Food as Medicine on a Government Level

By Irene Yeh 

At the Food as Medicine Summit in Chicago last week, Calley Means, senior advisor to the White House and Health and Human Services, and Stephanie Carlton, deputy administrator and chief of staff at CMS, partook in a keynote interview to discuss how the federal government is making changes and establishing plans to continue the food as medicine effort. 

Moderated by Scott Bowman, co-founder of the NOURISH Movement and board member of Clareo, their conversation explored a call to action to push for food interventions, the most recent achievements from the government, and empowering Americans to make their own decisions.  

The Sickest Country in the Developed World 

Means shared a few statistics from former FDA Commissioner Marty Makary: 48% of tax dollars are spent on healthcare. Additionally, the U.S. spends 3-4 times more per capita on healthcare and has a life expectancy six years shorter compared to other European countries. Americans also have the highest rates of obesity, diabetes, pediatric cancer, and autoimmune conditions of any society in human history. 

“We have a system that’s unsustainable that nobody likes,” Means stated. “We have a system that foundationally waits for you to get sick and then manages that condition once you’re sick with interventions.” 

Means emphasized to the audience that food as medicine needs to be pushed as a legitimate treatment, not as an add-on or supplemental option. However, he emphasized that it will be a 10-year process and a cultural challenge to change the conversation in medicine and the nation about the connection between food and health. 

Carlton added that the country is in a period of mistrust toward government and big institutions. There needs to be a focus on empowering individuals with the truth to take better ownership and care of their health.  

Clinical Proof 

As stated during the opening keynote panel, government partners require financial and health outcomes data to justify expanding food as medicine programs and enacting change.  

“We need more confidence in the food as medicine space to really hold it up as a key clinical intervention,” said Means.  

Means encouraged the audience to “aggressively prove efficacy, prove better outcomes, and prove lower cost” by pushing food as medicine, regardless of the rules or incentives of the current system.  

Data-based outcomes have already influenced a few changes. Carlton reported that there have been updates to dietary guidelines that reflect the most recent evidence on how food as medicine impacts health. There is also incentive for states to receive higher funding awards if they take bold actions, such as omitting sugary beverages from SNAP waivers.  

Other changes implemented by CMS include initiating a pledge for hospitals to change the food they provide in their facilities to be consistent with the new dietary guidelines, with the American Hospital Association chairman signing off on the pledge. The CMS also launched MAHA Elevate to set up a way to build an evidence foundation for food as medicine, which is what is needed to get coverage decisions in Medicare. 

Carlton also elaborated on plans for Medicare based on these new dietary guidelines. First, every senior-aged individual is entitled to an annual wellness visit that includes a questionnaire about nutrition, but there have been no changes nor actions from clinicians to talk about proper nutrition and food. The CMS is working on amending this. Second, Medicare Advantage grants supplemental benefits, but they were used for gift certificates for fast food restaurants. The CMS put in requirements that necessitate healthy food for the supplemental benefits. 

For too long, there has been too much focus on predictive risk, price risk, and then prior authorization to manage costs, said Carlton. “But it really does have to be tied to where the evidence is and the clinical case for what would move the needle.” 

Accessibility and Transparency 

Not all government programs, including HSA and FSA, are accessible to every American. So, what is being done to provide accessibility and tax-advantaged ways to take care of their health?  

Means shared that the plan right now is to drive healthcare spending toward root cause items, and this can be achieved by giving patients more control over their money. He broke down the flaws in the current system, where it “waits for you to get sick” and then performs interventions that manage the conditions instead of getting to the root cause. By driving transparency for consumers and then empowering patients with their own dollars, it can provide them the ability to “shop around” for their own medical resources and treatments. 

“The key is to provide consumers and patients more flexibility,” explained Means. 

Collaboration with Big Companies 

One of the biggest accomplishments this year was scrutinizing where the government procures food. There are also pilot programs and acquiring funds for pilot programs to show how improving school meals, military meals, and hospital food leads to better outcomes. Means also stated that major food giants, such as Sysco and Aramark, have huge initiatives to work with smaller companies. “Hopefully, there’s market opportunity and ability to drive change there.”  

In the Year 2033 

Means and Carlton expressed hope for a better American health system and more health awareness in Americans after two more administrations. 

Means discussed more patient empowerment, as well as more personalized, patient-centered healthcare that provides Americans with their own insights to their health. He also wants to see insurance incentives change to prioritize health as much as possible. Carlton hopes to see the obesity rate cut in half and for children’s physical fitness to improve, as well as increased longevity and improved daily habits in Americans.