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How Blue Cross NC Is Scaling Food as Medicine to Improve Health and Lower Costs · Becker’s Payer Issues Podcast

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  Everyone. This is Jacob Emerson with the Becker's
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  Payer Issues podcast.
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  Thrilled today to be joined by Colleen Briggs,
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  who's the president of the Blue Cross North
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  Carolina Foundation and vice president of corporate responsibility
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  at Blue Cross of North Carolina. Colleen, thank
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  you so much for taking the time to
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  be with me on the podcast today. Thank
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  you for including me. I'm looking forward to
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  the conversation.
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  Likewise. And before we dive into everything we
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  wanna talk with you about, can you tell
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  us a little bit more about yourself, your
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  background in health care, and what it is
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  that you're doing today at Blue Cross North
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  Carolina?
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  Yeah. So I'm I'm from North Carolina originally,
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  and and I've worked in various roles, both
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  at the policy level, at the corporate level,
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  as well as, corporate philanthropy. But most recently,
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  I've joined Blue Cross around two years ago
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  to to help establish their corporate social responsibility
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  division, which is really just responsible for how
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  do we make sure that we continue to
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  fulfill our purpose to improve health for all
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  with clear goals, metrics, and accountability,
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  and really trying to listen to not only
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  our members, providers, and communities, but really making
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  sure that we're building solutions that reflect their
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  voice, look at partnerships,
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  that really help drive measurable outcomes that are
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  improving the health and well-being of our members
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  and our communities.
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  Fantastic. So, Colleen, we wanted to get started
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  today by talking with you a bit about
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  the company's Feed Your Health initiative.
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  I think it'd be helpful for our listeners
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  who might not be familiar with the program
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  if you could give us a quick overview
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  of what it is and and how does
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  this, how do your members interact with the
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  initiative?
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  Yeah. So as context, figure health is really
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  a high touch
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  personalized approach
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  to managing uncontrolled
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  type two diabetes.
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  So eligible members get medically tailored meals,
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  culturally relevant groceries,
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  and one on one nutrition coaching from a
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  registered dietitian,
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  all at no cost.
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  Understood. And so from what I understand, the
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  program has demonstrated
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  strong clinical results for you all. A 1.5
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  reduction in a one c for members with
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  type two diabetes
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  over a sixteen week time span.
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  So talk to us a little bit about
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  how you're quantifying the return on investment for
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  a program like this, not just in improved
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  health outcomes, which obviously are very important, but
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  in terms of reduced medical spend or long
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  term value for the health plan itself.
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  Yeah. And and I do think it is
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  notable that we are seeing such strong clinical
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  results. But exactly to your point, what what
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  that really translates to is lower per member
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  per month costs, which ultimately drives affordability for
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  the plan, for our members, and for the
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  entire health care system. So our own research
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  shows that these pilots can show a reduction
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  of a 139
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  per member per month in total medical costs.
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  But importantly, we are seeing that it is
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  improving
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  participants'
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  overall well-being.
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  We're seeing decreased food insecurity,
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  lower body mass index, and improvements in mental
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  and physical health, again, outside of just those
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  a one c reductions.
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  And the reason that matters is that we
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  know these are drivers that ultimately influence long
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  term health care costs.
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  So by helping members meet these nutritional needs,
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  manage these chronic conditions more effectively,
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  we're reducing the likelihood of costly complications,
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  ER visits,
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  and, ultimately, really, that all goes back to
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  savings for our members and, ultimately,
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  the overall system.
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  Absolutely. No. It makes a lot of sense.
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  And, Colin, I wonder you know, we we
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  we talk to a lot of insurers and
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  all over the country, we we do see
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  these last few years, many of them have
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  been testing food as medicine centered pilot programs.
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  But but often, they do have issues scaling
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  them meaningfully across their entire populations,
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  or or across different market segments. So from
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  where you sit and from what Blue Cross
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  of North Carolina has seen so far, what
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  are some of the key operational or financial
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  level levers that enable a program like this,
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  Feed Your Health, to move
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  from a a a pilot to a sustainable
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  benefit? What are you seeing out there as
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  some of the barriers that the industry itself
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  that that they're facing with these kind of
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  with these kind of programs?
