Health Center Food Programs

In Vermont and New Hampshire, Federally Qualified Health Centers (FQHCs) are implementing “Food as Medicine” programs, bridging the gap between healthcare and nutrition. By collaborating with local farms and food programs, FQHCs are addressing food insecurity while promoting healthier lifestyles for patients. These centers are prescribing “produce prescriptions,” offering nutritional education, and providing access to wholesome food as part of a broader effort to improve health outcomes, particularly for those with chronic illnesses. This approach reflects Vermont’s innovative commitment to fostering a healthier, more food-secure population.

HRHI Webinar

The webinar titled “Food Access and Health Care Integration,” part of the VRHA Training Series, discusses the growing intersection of food access and health care. Presenters from Vermont FQHCs emphasize the importance of addressing food insecurity through health interventions like produce prescriptions and food pharmacies, highlighting successful case studies and practical strategies for health care providers to integrate these services into patient care. This discusses the critical role of food and dietary intervention in promoting health and managing illness/chronic conditions.

Watch the full webinar here: Food Access and Health Care Integration

NACHC Webinar

The social Drivers of Health (SDOH) Team at the National Association of Community Health Centers (NACHC) presented a webinar on: Cultivating Gardening and Farming Programs at Community Health Centers to Address Food and Nutritional Insecurity. A recording of the webinar can be found here: YouTube channel .

Health Center Highlights

BVHC

Works with a number of community partners such as the Hannah’s Pantry, Veggie Van Go, Grateful Hearts and the Arlington Food Shelf to increase access to fresh fruits and vegetables and pantry staples for patients who are lacking reliable access to sufficient food.

LHP

Screens patients for food insecurity and partners with Meals on Wheels, Moms Meals and Instacart to have foods that support heart health delivered to those who qualify. LHP offers cooking classes.

LRHC

Screens patients using the Hunger Vital Signs tool upon check in via an iPad. If a patient screens positive and is at risk for cardiovascular disease, LRHC refers that patient to their Food Farmacy program. The Food Farmacy offers qualifying patients food boxes that are tailored to the prevention and mitigation of chronic health conditions. The Food Farmacy is supported by Willing Hands, a local gleaning farm and the Vermont Food Bank. LRHC offers a CSA to participating patients during the summer months in partnership with Root 5 Farm.

NOTCH

Operates a a non-profit social grocery store in Richford, Vermont to ensure access to fresh, nutritious foods are available to residents of this remote, rural community. For patients who screen positive for food insecurity and are at risk for a chronic health condition, they partner with Healthy Roots Collaborative to offer a seasonal produce prescription CSA program which delivers fresh fruits and vegetables to patients across Franklin and Grand Isle counties. Additionally, a small fresh produce pantry can be found in the NOTCH clinic waiting rooms, and cooking and nutrition education classes are offered at the Richford Health Center and community partner sites across the region. NOTCH has also been involved in projects related to grocery retail based produce prescription modeling.

ACHS

Focuses on addressing diabetes, hypertension and substance use disorders for patients in rural communities, through food security and transportation. Food security is addressed through a Portable Teaching Kitchen initiative that educates participants on creating healthy, affordable meals using local resources in under 30 minutes. The program partners with local stores, farms, food pantries, and other community resources to enhance participants’ cooking skills and nutrition awareness. A transportation solution connects riders with trusted drivers to access health care, food, and other daily necessities. It uses a neighbor-to-neighbor model supported by community health workers to foster trust and logistical support.

Tips and Tricks for Starting a Produce Prescription Program

A Produce Prescription Program is a health initiative that provides patients, especially those with diet-related chronic conditions, with prescriptions or vouchers to purchase fresh fruits and vegetables, most commonly through a Community-Supported Agriculture (CSA) share. These programs are typically designed to improve access to healthy food, promote better dietary habits in order to enhance health outcomes. Implementing a produce prescription program in a Federally Qualified Health Center (FQHC) involves several key steps to ensure the program is successful, sustainable and consistent with the mission of FQHC’s to improve health outcomes and support vulnerable populations regardless of ability to pay.

Plan to Plan

Implementing a produce prescription program or a medically tailored meal program is going to require extensive planning time. There are many considerations that must be discussed, partnerships to be explored and short and long-term goals put into writing. Below are few questions to think about to get started.

1. What are your short- and long-term goals? What impact do you ultimately want to make?
a. Creating a mission, vision and strategic purpose may be helpful in guiding this work moving forward.

2. Who is the initial planning team?
a. A team may be small to start, but including a variety of team players will be the key to success. Is there a provider champion involved? Registered Dietitian? A program coordinator to oversee the logistics? Technology support? Community Health Worker (CHW)?
b. Do any job descriptions need to be developed or revised?
c. Establish frequent times to meet in the initial stages of building the program.

