Abby Burns (00:02):
From Advisory Board, we're bringing you Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. I'm Abby Burns. Today, you're going to be listening to a conversation that I had live on stage at Advisory Board's final research summit of the year in Nashville, Tennessee. I talked with my guests about a topic that is both hyper relevant to the moment that we're in right now, and yet, by most accounts, still manages to fly under the radar. We're going to be talking about food is medicine. I asked the audience in the room with us in Nashville to raise their hands if they had heard of food is medicine before as a concept and then to keep their hands up if they could actually explain what food is medicine really is, what's the value proposition of it. I'll say a lot of hands went up for the first question. A lot of hands came back down for the second question.

(00:54):
So today, we're going to talk about what food is medicine actually is and, to be blunt, why you should care about it, not just altruistically, but as healthcare business leaders. We're going to talk about what it actually looks like to do this well in practice. We're going to put this in the context of the current moment and look at how the policy landscape will affect food is medicine interventions. To do that, I brought two incredible guests with me on stage. Tomi Ogundimu, chair of the board of Washington DC-based food nonprofit, DC Greens, and Dr. Angela Fitch, co-founder and chief medical officer of holistic primary care and metabolic health clinic, knownwell. Here's our conversation.

(01:36):
Tomi, Angela, thank you so much for joining Radio Advisory Live.

Tomi Ogundimu (01:39):
Thanks for having us, Abby.

Abby Burns (01:41):
I want to start off with a question this afternoon that can act as a little bit of an equalizer for us. What is this thing that we call food is medicine? How should we understand it?

Tomi Ogundimu (01:50):
Food is medicine, I mean, I think as a concept, that's been around for a really long time, frankly, since the 1960s. But what it means today is both a recognition of the role that food plays, more importantly, food access or lack thereof, in helping people manage their diet-related chronic conditions. And instead of necessarily keeping these concepts of what it means to have access to and eat healthy, separate from what it means to have access to healthcare or health, integrating the two and addressing food insecurity or food access issues in a way that is well integrated with the healthcare system with the big H is what we see cropping up across the country in food is medicine programs.

Angela Fitch (02:33):
One of the things that as a physician, on that side of the coin, I've always been an advocate for nutrition and how do we help patients understand that, but one thing I find disconcerting currently in the movement is people put it into one or the other, meaning I don't actually think food is medicine. I think food is food and medicine is medicine, but the two have to work together to optimally treat chronic disease. And so, I'm an advocate of food as medicine, the movement, but I think we need to make sure we don't keep them in an either or bucket, that it has to be an and bucket because I think too often, the idea that food is able to completely replace medicine is where, when I say medicine, I mean medication in particular, right, I think that's where we run a little bit of a fine line of how do we balance that?

Abby Burns (03:23):
Right. It's not GLP-1 or green bean, right?

Angela Fitch (03:25):
Yeah, exactly.

Abby Burns (03:26):
These things should be working together. One of the things that you both mentioned in those definitions is chronic disease management. And I think that's a really important piece when we're talking about food is medicine. One of the things that I hear most frequently is the conflation of efforts to address food insecurity, and that is the whole of food is medicine. But what you're both saying is, "No, no, food is medicine is targeting, incorporating healthy eating into care delivery to address chronic disease." I have that right?

Angela Fitch (03:55):
Exactly. I think, especially for where I come from, which is I am a board certified in internal medicine, pediatrics, and obesity medicine, so I've been practicing obesity medicine for about 20 years. It wasn't till 2013 that the American Medical Association declared obesity a chronic disease, that it was actually a multifactorial chronic disease that is not a person's fault. Yet, our system, our society sort of takes that contrarian view that if people could just eat healthy, that they would therefore not have obesity, a chronic disease. And that's where I think my split comes from is that it's really about how do we help patients manage their chronic diseases within the context of getting them the appropriate nutrition, whether that's access or education around nutrition or even cooking.

Abby Burns (04:45):
One of the things I started to get to, Angela, is when we're talking about food is medicine interventions, it can look a number of different ways. To your point, it can be incorporating healthy foods. It can be like public entitlement programs like SNAP benefits, and we've got produce prescription programs. We've got medically tailored groceries, medically tailored meals. There are a lot of different flavors of food is medicine. I'm mindful that a lot of folks in this room, a lot of folks listening may not be familiar with knownwell and with DC Greens. So I'm hoping you can help us understand the food is medicine landscape as it exists currently in the US and where DC Greens and knownwell fit in. And maybe Tomi, let's start with you.

