Can Food Delivery and Digital Health Coaching Help Bridge the Gaps for Food-Insecure Individuals with Type 2 Diabetes?


Results from a program offered by Pack Health, a Quest Diagnostics company, suggest that the answer is very much 'yes.' Participants in the program who completed it saw a reduction of $139 per member per month (PMPM) in total medical costs.

Daniel Marks of Quest Diagnostics shares findings that show a food delivery program that includes digital coaching may be a very effective way to help people manage type 2 diabetes.

Daniel Marks of Quest Diagnostics shares findings that show a food delivery program that includes digital coaching may be a very effective way to help people manage type 2 diabetes.

Everyone knows the saying “an ounce of prevention is worth a pound of cure. Although that quote was originally about at fire prevention, it has been used for so many issues in healthcare. And we talk about it a lot: getting to the root of the issue, meeting people where they are and treating the whole person. All of this is done with the best intentions, but in many cases, programs designed to prevent still fall short.

Why is this? In some cases, programs may just not be the right fit. But in others, we’re missing crucial elements of the picture.

Let’s take diabetes, for example. The Centers for Disease Control and Prevention suggests the number one way to manage diabetes is to “make and eat healthy foods.” Other suggestions are to exercise, manage stress and take medications as prescribed.

Sounds doable, right? Well, let’s imagine another situation, one that many of us are familiar with. Imagine you come home after a long day of work. You didn’t eat lunch because there wasn’t anything in the fridge to bring.You had to get a $1 drive-through breakfast sandwich this morning for the same reason. As the day dragged on, it became hard to focus on work with your stomach growling. You start feeling more and more lethargic because of the lack of calories. By the time you get home, your head hurts and you’re irritable. You can’t think of much else besides getting something in your stomach.

Can you imagine feeling like that all the time?

Can you imagine feeling like that, and then being told to go for a run or to manage your stress?

Absolutely not.

If we don’t have our basic needs met, we are going to instinctively focus on attaining them. Exercise, stress management, and every other positive health behavior will go out the window.

What can be done?

I read a quote recently that said, “food insecurity isn’t just a hunger issue, it’s a nutrition issue.”When we address food insecurity with a mindset beyond just providing food, we can make a larger impact by simply providing dedicated programming to combat everything that comes with food insecurity, such as stress and higher rates of chronic conditions.

Dedicating more time, more focus, and more money to easing the impact of food insecurity can enable individuals to prioritize their overall health needs.

While simple food supplement options have been the way to go in the past, they have only primarily addressed food insecurity directly, and little more. These solutions, while successful in providing access to nutritious food, were limited in investigating how they are impacting healthcare spending and chronic condition management as a whole.

Pack Health success

For health plans to try to tackle the complex issue of food insecurity and its overall impact and consequences, it takes another step, but the outcomes are worth it. Let’s look at Pack Health’s Better Food for Better Health (BFBH) to demonstrate.

Our food insecurity solution combines biweekly food box delivery, food security screenings and digital health coaching into an in-depth, but practical, program for those experiencing food insecurity. BFBH presents a valuable opportunity for health plans, health systems, and employers to support vulnerable populations experiencing food insecurity.

To test the feasibility of our solution, we worked with Blue Cross and Blue Shield of North Carolina to conduct a six-month pilot study aimed at testing whether a combination of digital health coaching and biweekly food box delivery services could impact how members with type 2 diabetes manage their chronic disease and lower their healthcare spending.

Participants were matched with a health advisor who provided them with consistent accountability and social support in accomplishing their health goals throughout the pilot. Members' diagnostic data and level of food security were evaluated to determine their eligibility to receive food box deliveries. Some of the patient-reported outcome measures assessed at baseline, three months, and six months included diabetes distress score, hemoglobin A1c (HbA1c), and level of food security. To understand the financial impact of the pilot, medical costs incurred by participants were also examined during and after the six-month intervention.

Initial results from the pilot were presented at the 82nd American Diabetes Association (ADA) Scientific Sessions in 2022. They showed significant changes in health outcomes from baseline to month 3. Halfway through the pilot, the average diabetes distress score decreased by 31% and the average food security score had improved by 53%.

That’s right, in three months, food insecurity had been more than halved.

With such impressive results, we were excited to see the full impact at the completion of the pilot on how our participants engaged with the solution and transformed how they manage their condition without the restriction of food insecurity.

Final study results were recently reported in the New England Journal of Medicine Catalyst Innovations in Care Delivery, demonstrating significant improvements in participant engagement, satisfaction, outcomes, and health costs from baseline to month 6.

Only 19% of participants who completed the program reported food insecurity, compared with 42% at baseline. Not only did food insecurity decrease, but improved controlled diabetes increased: 87% of participants who completed the program that reported controlled diabetes at baseline reported HbA1c levels less than 6.5%. Plus, participants who completed the program saw a reduction of $139 per member per month in total medical costs.

These results have the potential to become the standard of care, but we have to cut through the status quo to see the vision and value. Initiatives like these are operationalizing what it means to be truly innovative in healthcare. It’s so easy to get bogged down in the upfront financial investment and forget what we’re here to do: help people achieve better health.

Let’s imagine a new scenario: you have food in your fridge, so you’re able to eat. You don’t forgo picking up your insulin at the pharmacy because you’d rather spend that money on food. You’re able to take a walk after work because you’re not so depleted of energy. It’s not always easy to make that choice, but it’s a lot more likely when your mind isn’t laser focused on your next meal. Healthy behaviors actually feel like they’re in reach now.

And the best part? This scenario is totally possible. And health plans can be a big part in making that happen.

Daniel Marks is the Senior Director of Commercial, Health Plans in the Diagnostics Services Division of Quest Diagnostics. Upon coming to Quest in 2017, he held the role of Senior Director of Health Plans for the Great Midwest before being promoted to Senior Director of Health Plans at Pack Health, a new acquisition of Quest Diagnostics.

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