Blue Cross NC, UNC Health team on study to improve food security, chronic health

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There are numerous issues that can cause food insecurity, ranging from high medical costs to social isolation, and one major insurer has set aside funding for a large-scale clinical study it hopes will help to address food insecurity among its at-risk members.

Blue Cross and Blue Shield of North Carolina has dedicated $3.2 million for the study, which will focus on members who also have hypertension. The study will measure how to best help people who are food insecure achieve better health through nutrition. 

UNC-Chapel Hill researchers are leading the study, in conjunction with the UNC Health Alliance, UNC Health's statewide, clinically integrated physician network and population health services organization. Blue Cross NC, utilizing support of its data scientists and analysts, is collaborating as a co-principal investigator of the study.

According to study co-leader Dr. Darren DeWalt, a practicing primary care doctor with UNC Health and director of the UNC Institute for Healthcare Quality Improvement at the UNC School of Medicine, the immediate goal is to find interventions to assist plan members who are both food insecure and have high blood pressure. Overall, he said, the aim is to "create and sustain research-backed, nutrition-based interventions for anyone dealing with food insecurity."

Study co-leaders are Dr. Alice Ammerman, the Mildred Kaufman Distinguished Professor of Nutrition at the UNC Gillings School of Global Public Health and director of the UNC Center for Health Promotion and Disease Prevention, and Dr. Seth Berkowitz, assistant professor in the UNC Department of Medicine and member of the UNC Cecil G. Sheps Center for Health Services Research. DeWalt is also the John R. and Helen B. Chambliss Distinguished Professor of Medicine, as well as division chief of General Medicine and Clinical Epidemiology.

WHAT'S THE IMPACT?

Many families across the country struggle with affordable housing, social isolation, low wages, health problems, high medical costs and other issues that can cause food insecurity. Individuals or households that are food insecure have insufficient or uncertain access to enough food for an active, healthy life.

Food insecurity affects more than 35 million people in the U.S., including more than 10 million children, according to Blue Cross NC data. In North Carolina, 1.6 million people are food insecure, including one in five children.

The research team will enroll 1,400 eligible Blue Cross NC members with hypertension who are also experiencing food insecurity. Recruitment for the study is set to begin in the fall of this year through the end of 2023, with results expected in 2024.

Based on screening questions around access to nutritious, sufficient food, each participant in the study will receive an intervention. One group of individuals will receive a $40 grocery store voucher each month to use towards fresh, frozen or shelf-stable produce. A second group will receive a box of healthful, affordable foods delivered to them twice a month, with foods such as seasonal vegetables from North Carolina farms, grains, healthful oils, nuts and the like.

To test how lifestyle support helps individuals develop healthy habits, half of the participants from each group will also receive educational materials, including samples, demonstrations and video instruction on how to prepare meals, and they'll receive direct assistance from UNC Health Alliance community health workers and registered dietitians, who will help participants understand dietary guidelines, prepare healthy meals, find affordable nutritious foods near them and identify resources to aid them in other aspects of life that contribute to food insecurity. 

Lifestyle support from the UNC Health Alliance staff will be offered for six months for one set of participants, and 12 months for the other set. The trained staff members and other providers will continue to help participants after the study is complete.

Blue Cross NC members who receive care from practices affiliated with UNC Health are eligible for the study. The research team will be enrolling only individuals with a diagnosis of high blood pressure and who have screened positive for food insecurity.

THE LARGER TREND

A Centers for Disease Control and Prevention study published in 2019 showed that food insecurity costs the U.S. health system an additional $53 billion per year.

Food insecurity can lead to diabetes, heart disease and other chronic conditions, all of which are costly to health and the healthcare system.

Hospitals, insurers and organizations nationwide have launched food insecurity, housing and other social determinants of health initiatives. When Montifiore in New York City invested in housing the homeless, it realized a 300% return on investment from savings, such as fewer emergency room visits.

ON THE RECORD

"This collaboration with UNC Health is the latest step in our ongoing commitment to improve health outcomes by addressing nonmedical drivers of health, which include access to food, transportation, shelter and social connection, among other things," said Dr. John Lumpkin, vice president of Drivers of Health Strategy at Blue Cross NC. "Our hope is that the findings from this study are instrumental in advancing the use of nutritious food as medicine to treat chronic conditions and improve overall health."

"We've designed the study to help provide healthy, inexpensive, and easy-to-make meals based on the Mediterranean Diet, adapted for southeastern taste preferences," Ammerman said. "Our aim is long-term sustainability for everyone enrolled in the study and to translate our findings to inform health care providers and insurance companies how to best care for people who are at risk for chronic disease and who experience food insecurity."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com