Tomi Ogundimu (05:24):
Absolutely. Okay. So DC Greens is a nonprofit organization that's focused on building a more just and resilient food system as a way to advance health equity. That is our mission. We do this across four different vectors. We've got a policy focus area that focuses on things like trying to expand 1115 waivers for Medicaid, thinking about how we can work with our MCUs to fund programs in the space differently, et cetera. We have a second focus area that is around community engagement. There's literally nothing we do in the community without them being close partners. Our third area is there was, for a very long time, a particular ward or two in DC where food insecurity and lack of access specifically to fresh fruits and vegetables is particularly challenged. So we have partnered with the community and actually operate and opened up an urban farm where community members are able to come and harvest their own fruits and vegetables.

(06:17):
But the fourth, and I think that's where going to spend on most of our time today, is a produce prescription program called Produce Rx, where we partner with 18 federally qualified health centers across the DC area to be integrated in how they do primary care and make sure that their patients are not only getting prescriptions to healthy foods, but are able to get them filled and have feedback loops back to primary care that not only keep patients sticky, but allow us to track biometrics to prove where we've actually inflected health outcomes.

Abby Burns (06:48):
What I'm hearing is you're acting as a facilitator and a connector between community-based organization and care delivery organization to not only open up patient access to these healthy foods and vegetables, but actually facilitate that access in a way that is connected with their healthcare.

Tomi Ogundimu (07:04):
You got it.

Abby Burns (07:05):
Angela, where does knownwell fit into the landscape of food is medicine?

Angela Fitch (07:08):
Well, knownwell is essentially a patient-centered medical home for people with overweight, obesity, or metabolic health concerns. We created knownwell about three years ago out of the idea that there's data to show that people with obesity feel very stigmatized by the healthcare system, and we wanted to create a non-stigmatizing, welcoming place where people could come for their weight management concerns, but also for their primary care concerns because there's data to show, for example, that because people are stigmatized around their disease of obesity, they don't go to the doctor. They don't get their mammograms. They don't get their colonoscopies, and then you see worsening disease down the line. We are hoping to be the first value-based care company for people with obesity to show that there is value in treating the disease of obesity over not just the long run, but even in the first year or two of engaging in treatment.

(07:59):
And so, we are in 50 states doing metabolic healthcare virtually, and then in six states, we have clinics in which we provide both primary care and weight management services for those patients. We wrap that care with dieticians and health coaches, pharmacists, nurses to do chronic care management, remote patient monitoring, et cetera, and then examine these social determinants of health, as Tomi mentioned, and figure out where patients can get access to some of these services as well because I think what Tomi highlighted is I think the integration there is what is frankly very challenging, and that figuring out which patients have access to which program as a primary care doctor or as a obesity medicine care provider, it's very challenging to figure out how to really improve the access for patients.

(08:44):
We talk a lot about, especially I think in the chronic disease management space, but especially obesity, is crowding in healthy nutrition. We have lived in such a long version of cutting out. How often do you go to the doctor and they say, "You need to stop doing that." We want to get out of this habit of saying, "Stop doing this," but instead, "How can we do something that promotes health? How can I add more vegetables to my day," not, "How can I stop eating ice cream?" And so, again, that focus is really what we need to be focusing on moving forward.

Tomi Ogundimu (09:18):
I just have to say, it's so funny, Angela, across any other industry in America, the mantra of giving American consumers more access to choices is like the peak element of how we think about things, what drives competition, what drives good performance, et cetera. Healthcare seems to be the only area where we look to, like you said, crowd things out. So I really like your guys' framework of how do we crowd things in, add more in there, and I think that's kind of what we see and try to do in the food is medicine movement as well for DC Greens.

Abby Burns (09:49):
Yeah. I think when you're talking about the idea of crowding and you're highlighting that our food policies, typically, when we do set policy around food and healthcare, they tend to be restrictive, right? What are we cutting out? And what you're talking about is food is medicine is really about opening up and then facilitating the access. Where I hear knownwell fitting in is providing that direct patient care with the dieticians as part of the care team to enable the access.

