Geisinger gets Type 2 diabetes costs under control

Fresh Food Farmacy in Scranton, Pennsylvania, is among three grocery stores piloted by Geisinger for health plan members living with diabetes.

Photo: Courtesy of Geisinger

Geisinger, an integrated health system of over three million patients in the central, northeastern section of  Pennsylvania, had a problem faced by hospitals and patients nationwide: Type 2 diabetes.

The total estimated cost of diagnosed diabetes in 2017 was $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity,  according to the American Diabetes Association. Inpatient care represented the largest component of medical expenditures, at 30% of the total medical cost.

"It was a number one issue from a healthcare cost standpoint," said Allison Hess, vice president of Health Innovations at Geisinger.

Four years ago, Geisinger took on diabetes reversal through grants, philanthropy and executive buy-in by piloting Fresh Food Farmacy in three locations identified as having both a high population of Type 2 diabetes patients and families who were food insecure. 

The program offers free, nutritious food, not just for patients, but for their families at brick-and-mortar grocery stores in Shamokin, Scranton and Lewistown, Pennsylvania. The food "prescription" provides enough food to make 10 meals per week. The stores are on hospital campuses or near them.

"It's like coming to a grocery store," Hess said. "They can come in and select. We also wrap that around healthcare services." This includes connections to clinicians and an evidenced-based, six-week class that meets one day a week. The program currently serves an estimated 667 participants, plus their household members, in semi-urban and rural Pennsylvania. 

Four years later, metrics have shown a drop in A1C levels, ER and medication use.

Geisinger's work to address the social determinants of health was already well underway before COVID-19, but the pandemic heightened the need to connect patients to community services through a platform called NeighborlyPA.

In March 2020, just as the pandemic was ramping up, Geisinger initiated an EHR-connected platform to identify patients with unmet social needs and tie that information into its Epic system. "It's a closed-loop referral," Hess said. "We can track that to understand if needs are being met. We saw some increased traction over the last two years."

The latest effort is digital support through a partnership with Season Health, a digital food pharmacy that offers dietician-approved, chef-designed recipes. It can also provide patients with a digital shopping list. Geisinger wanted a way to stay connected to patients outside of routine appointments, Hess said.

Beginning this year, Geisinger will enroll Geisinger Health Plan members living with diabetes into Season's Digital Food Farmacy program. Season and Geisinger will expand the geographic reach of this program and to multiple clinical conditions using Season's technology platform and virtual registered dietitians. 

The health system is also looking to expand its health food program via partnerships. Many available grants require a healthcare partner as part of the funding requirement, Hess said. Geisinger can provide administrative oversight.

"Our next phase, we want to partner with existing community-based organizations to help them procure healthier options and then be the food distribution resource," Hess said.

WHY THIS MATTERS

Diabetes reversal results through Fresh Food Farmacy are impressive. One key performance indicator is for hemoglobin A1C, a test that measures average blood sugar levels. Patients in the program have seen an average 2.4% reduction in their A1C, according to Hess. Most programs tout success for a 1% reduction.

Some patients are able to decrease their medications and even come off medications. There have been patient reductions in weight, LDL, or the "bad" cholesterol number and triglycerides, or body fat.

Feeling better about their overall health, patients have become more engaged, with some smokers voicing a desire to quit, she said.

The health system has realized a 27% decrease in emergency department use. Other savings results await data on the enrolled patients through a Geisinger and Massachusetts Institute of Technology study.

The focus is on getting healthcare and wellness closer to home, which is something all health systems are thinking about, Hess said.

"Health systems can't solve for all of this," Hess said, referring to the many factors that make up the social determinants of health. But there will continue to be programs to address the factors that affect both the health of the individual and the health system.

"There is going to be innovation in this space," she said. 

THE LARGER TREND

Since the food program began, Geisinger has provided 1.8 million pounds of food and distributed 1.5 million meals. Because the program includes family members, about 1,500 lives have been impacted, Hess said.

COVID-19 proved challenging, so getting food to patients quickly converted to a drop-off and curbside-pickup approach.

Because the pandemic created more food insecure families, emergency food boxes were also made available to individuals outside of the program, including those who were not part of the Geisinger system.

Type 2 diabetes reversal has also been the focus of a Banner|Aetna partnership with Virta Health on a Type 2 diabetes reversal program.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org