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  Yeah. And it's a great question. And I
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  will say what really has been successful with
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  Feed Your Health is that it was very
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  deliberate on the design and the coordination
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  across clinical teams, food vendors, and community partners,
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  but it all started just by listening to
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  our members, to providers,
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  to to communities. And we actually toured all
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  100 counties, and one message was clear across
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  all of those stakeholders
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  that diet related chronic conditions are hurting our
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  members, our communities, and they're ultimately driving up
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  health care costs.
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  Here in North Carolina, chronic
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  conditions like heart disease and diabetes
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  are a leading cost driver,
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  and they're ultimately
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  costing our system 65,000,000,000
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  in medical costs
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  by 2030. So and we continue to see
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  this. Our system of care
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  misses so many opportunities to address
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  these chronic conditions early on. And for example,
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  poor nutrition is at the top of the
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  list of drivers of poor health outcomes.
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  So based on these insights,
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  future health was offered really tailored
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  specifically to address chronic condition management
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  for with very clear eligibility.
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  The criteria was very specific that we were
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  looking at members who are 18 or older
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  with an a one c of eight or
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  higher.
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  Again, at no cost, but I think that
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  those very specific parameters really did help make
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  sure that it was successful.
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  But we also made sure that the program
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  was scalable, that we were really looking at
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  how could we make sure that we're partnering
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  with providers and with our community partners to
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  make sure that this is really reaching the
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  next level. But to your point there are
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  some significant barriers that remain.
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  I'd say sort of the big four that
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  we've seen
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  is first the lack of standardized reimbursement models.
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  Now nutrition interventions, as you know, often fall
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  outside of traditional medical co codes making it
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  harder for us to integrate into some of
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  the claims system. But, again, that's why we've
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  been able to really think about how how
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  do we make sure this is easier for
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  our commercial health plans, and we've been able
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  to do that for both Feed Your Health,
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  but also through some of our other offerings
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  like our preventative care visits that we offer,
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  up to 30 of those with a licensed
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  dietitian at no cost. I think the second
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  big area that we see as a barrier
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  is just the limited data on ROI and
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  outcomes.
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  So while we see these early studies show
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  promise, as you know, payers want robust longitudinal
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  data proving that food is medicine, programs reduce
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  health care costs, and improve outcomes.
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  That's why we're tracking and trying to share
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  our results
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  like this as well as future reports that
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  we're gonna continue to issue out really with
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  the goal of hoping to increase adoption with
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  this research.
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  I'd say the third big challenge is just
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  the operational complexity. It requires a lot of
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  coordination across clinical teams, food vendors, and community
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  partners.
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  And so we've really tried to build this
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  in a way that does make it easier
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  for all of those actors to come together
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  to coordinate and streamline the delivery and the
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  adoption. In fact we even work with local
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  partners
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  through our nonprofits and others to make sure
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  that it's actually locally sourced food and that
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  it's culturally relevant and more likely to be
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  adopted.
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  And then I'd say again, the fourth barrier
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  that I see is really just around member
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  engagement. You know, behavior change is hard,
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  and some members might resist dietary changes, especially
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  if it feels like programs are prescriptive.
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  So that's why all of our programs really
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  try to reflect the insights from behavioral science
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  and our partners
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  to really understand what's gonna lead to behavior
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  change, which means making it culturally relevant, making
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  sure that our interventions are actionable,
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  that they're timely when someone's actually thinking about
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  it, but also that it's ongoing. It can't
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  just be one moment in time. We know
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  that behavior change takes time to really lead
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  to that lasting outcomes that we wanna see.
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  Absolutely. You you explained that really well, Colleen,
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  that this is a very complicated
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  issue. People don't change their behaviors very easily.
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  There's limited data on this, and then these
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  these programs don't necessarily fit into our current
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  reimbursement and claims
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  system. So
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  given all of that, where do you see
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  food based interventions fitting into a broader benefit
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  strategy
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  moving forward. You mentioned how to grow this
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  more into a mainstream offering in in more
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  commercial employer sponsored plans. What what does that
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  look like from your perspective? And is there
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  anything,
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  given some of these challenges that you laid
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  out for us, is there anything regulatory
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  or,
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  that the policymakers could be doing,
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  to really accelerate some adoption here? What what
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  are you seeing in this space?