Angela Fitch (10:11):
Well, that's what we advocate for because you may or may not know, for Medicare, for example, what happened a couple of weeks ago was some of the opening of access to GLP-1 medications. You can't have a podcast without GLP-1. But with some of that access where our Medicare beneficiaries cannot see a dietician, they can't get that covered. They can get a dietician covered for diabetes and they can get a dietician covered for end-stage renal disease, but not for obesity, which doesn't really make a lot of sense. That's why we've been advocating for the Treat and Reduce Obesity Act before Congress. It's been before Congress for 13 years. I know that because I've been there 13 years, walking the halls of Congress trying to get it approved, which would add the ability for people with obesity to not only have access to medication for treatment, but comprehensive care in the sense of having access to a dietician to do that medical nutrition therapy, which is really what is needed to try to help coach people into that crowding out versus just cutting out.

Abby Burns (11:12):
Yeah. To realize the potential or the opportunity there, we need to see these different care models in practice, right? I think that's one of the reasons it's so important that if you look on stage, we have two folks on stage who are not part of what we might call the incumbent healthcare system. They're not representing hospitals.

Angela Fitch (11:29):
They used to be.

Abby Burns (11:31):
Ample experience with those players, but we're not talking to hospitals, health systems, health plans, not because those players are not involved in food is medicine work. There are a number of programs across the country where they're doing great work. I think it's important that we have the voice of the community-based organization, the voice of a startup provider up here because the incumbent systems aren't doing this work alone. If we are going to make progress here, I think we need to understand what are some of the superpowers that other players in the healthcare space are bringing to the table that we can collaboratively leverage, whether it is the trust and the deep understanding of the communities we're trying to serve so that these interventions actually work and see ROI, whether it's the ability to bring it back to be nimble and innovative in the care delivery models we're designing. I'm also mindful that we are talking to the incumbent system, and this work needs those voices as well in order to advance. So to ask the simplest form of the question, why should our traditional healthcare system care about, prioritize, invest in food is medicine?

Tomi Ogundimu (12:34):
As I scan the room, the reality is, and I think it's a staggering thing to think about, the cost of doing nothing actually fall back to you guys the most. So in DC alone, I believe it was in 2023, about $33 million in this relatively small district were attributed as costs back to the healthcare system only, so the providers, the emergency departments, the MCOs, et cetera, tied to food insecurity. I can promise you that number is going up as we are seeing about 20% in the DC area of the cost of food rising due to inflation, and even though we've been able to do incredible work with Produce Rx and partnering with our clinics in primary care, the waiting lists continue to grow for patients in these PCP offices that want to get on our list. The cost of doing nothing one way or another threatens your ability to manage your margins and manage your budget. I could give more answers, but I'll start there.

Angela Fitch (13:36):
I have worked in large health systems my entire career until I left to jump ship and come over into this startup world, and we've had some great programs, and I encourage you all to continue those programs and fund those programs, maybe find other philanthropy ways of funding those programs. I think that's another area where we see a lot of these programs cropping up is via people wanting to give resources to something that is going to have a direct ROI, and I think it is definitely something that can do that.

Tomi Ogundimu (14:06):
If I can add one more, because Angela just inspired me. So as Abby said, you're seeing two non-incumbent players at the table. Before, it was oftentimes for community-based organizations, we're able to captivate an audience that is oftentimes hard for you guys to keep sticky to your healthcare services. So for us, in our produce prescription programs, we work almost exclusively with Medicaid patients and then a version of Medicaid that is exclusive to the District of Columbia, but now, we've got innovators like knownwell cropping up, where for folks who may be able to afford it can also not choose you. So if we're losing the base of the patients that we take care of, if we're losing those who might be able to afford and not go through their PCP or not go through their traditional healthcare system, once again, the cost of doing nothing now is no longer just about the cost occurring to you, but also losing some of the revenue upfront.

Abby Burns (15:40):
I think a natural next question is, so why haven't we gotten here at scale? Where we understand the potential opportunities, what you're talking about is food is medicine interventions can directly feed the business priorities that we hear about every day. So why haven't food is medicine interventions gotten to scale? Why isn't this just the way business runs?

Tomi Ogundimu (16:02):
Money.

Angela Fitch (16:04):
I know. That's what I was going to say. I mean, all of us understand that there's a budget and that we have to figure that out, but I think that's where we could do more if we were to come together to fund some of these programs. I often think one of my goals personally is to create a philanthropy where people would donate into this in order to give people access to obesity medications because there is not a lot of coverage, and so people are having to pay cash. And I think a lot of people would donate to something like that that directly they know is going to move the needle on something. If you could maybe rally the community, I think, around some of these initiatives is where I've seen good things happen, at least in the Boston area and other places that I've worked over the course of my career.

