Obamacare: a prescription for farmers markets?

Oct 18, 2013

Gus Schumacher sees farmers markets playing a role in making the Affordable Care Act (ACA), also known as “Obamacare,” work.

According to Schumacher, the health care reform act could bring additional consumers to farmers markets because of new demands to promote healthier communities.

“Our objective is that some of that money should go to our farmers to provide health with food as medicine—farmers as pharmacies—to help improve the health of people who are diabetic or obese,” he explained.

Schumacher is co-founder of Wholesome Wave, a Connecticut-based group that develops programs to help provide more fruits and vegetables in underserved communities. Schumacher’s work on Wholesome Wave’s doublevalue program helped him win a James Beard Foundation visionary award last month for helping create a healthier food supply.

Schumacher’s role in agricultural policy runs deep. He served as a USDA undersecretary for Farm & Foreign Agricultural Services in the latter part of the Clinton administration.

Wholesome Wave created and promotes double-value purchasing at farmers markets. As many as 2,500 farmers markets participate in such a program that generally matches any amount spent for fruits and vegetables by people enrolled in various state food aid or welfare programs.

The double-value program has been successful enough that it is one of the few new nutrition programs that could receive new funds in the farm bill. Tied to other USDA nutrition programs, the Senate bill provides $25 million for the farmers market double-value program. The House version includes $5 million as of publishing.

Wholesome Wave and others have taken the idea of double value for fresh produce and transformed it to promote health and wellness. Better nutritional programs not only help community wellness, but also direct sales to local farmers and orchards. The idea is that hospitals or doctors prescribe fruits and vegetables. A $50-per-month prescription, coupled with a program that doubles the sale value, could lead to an undernourished family buying up to $1,200 in local fruits and vegetables.

“I want farmers to be the pharmacies to help provide healthcare for us,” Schumacher said.

Under the ACA, hospitals with a high percentage of readmissions risk receiving lower Medicare reimbursements. Hospitals will be motivated to find ways to keep their communities healthier. That means looking at more ways to target the dangers of chronic health issues associated with heart disease, obesity or diabetes.

Schumacher doesn’t see small potatoes in veggie prescriptions. Based on potential savings and how well Obamacare works, there is a market of up to $5 billion a year because of the tax implications alone. More people insured and fewer unpaid hospital stays may translate into more hospitals looking for avenues to offset income because of their non profit status.

Also, the ACA requires nonprofit hospitals to conduct a “community health needs assessment” every three years to keep their tax-exempt status. The hospitals have to look at needs not being met. Health challenges such as infant nutrition, diabetes and obesity levels are certainly areas where improvements could be targeted, Schumacher said.

Hospitals see this as a way of providing health and wellness, as well as a way to document health and wellness through medical visits and prescriptions. Schumacher said more hospitals, particularly in the Northeast, have developed farmer marketing programs.

“All of a sudden we are getting all kinds of calls from around the country to do more of these,” Schumacher said.

Improving community health could translate into providing healthier food to vulnerable or underserved populations. Hospitals also can meet community benefit standards through financial or in-kind support to programs that improve public health. Some hospitals that filed their community benefit reports earlier this year listed their relationship with a Community Supported Agriculture (CSA) group.

One hospital in Massachusetts stated it sponsors a CSA “to provide improved access to fresh fruits and vegetables to promote healthy eating and support local businesses. There was an effort to encourage individuals to collectively participate by splitting both the food and the cost of the food. This has been well received by those that participated, and we expect to offer this again next year.”

Wholesome Wave has created veggie prescription programs so far in Maine, Massachusetts, New Mexico, New York, Rhode Island and the District of Columbia. In some states, insurers also have created similar reimbursement programs for farmers markets and CSAs.

On average, the prescription for fruit and vegetable participants show a 38 percent improvement in their body mass index after 20 weeks on the program. Some people saw higher than 50 percent improvement.

In Washington, the group DC Greens has worked for the past two years as a liaison between a handful of farmers markets using the program. Lauren Shweder Biel, executive director of DC Greens, said the program there so far has targeted childhood obesity. More than half the participants have seen declines in body mass index and nearly 70 percent of them are keeping their monthly appointments with primary care physicians. The program will provide a family $1 a day for every family member to buy produce at a farmers market. That would be $28 a week for a family of four.

“It’s like we are giving people a literal carrot to go to their doctor,” Shweder Biel said. She added, “It’s a simple, but elegant, way to work on preventive health. When you compare the cost to dialysis, it’s a whole lot cheaper.”

Dr. Mike Lambke, a family doctor who also works on pediatric obesity in Skowhegan, ME, said his hospital and practice began writing prescriptions for produce four years ago. It became part of a program formed through talks with farmers, community residents and physicians looking for ways to cope with rural obesity issues. At first, the hospital targeted women who were pregnant. For medical professionals, it forced them to think more about preventive care through better nutrition.

“Physicians aren’t very motivated to talk to patients about nutrition, but that is changing,” Lambke said. “It is a real shift for physicians to think (about) prescribing a fruit or veggie.”

The prescriptions, however, were also a way to get the women to return for follow-up visits. The doctors saw a higher percentage of repeat visits and more people shifting diets. Then Lambke and others turned their attention to dia betics,

as well. Monthly visits for a group of diabetics became part of group classes focused on healthier lives. So many people are unfamiliar with old-fashioned cooking methods for some vegetables, so cooking, canning and freezing produce became part of the class. Lambke now has about 35 people in the class, he said.

The ACA moves from simple reimbursement for services to payments for outcomes. For rural areas, more than 1,800 critical care hospitals are exempt from some of the provisions of the ACA, but major insurers nationally are expecting all medical providers to adopt many of the ACA requirements. Rural hospitals will be searching for ways to better build their physician networks and patient relationships.

“Veggie prescriptions definitely fit into the whole preventive care aspect,” Lambke said. “I think we’re all going to have to be thinking about this. It doesnt take too much in terms of resources, but you have to figure out what resources you can depend on.” — Chris Clayton, DTN