diagnosed with diabetes, heart disease, hypertension, and obesity. The Rx is fresh food. 
 
Since March 2021, the health care provider’s Fresh Food Pharmacy in partnership with the South Michigan Food Bank (SMFB) has been providing these patients with boxes containing meat or poultry, eggs, dairy products, fresh fruits, and vegetables. They come with recipes tailored to the ingredients in the food boxes. Over the course of nine months, the boxes are picked up by patients at the food bank or delivered to them by volunteers every two weeks.
 
The idea for the fresh food delivery program originated with Dawn Opel, Director of Research & Strategic Initiatives and General Counsel for the Food Bank Council of Michigan, headquartered in Lansing. It serves as the umbrella organization for the state’s seven food banks, including the South Michigan Food Bank based in Battle Creek. Since being hired two years ago, her focus has been on forming health care partnerships with food banks to create opportunities to get fresh and healthy food to patients.
 
The Grace Health initiative is modeled on a similar program called Henry’s Groceries for Health, operated through a partnership between Gleaners Community Food Bank and its funder, Henry Ford Health System.
 
“It’s incredibly difficult work because no part of the partnership is already built,” Opel says. “It feels like not every health care system is designed for this partnership. It’s a question of how we can address the basic needs of patients in a clinical setting. There’s a lot of interesting work going on, especially around the pandemic, about how we live and how the way we live affects our lives. There’s a newfound interest in assessing it.”
 
Peter Chang CEO of Grace Health, helps with distribute boxes of fresh food to those participating in the Fresh Food Pharmacy program.Several programs similar to those in Battle Creek and Detroit operate in other parts of the state, but Opel says they have “waxed and waned.”  

Opel says she found a real “champion” of the project in Grace Health. She says working with federally funded health centers such as Grace Health makes sense because “We share common missions and a common patient population and are really aligned with what they’re trying to do.”

Nurses, nutritionists, and life coaches from the health care provider meet with the patients who receive food boxes on a monthly basis to provide support and document how the Fresh Food Pharmacy is helping them manage the diseases they are diagnosed with. She says she also has a “great partner” in Peter Vogel, CEO of the South Michigan Food Bank.
 
In 2020, following a meeting with Vogel and Dr. Peter Chang, CEO of Grace Health, Opel submitted a grant application to the Michigan Health Endowment Fund (MHEF). The fund subsequently awarded the team $500,000 to get the local program up and running.
 
The food filling the boxes is purchased from the South Michigan Food Bank. The food bank receives large-scale donations of fresh produce and dairy products through its affiliation with the Michigan Food Bank Council and items that are purchased through grants and donations. Opel says the Food Bank Council of Michigan also distributes commodities through the USDA (United States Department of Agriculture) which directly benefits clients at each of its seven member-food banks.
 
Some of the food delivered in a box as part of the Fresh Food Pharmacy program.“We know that our clients are disproportionately affected by chronic disease,” she says. “We very much want to understand what the relationship is between having access to healthy food and how that helps with disease management. Food insecurity results in health care costs of more than $1 billion annually. Most people don’t put those two things together.”
 
The journey to healthy outcomes
 
The Fresh Food Pharmacy program launched with 377 patient participants who qualified for the program. They had to be willing to commit to including the food as a standard part of their disease management plan, says Andrea Bishop, director of non-clinical Support Services with Grace Health.
 
In January, 11 participants graduated from the program after they had improved biometric screenings based on comparisons of an initial screening and one done at the end of their nine months in the program. 

Another 199 are actively involved in the program and seven are waiting to get an initial biometric screening with a nurse.
 
“Of those 377, they haven’t all been glory stories, but we went in with our eyes wide open,” Bishop says. “Some of them discovered that it was just not a good fit for them, and maybe they didn’t like any of the food, or they secured gainful employment and decided that they didn’t need the food boxes.”
 
“We can’t talk scientifically about the results yet. We have hired a group of analysts who are coming in April to research the data we have collected,” Bishop says. “The successes we have now are based on conversations, a reduction in A1C levels, and documented weight loss.” (A1C refers to blood sugar levels.)
 