Tomi Ogundimu (16:48):
And I say money for those same reasons. In fact, if I can walk through our Producer RX for a second to highlight what I mean by money and budgets.

Abby Burns (16:54):
Just to put a fine point on it, Produce RX is, like you said, your produce prescription program, this has been operational for coming on 14 years, I believe-

Tomi Ogundimu (17:01):
You got it.

Angela Fitch (17:01):
It's amazing.

Abby Burns (17:02):
... which is unbelievable.

Angela Fitch (17:04):
We need to scale that.

Abby Burns (17:05):
So let's talk about exactly how it's been able to get to the point of being sustainable for 14 years and yet not getting bigger than it has gotten today.

Tomi Ogundimu (17:14):
Yeah, it's a good question because at the end of the day, what's nice about partnering with community-based organizations is that we can be more agile, I think, than larger incumbent systems. One of the reasons why when we first started Produce RX in 2012, it was only oriented around, I think it was called the Fruits and Vegetables Program, and we started with 20 or 25 families. We are now over a thousand. And like I said, growing, but the limitation to doing more are people sitting on waitlist to have enough funds to get them their cards. But we first started working with one federal qualified health center in the DC metro area. We now have 18 across this space. And the reasons why I was saying money being a challenge is if you think about the funds flows that matter oftentimes for large incumbent systems, it's hard to track where paying for food access actually supports or hampers your budget. For us, to walk you through the workflow of our program, it is the PCP during an office visit that identifies whether or not a patient is eligible.

Abby Burns (18:15):
So it starts off at the FQHC in the clinician office.

Tomi Ogundimu (18:18):
It starts off at the point of service, and it starts with an understanding of whether or not this patient is on Medicaid. Medicaid eligibility must be at least 18 years old and must have one of three chronic conditions, hypertension, diabetes, or prediabetes.

Abby Burns (18:34):
Which, I mean, every health system that I know of operates some sort of population health management program, right?

Tomi Ogundimu (18:39):
Mm-hmm.

Abby Burns (18:39):
We know that eligibility criteria is a key to having a strong and a sustainable population health management program. So right off the bat, this is a muscle that health systems have, right?

Tomi Ogundimu (18:50):
You got it. And frankly, it gives the PCP something to do with all of our social determinants of health surveys and questionnaires, right? Full disclosure, I also sit as a chair of equity and advocacy for the local primary care association, so I work with a lot of these federal qualified health centers from that standpoint. And the number of times I hear from PCPs, I hate those questionnaires because what do I do about them? Where do I send my patients? But working with a community-based organization and having a post prescription says not only do I get to write a prescription to this service or to this program, but now, I get to let go and trust that my patient's needs are going to be served and the information is going to come back to me through technology, whether it's the EMR, et cetera. Or in what we know works in our program after toiling with it for the last 12 plus years is after the PCP gives them the prescription program, our people, we've got health coordinators on staff and program managers, they send them a debit card.

(19:46):
And I have to say, one of the biggest changes in the program that increase uptake from a scalability standpoint is having technology available to do electronic based payments and communication with partners, so major lesson learned. Secondly, they get a chance to go to a number of different grocery stores, farmer's markets, mobile food pantries, mobile markets. They get about 80 to $120 based on the size of your family every single month loaded on that card and buy all your groceries, use that card first. People don't even need to know that you are on some sort of program that helps pay for it. Anything that is qualified and categorized, and we've worked with all the grocery stores to determine what that looks like as a fresh fruit or a vegetable, whether pre-cut or whole, gets eliminated from their overall bill. So whether they have cash, whether they have SNAP, whether they're using a credit card, everything else gets paid for from there.

(20:37):
Oh, also at the point of enrollment, they also take a baseline screening survey and biometric survey for baseline data. The kicker for this program is they must go back to their PCP every four to six months to stay enrolled.

Abby Burns (20:52):
Every four to six months?

Tomi Ogundimu (20:53):
Yeah. We will disenroll people from the program if they have not seen their PCP within six months. Once again, talking about the healthcare providers themselves, not only are they keeping patients in primary care, they're oftentimes lost to follow-up, right? But secondly, from a funds flow perspective, they're able to justify that revenue back from Medicaid because Medicaid's paying for primary care, we've got the access to these services, and now, we've got engagement from a traditionally hard to reach population all through tight-knit partnership. The budget just makes sense there.

