A clinical-community partnership to understand health impacts of a food insecurity intervention

Project Summary Food insecurity exacts a devastating toll on U.S. families and reflects a long history of structural injustices. Experiences of food insecurity are associated with higher rates of chronic disease, greater health care costs and higher acute health care utilization compared to food secure populations. To address food insecurity and

reduce health disparities, there has been a rapid increase in health care-based delivery of food insecurity interventions. However, evidence demonstrating impacts of food interventions to improve health outcomes remains mixed. Most existing food interventions act downstream, solely at the individual level, and focus on

delivering food as treatment rather than prevention. There is an urgent need to identify more holistic, patient- centered food insecurity interventions, and understand their effectiveness in improving health across diverse populations. This proposal leverages a strong clinical-community partnership that was formed under a

Massachusetts Medicaid (MassHealth) 1115 waiver demonstration to encourage clinical-community collaboration to identify and address food insecurity as part of value-based care. Under the MassHealth demonstration, community based organizations (CBOs) design the food insecurity interventions, which are

implemented in partnership with health care organizations. There is growing interest in not only understanding impacts of state-incentivized food interventions on health, but how to sustain the program and refine program implementation to achieve the greatest benefit for the largest number of participants. Given the natural

experiment in food intervention delivery unfolding across Massachusetts, we propose a hybrid implementation and effectiveness evaluation of a multi-component nutrition program developed as a clinical-community partnership. Aim 1: Quantify the effects of a multi-component food insecurity intervention on clinical outcomes

among Medicaid enrollees with diabetes, hypertension and depression receiving care at a large federally qualified health center. Using a quasi-experimental difference-in-difference design we will compare health outcomes between participants and two separate propensity weighted comparators. Aim 2: Evaluate the

impacts of a multi-component food insecurity intervention on (a) cost and (b) health care utilization among adult and children Medicaid enrollees receiving care at a federally qualified health center. Using administrative claims data, we will compare changes in total cost of care and acute health care utilization (ED visits, inpatient

hospitalization days) between participants and propensity weighted comparators. Aim 3: Using the I-PARIHS implementation framework, identify determinants of implementing a food insecurity intervention for scaling and sustainment.