Amy Dandenault helps distribute boxes of fresh food to those participating in the Fresh Food Pharmacy program.Every patient interested in participating in the program has an initial meeting with a Grace Health Resource Specialist who screens them to make sure that they have the greatest opportunity to be successful in the program. For example, Bishop says among the questions asked is do they have regular access to an oven or stove. 
 
“Out of all the people screened only 20 were ineligible when we screened them,” she says. “We direct them to other fresh food initiatives in the community.”
 
Those accepted into the program receive a toolkit box that contains a colander, a sharp knife, a vegetable peeler, food storage containers, and spices and olive oil during an initial meeting with a nurse. They are then required to meet monthly with a Grace Health provider to gauge their progress.
 
Staff with Grace Health developed screening questions and established templates for electronic health records to perform screenings and counseling visits.
 
The original goal was to connect 300 patients to the Fresh Food Pharmacy program. Bishop says she and other members of a committee formed to support the program consulted with physicians, nurse practitioners, and other providers with Grace Health who routinely serve patients diagnosed with diabetes, heart disease, obesity, and hypertension.
 
“We talked to them about how these patient populations could benefit from eating healthy foods,” she says. “When we started brainstorming about the project it was pre-COVID. The original plan was for Grace health to have big, walk-in coolers to take delivery of the food items from the food bank. The food would be boxed up here where patients could come and pick it up.”
 
Andrea Bishop and Pete Vogel CEO SMFB help distribute boxes of fresh food to those participating in the Fresh Food Pharmacy program.When COVID hit, organizers pivoted to a different plan. Food bank volunteers would fill the boxes and deliver them to program participants. Bishop says she thought this would be a “deal-breaker” for the food bank and the patients, but this was not the case. Participants now have the option of picking up their boxes or having them delivered.
 
It’s a pretty even split between those who pick up and those who want their boxes delivered, says Amanda Feighner, Community Nutrition and Health Programs Manager with the local food bank.
 
“As a food bank we’re interested in learning about community needs and how we can best serve our clients,” says Feighner, who was hired 18 months ago. Her position is partially funded through the MHEF grant. 

“We've had a big increase over the years in the amount of fresh food distributed. In general, we are interested in seeing how we can serve our community with healthy, nutritious foods. We are continuously exploring new ways of doing that.”
 
An edible toolkit
 
Although the major focus is currently on the Fresh Food Pharmacy, Feighner says the South Michigan Food Bank would like to have more specialized programs in the near future. She's taking a deeper dive into determining community needs and creating different approaches to meet those needs.
 
She also is identifying recipes to include in the Fresh Food Pharmacy boxes that will work with the food provided. These recipes come from Cooking Matters operated by Share Our Strength, a national program.
 
“After they’ve been in the program and getting boxes, they meet virtually with our Healthy Lifestyles counselors or a dietitian to talk about the recipes, if they like them, and if there are any tweaks that they’d like made,” Bishop says.
 
Feighner says two recipes are included in each box. Participants receive a cookbook she assembled with all of the Cooking Matters recipes she has found and handouts that offer easy and inexpensive cooking tips.
 
“With the Fresh Food Pharmacy program, there are a total of six different food box combinations that everyone can select from. They can pick all six if they want the most variety and their selections will rotate through the nine-month timeframe for the program,” she says.
 
The majority of participants opt for the six-box variety rotation because they like having more recipe options. Besides, the protein, dairy (almond milk is an option) and produce, the boxes contain breakfast foods such as cereal or oatmeal.
 
Opel says there is a growing trend among food banks to provide similar food box options to all of their clients. This will provide them with fresh food, in addition to staples such as peanut butter, pasta, and tuna fish.
 
Programs like the one at Grace Health are helping them to make a case for the need for additional funding to make such an expansion a reality.
 
“With these Pharmacy programs we know we can improve the ROI (Return on Investment) for insurance companies and achieve healthy outcomes if we can get quality food to patients. We can demonstrate these outcomes and have proof of a concept for a model and clinicians can see clients who are self-managing their health with a tailored food program.”
 
However, there is an issue of sustainability and she says inflation has taken a toll on food banks.
 
“We’re looking at the role of different health care providers. There’s a lot of movement in other states for Medicaid reimbursement and we have been looking at how we could partner with the Medicaid program which has to be part of the sustainability conversations. When you introduce that kind of funding, then you will start to see changes in the health care system.”