Abby Burns (21:26):
Tomi, as you were talking, I started tallying the number of different players that you're mentioning because it started off in the primary care office, and DC Greens came into the field with the debit card. And then, you start talking about grocery stores. So now, we're adding in even a third partner that seemingly doesn't necessarily need to take a great number of actions to be part of making this program work.

Tomi Ogundimu (21:47):
Mm-hmm. Selling it to grocery stores in the early days was a bit of a challenge and figuring out how best to get the grocery store's money or payment through this program. We started with paper cards or paper checks similar to what the old SNAP program used to look like before it got digitized. The second thing we tried was getting the funds loaded on the loyalty cards for grocery stores, so Giants loyalty card, Safeway's loyalty card. However, we're talking about having to do this individually for individual grocery stores. That does not scale. So the solution of investing in a payment technology that lets us integrate both the payments and how we even track some of the biometric and screening data through the EMR allows us to do that communication, make things happen seamlessly, have less hiccups with patients, and have an overall activity rate among those who are offered the program at the beginning of the year, look at 96% now-

Abby Burns (22:38):
Wow.

Tomi Ogundimu (22:38):
... which I think the data says it all, in addition to having outcomes after 12 months in the program where we've seen measured biometrics where folks HbA1cs have decreased, blood pressure is lower, even depression scores are lower, and increased consumption of healthy fruits and vegetables, which we can also track through the use of this card.

Abby Burns (23:00):
Angela, I'm curious what jumps out at you from the different elements of the program that Tomi just talked about, both from wearing your knownwell hat as well as wearing your clinician hat as someone who's in the clinic seeing patients several times a week.

Angela Fitch (23:12):
Well, I think Tomi highlighted it, right? I mean, one of the barriers even to, for example, obesity care, people say, "Oh, primary care physicians, they don't want to do that or they don't know how to do that." They do want to, but they haven't had the tools in front. When you don't have anything other than telling a patient, "Eat less, exercise more," if you don't have access to tools that you can prescribe, you end up not treating it. And so, I think this just highlights in particular that we need to do it all together. Bringing that all together, especially the coming back to your primary care doctor, I think that piece of it is clearly extremely innovative in that I often thought about that even with some of the programming that's being instituted around obesity care. If a patient comes back, then maybe they get that access again, right?

(23:57):
Because again, it's really about chronic disease management. You asked earlier what do we think is getting in the way. Well, it's very similar to people not covering obesity care in the sense that this payer or this employer says, "Well, this patient's only going to be with me for a year. And so, this other person's going to win down the road when they don't have their heart attack under that plan." You're going to also benefit from these other patients that get access to that, so I think we all have to come together and start thinking more about health and less about how do we treat people that are sick because that's been the focus for so long is that we're just treating people that are sick.

Abby Burns (24:33):
What I'm also hearing in what you're saying is a little bit of what do we need to own versus what do we not need to own?

Angela Fitch (24:38):
Right.

Abby Burns (24:39):
What can we hand to somebody else or both hold onto at the same time, which is a lot of, Tomi, when you're talking about DC Green's model or the Produce Rx model. Angela, I would be curious from your perspective, what integrating food is medicine into clinical practice and thinking into the patient-doctor interaction in the room, what that looks like and what that affords for you and for your patients?

Angela Fitch (25:02):
Well, it really has to be easy like Tomi mentioned because we direct patients and we give them the knowledge about increasing their fruit and vegetable consumption, for example, or crowding things in, but yet, at the same time, being able to tell them how to do that is the part that we don't need to be doing in the office. I mean, meaning this is where outsourcing it, being able to say, "Here, go here, get this," I think is clearly the answer because we have very little time, right? As you saw earlier, there's a shortage of primary care clinicians if you were at the opening session. And so, we have very little time. We need to use our technology and our integration across systems a lot better so that we can take care of patients.

Abby Burns (25:42):
Yeah. I will say one of the program elements that I saw you perk up a bit at Angela and that I was most surprised to hear you say, Tomi, was the EMR integration because I think that's a barrier even within-

Angela Fitch (25:53):
Huge.

Abby Burns (25:53):
... individual organizations, nevermind across FQHC networks with a nonprofit partner.

