Q&A with Andrea Feinberg, medical director of health and wellness, Geisinger, and program champion for the Fresh Food Pharmacy.

Andrea Feinberg

AMGA: How did you conceive of the Fresh Food Pharmacy?

Feinberg: Geisinger’s focus on population health and using our community health needs assessments has led us to an understanding of the challenges that some of our patients face. Diabetes management begins with a proper diet and exercise plan— if our patients cannot obtain healthy, safe and nutritious foods, their diabetes outcomes will be compromised.  Geisinger’s focus on the individual as well as the population has led us to addressing food insecurity and health care disparities in communities at high risk for diabetes. Many of our patients are food insecure, and it seems like an insurmountable task for an individual with diabetes to manage their disease if they are watching every dollar and are deciding between paying for food, housing, health care or other essential items. With limited food dollars, our patients are often faced with difficult decisions leading them to spend on inexpensive, nutrition-poor foods. With our patients’ increasing need for emergency food services, the Fresh Food Pharmacy was developed to deliver the gold standard of diabetes care in conjunction with providing healthy food in a sensitive, caring and respectful manner.  Geisinger’s Medical Home model at the Fresh Food Pharmacy now serves to meet the medical needs of our patients with diabetes having sugars out of control and to close the meal gap.

AMGA: How do you screen for food insecurity?

Feinberg: We began in Northumberland County and used our Electronic Medical Record to identify patients with sugars out of control typified by HBA1C > 8, and then screened our patients with a two-question questionnaire for food insecurity. If a patient answered affirmatively, they were referred to the program.

AMGA: How does the program work?

Feinberg: After identifying the patients by HBA1C and food insecurity, the patients were referred to the other team members, including an RN health manager, pharmacist, nutritionist, and a health and wellness coach who teaches a Diabetes Self-Management class.  Then, each week, the patient picks up fresh groceries along with menus and recipes for the week based on items consistent with American Diabetes Association guidelines. We provide enough food for the patient and the entire household for five days a week. The Central Pennsylvania Food Bank has been a key partner and instrumental in the sourcing and provision of diabetes-appropriate food including fresh fruits, vegetables, lean proteins and whole grains.

A key component of this medical home is that the RN health manager, physician, pharmacist, nutritionist and community health worker all work closely together to assist our patients with education and support while monitoring the patient’s condition and their changing medication needs. Free diabetes wellness classes, dietary consultation, and workshops address healthy eating, and diabetes challenges.

AMGA: What are the outcomes of this program?

Feinberg: Our outcomes have exceeded our expectations. This patient population was disengaged and historically had poorly controlled diabetes. By participating in our classes, the patients realized they weren’t alone, and the challenges they faced were faced by many others. By providing the food free of charge, the stress of food insecurity was lifted from the patients and their household members, which seemingly has had a positive psychosocial effect. Blood sugar control has been remarkable with an average drop in HBA1C by 2 points or 20%. Patients have also noted drops in weight and cholesterol, and improvements in their mood.

Based on these initial encouraging results, we are expanding the program to other challenged communities in Pennsylvania and New Jersey. We believe, by providing patients with key tools for success including diabetes education and healthy food, we are designing a new health care model by removing obstacles and caring for patients the way they need to be cared for.