Written by Erin Yeh
At the Food as Medicine Summit in Chicago last week, Callie Means, senior adviser to the White House Health and Human Services, and Stephanie Carlton, deputy director and chief of staff at CMS, participated in a keynote interview to discuss how the federal government can make changes and develop plans to continue its food as medicine efforts.
Their conversation was moderated by Scott Bowman, co-founder of the NOURISH movement and Clareo board member, and explored the call to action to push for nutrition interventions, the latest government advances, and empowering Americans to make their own decisions.
The sickest country in the developed world
Means shared some statistics from former FDA Commissioner Marty McCurry: 48% of tax dollars are spent on health care. In addition, the United States spends 3 to 4 times more per capita on health care, and life expectancy is six years lower than other European countries. Americans also have the highest rates of obesity, diabetes, childhood cancer, and autoimmune diseases of any society in human history.
“We have an unsustainable system that no one likes,” Means said. “We have a system that basically waits for you to get sick and then manages that condition once you get sick with interventions.”
The means emphasized to the public that food as medicine should be pushed as a legitimate treatment, and not as an additional or complementary option. However, he stressed that changing the conversation in medicine and the nation about the relationship between food and health will be a 10-year process and a cultural challenge.
Carlton added that the country is going through a period of distrust towards the government and large institutions. There must be a focus on empowering individuals with the truth so they can take better control of their health and take care of it.
Clinical guide
As stated during Main opening panelGovernment partners need financial and health outcomes data to justify expansion of food-as-medicine programs and drive change.
“We need to have more confidence in food as an area of medicine to consider it as a major clinical intervention,” Means said.
The media encouraged the public to “strongly prove effectiveness, prove better results, prove lower cost” by promoting food as medicine, regardless of the rules or incentives of the current system.
Data-driven findings have already influenced some changes. Carlton reports that there have been updates to the dietary guidelines that reflect the latest evidence on how food as medicine affects health. There is also an incentive for states to get higher funding awards if they take bold actions, such as eliminating sugary drinks from SNAP exemptions.
Other changes implemented by CMS include launching a pledge for hospitals to change the food they serve in their facilities to be compliant with the new dietary guidelines, with the president of the American Hospital Association signing the pledge. CMS also launched MAHA Elevate to prepare a method for building an evidence basis for food as a drug, which is needed for coverage decisions in Medicare.
Carlton also explained Medicare plans based on these new dietary guidelines. First, every elderly person is entitled to an annual health visit that includes a nutrition questionnaire, but there have been no changes or actions on the part of doctors to talk about proper nutrition and food. The Content Management System (CMS) is working on adjusting this. Second, Medicare Advantage gives supplemental benefits, but these have been used for gift certificates to fast food restaurants. CMS has established requirements that healthy food be required to obtain supplement benefits.
For too long, there has been too much focus on predictive risk, price risk, and then prior authorization to manage costs, Carlton said. “But it has to be related to where the evidence is and the clinical case of what can move the needle.”
Accessibility and transparency
Not all government programs, including the HSA and FSA, are available to every American. So, what is being done to provide access and tax-free ways to take care of their health?
Common means that the plan now is to push health care spending toward the root causes, and this can be achieved by giving patients more control over their money. He dismantled the flaws of the current system, whereby it “waits until you get sick” and then makes interventions that manage conditions rather than getting to the root cause. By promoting transparency for consumers and thus empowering patients with their own money, it can provide them the ability to “shop” for their medical resources and treatments.
“The key is to provide consumers and patients with more flexibility,” Means explained.
Cooperation with major companies
One of the biggest achievements this year was auditing where the government buys food. There are also pilot programs and getting money for pilot programs to show how improving school meals, military meals, and hospital foods leads to better outcomes. Means also mentioned that big food giants, like Sysco and Aramark, have huge initiatives to work with small businesses. “We hope there is a market opportunity and the ability to make a difference there.”
In 2033
Means and Carlton expressed hope for a better American health system and more health awareness among Americans after two more administrations.
Methods discussed more patient empowerment, as well as more personalized, patient-centered health care that provides Americans with their own insights into their health. He also wants to see a change in insurance incentives to prioritize health as much as possible. Carlton hopes to see the obesity rate cut in half and children’s physical fitness improve, as well as increased longevity and improved daily habits among Americans.