Tomi Ogundimu (25:58):
Yeah. And to be fair, we don't have that fully figured out yet, but it is, I think, in a critical part of when we talk about scale. What are the questions you ask yourself for which organizations or partners have read only versus write access to your EMRs and why? And if there are citywide or area-wide or statewide HIEs, so that's where our electronic platforms are really helpful, where we can be dumping some of the data in at scale as well to once again have a central repository where we can justify the need for the spending. And if there's anything that I've learned the most working with DC Greens, it's that, especially as my role as board chair, justifying the need for spending, talking about why, frankly, the values to the community, which we owe them a lot. But with that said though, we have to make the business case for everybody else.

(26:45):
So having the shared integration through HIE networks or EMR or even frankly, some data or information sharing with the grocery stores and the MCOs, we work really closely with the Medicaid MCOs in the community, allows us to get to access to the information we need to either go to the DC government and establish new policies or even justify to different MCOs, CFOs, et cetera, that continued funding needs to happen here or finally, and in fact, if I could give you guys one action item to walk away in this room with, is doing more advocacy for 1115 waivers and more specifically nutrition related programs. I think across 47 states right now, we've got 1115 Medicaid waivers, which basically allow you pay for the different social determinants of health for those who are not familiar with it. Across those 47 states, only 12 do this for food.

Abby Burns (27:38):
Wow.

Tomi Ogundimu (27:38):
That is a stark difference. I think most of the focus goes to housing, which I would never tell you the Housing First movement is nothing but preeminently important, but we should be raising our challenging food system to that same level of seriousness, and every single person should be talking to their government affairs office about how do we make sure we're including nutrition and food in those waivers.

Angela Fitch (27:58):
And I think in particular, what you're saying and there's others doing this too, is the fresh produce, right? We have good data on increasing vegetable consumption essentially for lowering blood pressure, for lowering A1c. I mean, that is good randomized controlled data out there around the importance of that. And so, for a lot of us, we think that if we give people money on a card, they will spend it on something that is not as healthful. But when you only have options of fruits and vegetables as the choice, I think that's where it can be transformative because that's what people need access to.

Tomi Ogundimu (28:32):
Can I double down there back to your point about crowding in, right?

Angela Fitch (28:35):
Yeah.

Tomi Ogundimu (28:36):
What I like about what we do and even what you were sharing is the thing is we're not telling you what to buy or what not to buy. We're just saying, "We'll pay for your fresh fruits and vegetables." Those are oftentimes, what, the most expensive things in the grocery store. Let's be honest. We make most expensive the things we want to incentivize people to eat or people to do. So reducing the barrier access also requires being strategic and thinking about where is that sweet spot between what's expensive and what's good for you and how do we make it a little bit easier to get closer to crowding those things in?

Angela Fitch (29:06):
Well, and that's what the data shows, right? The data shows that when you eat more vegetables, you are healthier.

Abby Burns (29:12):
Right. This is not an altruistic undertaking.

Tomi Ogundimu (29:14):
No.

Abby Burns (29:14):
This is grounded in clinical evidence. We've got a few minutes left, and I think where you've both sort of started towing us in the direction of something I don't think we can ignore in this conversation since we're having it in 2025, and that is talking about policy, and specifically the federal policy landscape and how that's going to affect food is medicine programs in the short term, as well as in the long term. I'm thinking about this from a couple different angles. I am curious, when I look at where some of the focus has been so far from the MAHA movement, they've put food on our radar as a healthcare system to a great extent in 2025. I think a lot of the focus has been on cutting out specific things. What I'm hearing from you is that it doesn't need to be at odds with the ethos of food is medicine. It also means that MAHA isn't going to solve the goals of food is medicine. How do you think about these things?

Angela Fitch (30:07):
Well, that's where, again, I think the misalignment there is in this idea that if we cut out this or cut out that, that we will be well, and we have data the opposite of that, that we really need to figure out how do we crowd in more fruits and vegetables or whole food in general? How do we use this movement that we have right now, which as you mentioned, it has brought some light to it, but how do we transition that into increasing the programs like Tomi has in terms of how can we work on getting people more access to whole foods instead of cutting out this or that?

Abby Burns (30:41):
In other words, we still have work to do.

Angela Fitch (30:43):
What we have today is increases in medical advancement that have created medications for us that can radically improve our health and longevity. We need to figure out how to balance that, not this, again, either/or sort of as I started the conversation. It shouldn't be about either/or. It should be about both because we're not going to solve the obesity epidemic or any of these chronic diseases that we're talking about today by food alone, and that's where we have to really sort of refocus as well because I think too much of the current landscape has been focused on that piece of it. If we get rid of this, we will cure obesity. No, that's not going to be the case.

