Toward health promotion and prevention: Evidence from a food and health partnership model of care

Health promotion and disease prevention requires health systems address the patients' social needs using new care delivery models. Yet, research in this area has stalled for several reasons. We study a partnership model of care that couples clinical care delivered by primary care providers and social services delivered by community-based organizations, and its impact on patients' preventive health outcomes and behaviors. We use data from the Mid-Ohio Farmacy, which is a collaboration across the Mid-Ohio Food Collective (MOFC), a network of 650+ affiliated food pantries, and a large federally qualified health center (FQHC). The FQHC offers primary and preventative healthcare services across eight free clinics, which are co-located with the MOFC-affiliated food pantries. Patients were screened for food insecurity during their clinic visit and, if positive, were referred to the Farmacy. Compliers made at least one visit to the food pantry after referral, while noncompliers did not. Using difference-in-differences, we find that compliers had no discernible change in their body mass index (BMI, kg/m2), which we refer to as a BMI stabilization effect. Noncompliers' BMI increased after referral. High comorbid and high pantry use compliers experienced a significant reduction in their BMI and a marginally significant reduction in glycated hemoglobin (HbA1c, %). These patients had unique compliance behaviors, including greater search, frequency, and consistency of food pantry use. Travel costs suggests that high comorbid patients ascribed a greater value to the Farmacy program. In terms of primary care utilization, we find that compliers' clinic visit patterns after referral were consistent with the visit patterns observed in the food secure cohort, suggesting that the Farmacy program may have helped compliers address competing demands that are known to inhibit health behaviors. The food and health partnership model of care helps stabilize patient health outcomes, curbing the progressive risk of chronic conditions like obesity, hypertension, and diabetes. Patients with co-morbid conditions had greater search, frequency, and consistency of food pantry use after referral, suggesting that these patients were more likely to use "food as medicine." In terms of primary care utilization, food insecure compliers' clinic visit patterns after referral were consistent with the visit patterns observed in the food secure cohort, suggesting that the partnership model helps compliers address competing demands that inhibit health behaviors.