Expanding the roles of healthcare providers, institutions, and insurers in improving healthy food access and strategies that improve health outcomes can have a profound impact on residents in Massachusetts, and especially those that are food insecure.
It is essential to reduce overall health care costs in Massachusetts. These costs are increasingly crowding out the ability of State government to maintain and invest in other services that are critical to public health, including early childhood education, mental health, and public safety. Institutions with a stake in public health outcomes have an opportunity to help meet this need by taking more actions to address and reverse the public health crisis of obesity and other health problems that are related to poor nutrition and inactivity.
As anchor institutions, nonprofit hospitals, and health maintenance organizations have an obligation to fulfill the Massachusetts’ 2009 Community Benefits Guidelines. These include improving chronic disease management among vulnerable residents, reducing racial and ethnic health disparities, and promoting wellness for all. Exemplary programs include Mass in Motion, Shape Up Somerville, Live Well Springfield, Mass General Hospital’s Center for Community Health Improvement, and similar initiatives.
In addition, the federal Affordable Care Act of 2010 established several community service obligations for nonprofit hospitals, the most relevant of which is the requirement to conduct a community health needs assessment (CHNA) and adopt an implementation strategy at least once every three years, as described in Section 501(r) of the Internal Revenue Service tax code.
Health insurers also have an interest in keeping their customers healthy, which helps control premium costs for all subscribers. Many insurers already offer incentives for healthy behavior, such as gym membership rebates. Expanding such incentives to encourage the regular purchase and consumption of healthy food could help further healthy behaviors.
Recommendation 5.1: Support actions by health care providers, hospitals and medical institutions that improve access to, and education about, healthy food, especially to people who are food insecure.
Action 5.1.1: Incorporate food insecurity screenings and referrals to food assistance resources into regular practice for visits to the doctor’s office or clinic. Encourage health care institutions to partner with agencies that can provide SNAP enrollment assistance to patients, and encourage utilization of benefit enrollment centers to provide referrals for patients in need of additional services.
Action 5.1.2: Support strategies to address immediate food needs of patients at doctors’ offices, hospitals, and health centers including scaling of programs in which doctors write prescriptions for patients to fill for fresh fruits and vegetables – at no cost – at local farmers markets and other retail outlets.
Action 5.1.3: Encourage and support nonprofit hospitals in supporting and partnering with community-based programs that promote healthy food access and nutrition education. Support pilot programs that provide direct support to patients in acquiring healthy, such as on-site fresh produce sales to immediately fill fruit and vegetable prescriptions.
Action 5.1.4: Study the Determination of Need process and related community health improvement resources for opportunities to expand and enhance health care facilities’ role in promoting and increasing access to healthy food. Innovative examples include mobile markets and fresh produce kiosks inside hospitals.
Action 5.1.5: Encourage medical institutions to modify food procurement contract language to purchase more locally produced healthy foods, including setting local food procurement benchmark of at least 20 percent.
Action 5.1.6: Encourage and support greater nutrition education in medical schools and relevant trainings for all medical professionals.
Recommendation 5.2: Encourage insurance providers to increase and scale up incentives and outreach that will encourage purchase and consumption of more healthy food.
Action 5.2.1: Provide SNAP application assistance at the time of enrollment in public health insurance programs, as well as providing easy-to-use directories and information about local DTA offices and services, nutrition trainings, and WIC application assistance.
Action 5.2.2: : Encourage insurance providers to expand and offer discounts or rebates on premiums for purchase of healthy foods including CSA memberships and documented farmers market purchases, similar to health club discounts currently offered, or when prescribed as part of a fruit and vegetable prescription program.
 MA Office of the Attorney General Maura Healey. (n.d.). Community Benefits Guidelines for Health Maintenance Organizations. Accessed November 2015 from http://goo.gl/YSsG8g .
 Internal Revenue Service. (2015). New Requirements for 501(c)(3) Hospitals Under the Affordable Care Act. Accessed November 2015 from https://goo.gl/hZg5rr.