Abby Burns (31:24):
I also want to talk a little bit about the One Big Beautiful Bill Act and specifically about Medicaid cuts because Tomi, one of the places that you started off when you're talking about your eligibility criteria for Produce RX is it's patients who are eligible for Medicaid. We know that if we look over the next 10 years or so, people are probably going to roll off of Medicaid as a result of some of the new work requirements, eligibility, restrictions, et cetera. How does that affect the opportunity, the sustainability, the outlook for some of the programs that we're talking about?

Tomi Ogundimu (31:52):
Yeah. If I can actually take off my DC Greens hat representative right now and just speak as someone who has worked with healthcare systems and policies and infrastructure for the last two decades of my career, I think oftentimes we talk about programs like Medicaid as the safety net, but the reality is the true safety net oftentimes relies at nonprofits, including your healthcare systems, there are nonprofits, right, and community-based organizations. So any cuts to federal related programs for safety nets means our seams exploding. We saw earlier in this year when we saw projected cuts to GusNIP, to USDA grants, more recently, the pause of SNAP. We see it in terms of loss to follow up in primary care, et cetera.

(32:33):
I think the thing that I don't hear enough people talking about, given the time we have, I don't want to repeat a lot of points that I think you can hear in discourse out there, but the thing I very rarely hear people talking about of what that does to the infrastructure is let's represent PCPs for a moment. We all know how busy we have asked them to be in a 15-minute visit, and they're able to make traction in helping us do a better job of integrating our housing systems, our food systems, our healthcare systems. They're at the front lines of doing that. We're asking them to do it all. And then, you take away the funding, and you hope that they have to restart all over again. They will become disengaged. They'll become disengaged with community-based organizations like myself.

(33:13):
If they can't get their patients in, they'll become disengaged with referring patients or doing work with housing support systems. While the federal government programs like the Medicaids of the world, et cetera, start to fall apart, now, the nonprofit and community-based systems no longer even have enough of the resources or funding to catch them. And oftentimes, when you look at that longitudinally since the 1960s, individuals in the community like that get lost to follow up in the system altogether. We may never see them again until it's too late to intervene. That creates loss of life, that creates exorbitant costs on the system in both time and money, and frankly, that's not who we are.

Abby Burns (33:57):
In our last minute, I want to close this out by looking forward in a world where we have achieved getting food to medicine as part of our healthcare system. This is how business as usual operates. Complete the sentence. We got here because healthcare stakeholders did what?

Tomi Ogundimu (34:19):
We got here because healthcare stakeholders see themselves as part of an ongoing ecosystem of community care and commit the funds, the budget item, and frankly, the time of someone in the C-suite to ensure that we're a member doing our own diligence.

Angela Fitch (34:38):
And I will just say very simply that healthcare leaders, all of us, recognize the value of health. We talk about in our clinic all the time, we do this for the health of it, not the weight of it. It's not about losing weight, it's about gaining health, and we really need to refocus on how can we gain health in the long run, not necessarily just how can we treat individual diseases.

Abby Burns (35:03):
Well, Tomi, Angela, thank you for joining us for Radio Advisory Life.

Tomi Ogundimu (35:07):
Thank you, Abby.

Angela Fitch (35:08):
Thank you for having us.

Abby Burns (35:18):
Food as medicine is important in a world where more than one in seven households in the US is food insecure, and where the majority of health spending, 85% of health spending in this country, is tied to the management of diet-related chronic disease and where we know that healthy eating is associated with better health outcomes. I hope you took a few action steps away from today's conversation. Maybe it's to focus on programs and policies that aim to crowd healthy food in, not just cut unhealthy food out. If you operate in one of the 47 states that uses 1115 waivers to work with your government affairs team to figure out whether you currently use them to improve access to healthy food, or maybe the action step is to identify the superpowers of your peers in other parts of the industry to help make food is medicine programs a sustainable part of our industry. Remember, as always, we're here to help.

(36:08):
Next week on Radio Advisory, we have our sight set on 2026. We're going to pull back the curtain on the questions that our research teams are asking next year. In other words, what's on Advisor Board's research agenda? New episodes drop every Tuesday. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Abby Burns, as well as Rae Woods, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson, with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. Special thanks to Amanda Okaka and Daniel Kuzmanovich. We'll see you next week.