3. Who do you want to reach with your program?
a. Which communities will you be impacting? What rural considerations should you be thinking about? Is there someone with lived experience you could consult with? Is there a target population such as older adults, or people who screen positive for food insecurity?

4. What is already being done in the community and what is the need you are targeting?
a. Are you planning to expand upon a program? Or reach new participants?

5. What external partners will you be working with?
a. Farmers, local organizations such as faith-based organizations or others such Meals on Wheels?

6. Would MOUs, MOAs, or BAAs be helpful in securing any partnerships? If likely, consider having a template already made.

7. What is the referral process going to look like for your program?

8. Is there funding available for your program?

Assess Community Needs

Conduct a community needs assessment to determine the prevalence of diet-related chronic conditions, food insecurity, and other barriers to healthy food access. This can be done in a variety of ways, such as surveys, focus groups, 1:1 interview, and looking at SDoH data, such as race, ethnicity, disability status, employment income, sexual orientation and identity, education level, language needs etc.
Engage patients and staff to understand their needs and potential interest in a produce prescription program.

Form Partnerships

Partner with organizations that can support your program, such as local farms, food network programs, farmers markets, and food retailers to provide fresh, locally grown produce to participants. Building strong relationships with community food providers is essential for success.

Collaborate with state or local public health agencies and other relevant organizations (e.g., food banks, public health departments) to secure resources and guidance.

Design the Program

Identify patient eligibility criteria, such as those with chronic conditions like diabetes, hypertension, or obesity, or those facing food insecurity. Consider how your Electronic Medical Record (EMR) can be used to identify potentially eligible patients.

Determine the scope of the prescriptions (e.g., vouchers, direct access to produce, CSA shares) and how patients will redeem them. This may require evaluating the Electronic Medical Record (EMR) platform for program enrollment and documentation. Technology support for including this in the workflow may needed. Determine the monetary value of the offerings and track them. Become familiar with any local or federal laws that pertain to offering these types of programs to patients, to ensure compliance.

Establish a workflow for clinicians to screen for food insecurity and prescribe produce during medical visits. How often will these screenings take place, and at which visits? Consider conducting other screens as well, such as for transportation
needs, nutritional needs, depression, and other screenings relevant to the person’s situation. Determine and evaluate what appropriate referrals should take place as a result of a positive screen, such as referral to a nutritionist, CHW, transportation assistance, housing assistance, etc. • Integrate nutrition education into the program offering cooking classes or consultations with a dietitian to ensure patients know how to use the produce effectively.

Integrate nutrition education into the program offering cooking classes or consultations with a dietitian to ensure patients know how to use the produce effectively.

Consider how you will track patient enrollment which may be in your EMR or a separate database. What information will you need in the short term and long term?

Secure Funding

Develop Infrastructure

Create systems for distributing produce and tracking prescription use. This could involve vouchers or electronic systems for redemption at participating vendors. Consider if additional support will be needed in order to distribute the produce. This might include volunteers to help with food packaging, distribution, or other tasks.

Implement electronic health record (EHR) integration to track screening, prescriptions and evaluate patient outcomes.

Train staff on how to incorporate produce prescriptions into patient visits, including screening for food insecurity and using referral systems. Consider ongoing training to support health professionals around consistent screening practices to ensure that clinicians are up to date with their practice.

Create system for tracking data for baseline measures as well as what data is going to be collected periodically throughout in order to measure success and sustainability entering data in the EMR, using a spreadsheet to monitor pounds of produce distributed, the number of people in the program, any demographic information etc.

Pilot the Program. Start with a pilot phase to test the program on a small scale, gathering feedback from participants, clinicians, and partners.

Adjust the program based on the pilot results, optimizing workflows and refining eligibility or redemption processes.

Evaluate and Scale

Monitor outcomes like patient health improvements (blood sugar levels, blood pressure), food security, and patient satisfaction. Regularly assess whether the program is meeting its goals. Describe how this might be done – EHR reporting, patient surveys, etc. This could be done in a variety of ways, for example, an initial survey to patients prior to starting the produce prescription program and a final survey at the end of the program. This survey could measure overall satisfaction with the program, general well-being questions. Additionally, pre and post health measurements such as blood pressure or A1C numbers, could be helpful as a means of tracking how well the program worked.

Adjust as needed and scale up the program, potentially seeking additional funding and/or partners for expansion.

Promote the Program

For additional information check out the Rural Produce Prescription Toolkit created by No Kid Hungry and Vouchers 4 Veggies and the No Kid Hungry Center for Best Practices.

Contact Us

Interested in learning more? Contact us at Bi-State Primary Care Association for more information.