Imagine going in for your annual check-up: you explain your symptoms and your doctor gives you a prescription or refers you to a specialist.
Now, M Health Fairview patients can get a different kind of referral after their appointment: If they “screen” positive for food insecurity, they’ll get a call from a food navigator.
A phone call usually looks like this:
Man Van, who joined Fairview Health Services in March, assures patients he can help at no cost and discusses options with them based on where they live, other medical conditions and their government assistance status.
Patients might say they weren’t able to get to their local food shelf during business hours, in which case Vann reassures them that they can contact the food shelf to set up an appointment and help with the process.
Patients might discuss other options, such as services that deliver groceries to their doorstep. Another service, called Veggie Rx, provides patients with culture-specific boxes of fresh produce from local farms.
Once the call is over, patients usually express a great sense of relief, Vann said.
M Health Fairview created the food navigator position in response to a growing number of food insecure patients struggling to navigate food shelves and government assistance.The program also represents a growing awareness of the impact nutrition has on conditions such as Type 2 diabetes, asthma, obesity and high blood pressure.
Vang helps the hospital system’s most needy patients at five clinics in East Metropolitan, connecting them to outside resources like M Health Fairview’s “Food Is Medicine” program and food shelves and government benefits. A second food navigator recently started working at West Metropolitan.
The hospital believes the program is the first of its kind in Minnesota with a one-to-one food-specific navigator model, but it’s part of a growing health effort that goes beyond just providing health literature, said Dr. Diana Katz, a pediatrician at Hennepin Healthcare and a nationally recognized expert on the health effects of food insecurity. (Dr. Katz is not involved with M Health Fairview’s work.)
“We’ve learned the hard way that simply giving families a printout or a brochure isn’t enough. Too many people don’t make the connection we’d hoped they would,” Dr. Katz said.
Government and nonprofit aid networks can be confusing; application procedures vary from program to program; one-on-one assistance can help patients break through these barriers.
Since the time of Hippocrates, health professionals have recognized that nutrition is fundamental to health, Katz said. Recent research has focused on the extent to which food security positively impacts health. But helping patients access healthy foods has not been a consistent role of the health system.
Minnesotans visited food shelves more than 7.5 million times in 2023, the highest number ever recorded, according to the nonprofit Hunger Solutions, and at any given time, 1 in 9 Minnesotans experience food insecurity.
Public policy should be the path to change, Katz said. For example, “there shouldn’t be eligible pregnant women who aren’t enrolled in WIC (the federal nutrition assistance program for Women, Infants, and Children),” she said. “But it happens all too often.”
Now the health care system is stepping in to fill the gap.
How do doctors diagnose food insecurity?
In a recent survey of health care workers, 99% of respondents said it is important to screen for food insecurity in their settings, and most said that at least some patients are screened at their hospitals. But only 55% said their hospitals have systems in place to help hungry patients.
Food insecurity refers to a household that does not have consistent access to food, and as a result of food insecurity, individuals may experience hunger.
In fall 2023, primary care providers at M Health Fairview began formally screening for food insecurity by asking patients to agree or disagree with two questions used by the U.S. Department of Agriculture.
For the past 12 months we have been worried that we would run out of food before we had money to buy more. For the past 12 months the food we bought didn’t last and we didn’t have the money to buy more.
Before this screening process, many physicians had informally discussed food resources and supported patients through the hospital system’s “Food Is Medicine” program, which began in 2016. But in the past few years, doctors and clinical staff have increasingly called on them to help ensure patients have stable and dignified access to food, said Therese Hill, community advancement food systems strategy supervisor at M Health Fairview.
Now, if a patient agrees with either or both of these statements, health care providers can flag Vang in the patient’s electronic health record.
Eliminate the need for patients to keep track of meal shelf times
Vang has experience working in communities across the eastern metropolitan area, most recently working for the state health department helping people get tested for cancer.
Patients respond to her calm demeanor.
“I’ve been advocating for them, teaching them, helping them navigate this very complicated health care system,” Vang said. “So I [the] food [I]Medicine [position] Once they open up, I’m like, ‘Hey, I love to eat.’ I didn’t know the whole story about food insecurity, but when I put those two together, I’m like, ‘Hey, I’m going to help you fight that.'”
Vang typically starts her day at Food Is Medicine’s office in the Fairview Community Health and Wellness Hub in downtown St. Paul. She looks through patient referrals from health care providers to learn about people seeking help. Doctors take note of a variety of things, like whether a patient is pregnant and in need of food, or a parent of five who recently lost her job.
If her patients speak English or Hmong, Vann speaks with them without an interpreter. She’s already found that some patients need a lot more help than others. One patient, for example, explained to Vann that her family suddenly had no access to food because the state had cut food assistance.
The woman spoke Karen, so Vann called Ramsey County’s human services office and asked her to speak to a Karen-speaking welfare worker. But the patient sounded depressed, so Vann realized she was unlikely to call. So Vann connected her to a Karen-speaking cultural mediator (another new role at M Health Fairview) who could help with the call to the county.
“The patient was very happy,” Vann says. But these interventions are most effective as a first step: The goal, she says, should be: “How can we help you?”
Vang can fluently recite the opening hours of grocery stores in the East Metro and how to get there. If the program requires filling out forms, he usually does so for his patients.
They offer a number of low-cost grocery options, including $40 gift cards to Cub, funded through outside partnerships.
Patients will receive an $80 voucher to shop at the Twin Cities Mobile Market, a converted bus that stops near the clinic and distributes produce and essentials such as canned soup, bags of rice and cereal.
Vann’s and the program’s other food navigators’ salaries are covered through a partnership with UnitedHealth Group, and Fairview funds the vouchers through the Fairview Foundation.
According to an internal study, about 500 M Health Fairview patients enrolled in the food voucher program in 2023. The hospital system found that food insecurity among these patients decreased by about 10% and self-reported “good, very good or excellent” health increased by 13%.
While there’s no standard best practice among hospitals, one-on-one assistance makes sense, Dr. Katz said.
Shopping on the mobile market
On a recent Wednesday afternoon, a small crowd lined up to pick up groceries at a bus that parked near the Rice Street Clinic. One of today’s customers (patients) was Stephanie Anderson, 51, who recently moved to the Twin Cities to stay with a friend after losing her home in Northfield.
Anderson had just moved to the Twin Cities and couldn’t find the fruits and vegetables she wanted at the grocery store near her friend’s house. She’s overweight and has knee problems that prevent her from exercising. After her doctor referred her to Van, Anderson showed up to the mobile food truck with her new voucher.
Anderson walked down the aisles of a “market” where bus seats have been replaced with refrigerators, carefully examining each shelf before selecting $6.64 worth of bananas, apples and butter.
“I love fruits and vegetables,” she said, “and not always just canned.”
Anderson said one of the stresses of being homeless while dealing with health issues is the struggle to find decent food. With Van’s help, she said, she’s been able to cut out many of the chips and processed foods she relies on and eat healthier meals. She’s also planning meals using an Instapot.
“Just throw in a bunch of carrots, put them in the slow cooker for about 20 minutes, and you’ll have the best carrots you’ve ever eaten,” she says.
When Anderson finished her checkout, the cashier wrote down her balance and told her she still had $73.36 left on the voucher, which she said she planned to come back soon to spend.
As Anderson headed for her car, Van called out, “Don’t forget, call me anytime!”
