Research has shown that those who are food insecure are also more likely to be affected by other non-medical drivers of health that contribute to worsened health outcomes. Barriers such as lack of access to safe and affordable housing, social isolation, and lower annual earnings, all contribute to the likelihood of having or developing chronic conditions, as well as having difficulty managing them. A lack of access to nutritious foods compounds these factors and leads to conditions such as obesity, high blood pressure, heart disease, and diabetes.

To treat these conditions, doctors often recommend making significant changes to one’s diet, which presents a further dilemma for those who are food insecure. Without adequate food access, condition management becomes an even bigger, if not impossible, struggle. In most cases, individuals without food security will have little success managing health conditions, and this can have catastrophic consequences.

Committed to improving health and lowering costs for its members, Blue Cross® and Blue Shield® of North Carolina (Blue Cross NC) has partnered with Pack Health to deliver an innovative, one-of-a-kind program that supports eligible members with type 2 diabetes who are also experiencing food insecurity. Blue Cross NC’s Lori Taylor serves as the program owner.  Pack Health CEO and founder Mazi Rasulnia and Blue Cross NC Vice President of Drivers of Health Strategy Dr. John Lumpkin spoke on how this collaboration is working to meet members’ needs, specifically those experiencing chronic conditions and food insecurity.

Q: Why has Blue Cross NC chosen food insecurity as a focus area?

A (Dr. Lumpkin): As part of our Drivers of Health strategy, we’re focusing on food security and other drivers of health, because we know that they make a big impact on our members’ overall health. Factors like access to adequate food, safe housing, and social support are really fundamental to good health.

Of these, food security is the most commonly reported unmet social need. Over the past year, the COVID-19 pandemic has made it even more difficult for many people to access the healthy food they need. At Blue Cross NC, we knew we needed to do something to reach out and help our members.

Q: Can you tell us about some of the ways you’re doing that?

A (Dr. Lumpkin): We’ve put several programs and services in place. For example, we’re offering a prescription-based food purchasing program to eligible members experiencing food insecurity and a post-discharge meal program available to Blue Medicare Advantage members. We’re also working with local community organizations to help connect members who may qualify to join the Supplemental Nutrition Assistance Program (SNAP), for example. We’ve also teamed with several great collaborators, like Pack Health. These coalitions have allowed us to reach our members in really unique and high-touch ways.

Q: Are you focusing these Drivers of Health programs and services on any other health targets?

A (Dr. Lumpkin): Yes, because we know that food insecurity makes it harder to manage chronic conditions, like diabetes and heart disease. For so many health conditions, your doctor may advise you to eat differently. But if you’re struggling to find enough to eat or having to make a tough choice between paying your bills this month or spending more at the grocery, that advice is hard to follow. With Pack Health, we’re focusing on collaboratively addressing food insecurity and type 2 diabetes.

Q: Could you share what is unique about the service from Pack Health?

A (Rasulnia): This has been a really powerful program to be involved in. When eligible members enroll in this program, they get healthy, condition-specific groceries delivered to their homes every two weeks. They also get paired with a personal Health Advisor, a health professional who connects with participants weekly, through phone calls, texts, and emails. We provide easy recipe ideas to help members learn new ways to prepare healthy meals, and their Health Advisor plays a key support role to check-in and help the member in a variety of ways.

Q: What are some of the ways the Health Advisors support members through the program?

A (Rasulnia): After each member is matched with their personal Health Advisor, they can expect the same person to reach out each week. After talking on a weekly basis, a real relationship is formed. With this relationship, we can learn about the specific challenges each member may be struggling with and what they need to better manage their health. We can connect them with needed resources, offer education, be a cheerleader – it’s really an extension of care into the member’s daily life, so we can help them be more compliant and sustain healthy habits. Most people living with chronic conditions know what they should be doing differently, but struggle to make that happen on their own. Ultimately, our goal with members is to drive them towards better self-management of their health.

At Pack Health, we’ve learned that to help people be successful with self-management, we have to get to the root of their barriers. Whether that’s motivation, or daily schedules, or social determinants of health, addressing what’s in your way is a key to changing behaviors.

Q: How does the program measure success? Are the metrics more around food insecurity, or diabetes management?

A (Dr. Lumpkin): The stories we’re hearing from our members are already demonstrating significant impacts in their lives. Members have told us they are better able to afford their medications, that they’re passing new knowledge on to family members and friends, and that they’ve tried new foods as a result of the program. One member shared that she was working on conquering her eating disorder, and every week her grocery delivery helps her incorporate new foods into her diet. She has expressed how great it feels to be supported.

These personal stories are important to us, but we are also conducting rigorous quantitative analysis that will help us evaluate the program. We’re gathering and analyzing data gathered from across our participant pool to help us measure vital outcomes. We’re looking to see if this program helps members establish habits for good health that actually stick and if these habits ultimately reduce the need for expensive medical interventions.

A (Rasulnia): Pack Health is measuring how the program affects food insecurity, diabetes management, and several other impacts, too. We’re gathering patient-reported outcomes at the beginning of the program and at 3-month intervals, looking at blood sugar control, weight, daily eating habits, medication adherence, food security, mental health, even utilization of health care services. We’ve already seen that food delivery has been an attractive feature for members and we’ve seen heightened engagement with this program in particular. Blue Cross NC’s program enrollment runs through the end of June and, based on the feedback we’ve received, we’re expecting strong outcomes.

A (Dr. Lumpkin): We can’t improve health without addressing food security and other non-medical drivers of health, and this collaboration represents an important effort to improve the health and well-being of members who face challenges trying to get food on the table. Our experience is showing that the positive impact of this work extends beyond the individuals who participate in this program. Drivers of health impact us all. A healthier North Carolina will reduce the strain on our healthcare system and reliance on emergency room visits. This will improve health and ultimately lower health care costs for everyone.

BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association.  Pack Health is an independent company providing chronic condition care services on behalf of Blue Cross NC.