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  Yeah. So I we really do believe that
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  food based interventions will become a core part
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  of addressing chronic conditions.
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  And in commercial plans, we've shown that it's
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  possible to offer these programs
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  through disease management pathways.
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  And
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  according to our data, we are seeing a
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  high demand. You know, nearly half of commercially
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  insured members
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  with uncontrolled type two diabetes
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  are screened positive for food insecurity,
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  and that more than half
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  consistently lack access to nutritious food that's needed
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  for help. So clearly, the demand is there.
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  Now I think on the solutions, we're starting
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  to see scalable solutions that make it easier
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  to really help address those needs.
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  So and and I think what you've seen
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  here is even though we've talked about some
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  of those challenges that are operational, financial, and
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  cultural, that we're seeing really effective solutions like
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  Feed Your Health programs that really are addressing
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  those head on.
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  And, you know, I think we're seeing policymakers
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  as really important partners at the table of
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  helping accelerate the adoption and support this. So
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  I actually think there's a lot of exciting
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  momentum around this space, and I think we'll
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  continue to see more. And especially,
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  I do think that we should see a
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  role that insurers have to really lead not
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  just by funding, but how do you actually
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  look at these systemic issues that might be
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  getting in the way, and how can we
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  remove those barriers from our side, how do
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  we build the infrastructure,
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  And, really, how do we work with policymakers,
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  community groups, and others to ensure that food
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  is medicine is really scalable
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  and that ultimately healthy food is just built
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  into the standard of care. And so I
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  think what we're gonna start to see over
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  the next few years is really what we're
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  doing right now at Blue Cross, which is
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  moving beyond pilots
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  to really building out these statewide and national
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  level ecosystems that really make food a core
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  part of treatment.
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  Certainly. And and what you just said, Colleen,
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  really does match with what we are seeing
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  nationally, what we're hearing daily from insurers that
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  they're putting the infrastructure in place now. The
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  momentum really is building. We hear about food
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  as medicine consistently now. And and it seems
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  like over these next few years, to your
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  point, this is something that is really going
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  to be continuing to take off. So it's
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  it's really wonderful to see, Blue Cross of
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  North Carolina,
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  leading the charge here. But I wonder you
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  know, you've got the ears of a lot
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  of other health plan leaders from all over
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  the country, some insurers
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  more further along than others in this kind
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  of, space.
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  What would be your final thoughts for them
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  or or final bits of advice as they
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  continue
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  on similar journeys?
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  Yeah. You know, our health care system really
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  excels at treating acute medical issues and managing
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  symptoms.
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  But I think what we're seeing is just
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  this opportunity for insurers, providers, employers, and communities
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  leaders to really come together and collaborate to
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  address some of the root causes of poor
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  health.
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  By investing in this kind of preventative full
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  person care, we can continue the shift from
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  just reactive treatment to really proactive wellness
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  and ultimately help the people we serve not
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  just get healthy, but really stay healthy.
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  And I think that's why you're seeing what
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  we're doing is trying to think really broadly,
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  not just how we help individuals make healthier
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  choices,
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  how we integrate
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  food into health care,
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  and, ultimately, how do you improve access to
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  nutritious food. So we're really trying to tackle
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  this from kind of a holistic,
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  multipronged strategy
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  called our health through food initiative because these
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  are all interconnected pieces. And if we do
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  it together, we can really start to move
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  the needle
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  and show how investing in nonmedical approaches
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  to preventing, treating, and managing chronic conditions
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  can ease the burden on our health care
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  system,
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  can lower costs for the plan, and for
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  the broader, you know, system that we all
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  operate in. But ultimately, most importantly, why we're
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  all in this business
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  is it can help the people that we
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  serve ultimately
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  enjoy healthier lives. So, again, I think there's
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  so much exciting opportunities to collaborate and work
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  together to really get to the root causes
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  of these issues and really start to move
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  the needle on not only improving health, but
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  ultimately driving affordability in the system.
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  Wonderful. Well, Colleen, I wanna thank you for
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  taking the time to sit down with us
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  and for sharing your insights about the important
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  work going on under your leadership at Blue
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  Cross. We really appreciate it. Thank you again
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  for including me.
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  And to our listeners, if you'd like to
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  listen to more podcasts from Becker's HealthCare, you
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  can visit beckershospitalreview.com.