As we reported in May, funding for a first-of-its-kind Produce Prescription (“Produce RX”) pilot program was included in the 2018 Farm Bill. Produce RX programs seek to connect physicians and patients with vendors that accept prescriptions for fruits and vegetables. The federal government is currently evaluating proposals from organizations hoping to use this funding to launch their own pilot Produce RX programs.
Over the course of our research on this exciting topic and our efforts to highlight programs addressing social determinants of health, we had the pleasure of speaking with program leaders at Wholesome Wave—an organization that, since its inception, has led the charge in advocating for increased access to fresh produce. As part of this mission, Wholesome Wave has long been a proponent of enhanced Supplemental Nutrition Assistance Program (SNAP) benefits. The company’s founders were also pivotal in ensuring that federal funding for Produce RX pilot programs was included in the 2018 Farm Bill, highlighting the success of the Wholesome RX programs that Wholesome Wave operates and supports across the country.
In our conversations with Wholesome Wave, we hoped to understand the current funding mechanism for programs of this type, as well as what is needed to close the gap between physician recommendations and measurable benefits to patients that lack the means or encounter access barriers when trying to enact health changes.
Barriers to Utilization
There are two known barriers to more widespread utilization of Produce RX programs:
- Lack of funding for produce prescriptions at participating stores;
- The stigma of paper benefit models (which depresses benefit utilization by patients).
To surmount these obstacles and make a real impact on diet-related health determinants in the United States, Produce RX programs need additional funding, as well as to shift their payment methodology from paper-based prescriptions to an electronic, more widely accessible fiscal support program that would increase patient utilization.
Currently, most operational Wholesome RX programs are funded by community non-profits or collaborations with private funding sources. Additionally, if the Farm Bill’s funding for Produce RX programs proves effective in mitigating social determinants of health—i.e. improving health outcomes for high-risk consumers—simply by providing direct access to fresh produce, it could serve as the catalyst for more widespread reimbursement of these benefits by both public and commercial insurance providers.
Though results from the forthcoming Farm Bill-funded pilot remain to be seen, early findings from a similar 2018 Wholesome Wave pilot seem to indicate a promising future for the federal program’s outcomes.
Case Study: Wholesome Wave Rewards Card Program
From May through the end of December 2018, Wholesome Wave—in partnership with Naked Juice—kicked off a pilot program in New York City that addressed both barriers; access and destigmatizing the use of fiscal supports. The “Wholesome Wave Rewards Card, powered by NutriSavings” gave qualifying families a card pre-loaded with $20 a week, up to $180 dollars total, for use toward the purchase of fresh produce.
Implementation of this pilot allowed the Wholesome RX model to reach many more supermarkets than its previous iteration, which required outreach to individual grocery stores to garner support and participation. Wholesome Wave is currently seeking to expand the pilot program by locating additional communities or partners with which its model can be replicated, and its findings reviewed.
One positive observation from the pilot programs to date is that user compliance with the purchasing restrictions put in place for the RX cards is high. To ensure participants used their rewards card solely to purchase fresh produce, Wholesome Wave has utilized two models by which to restrict card use: 1) real-time, retailer-specific SKU monitoring at the time of use; and 2) card use purchasing review prior to reload—with participants who made non-qualifying purchases blocked from future fund reloads. Current results indicate that both approaches correlate with high user compliance with purchasing parameters.
Additional findings from post-participation surveys conducted by Wholesome Wave indicated that overall, the RX pilot programs were successful in exposing participants and their families to more food options—in particular, when the participant was a female head of household.
Although these programs may be required to meet health-specific targets (such as changes in BMI) to be integrated into federal or private insurance model reimbursement methodologies, it is also important that insurers focus on holistic success factors—for instance, teaching families about healthier food options, and providing recipients with tools (in the form of fruits and vegetables) to make necessary improvements to their health. Wholesome Wave continues to partner with nutrition research institutions such as the Friedman School of Nutrition Science and Policy at Tufts University to study the impact of program models like enhanced SNAP and Produce RX on the participants and communities in which they are available.
Wholesome Wave provides tools and guidance for those seeking to establish Produce RX programs. To join their network and take the first step to increasing access to fresh produce in your area, please visit their website.
 AMA Journal of Ethics® October 2018, Volume 20, Number 10: Produce Rx Programs for Diet-Based Chronic Disease Prevention Haley Swartz, MPP