{"title":"Equity And Justice In Food As Medicine.","authors":"Jessica Bylander","doi":"10.1377/hlthaff.2025.00197","DOIUrl":"10.1377/hlthaff.2025.00197","url":null,"abstract":"<p><p>A collective of Black, Indigenous, and people of color-centered organizations is bringing an equity focus to food as medicine.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 4","pages":"382-383"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cultural And Place-Based Wisdom For Implementing 'Food Is Medicine' Programs In North Carolina.","authors":"Rochelle Bellin, Sonya J Jones, Sheherzad Maham Rizvi, Meredith Mastramauro, Donyel Barber, Chasidie Glover, Amy Kathryn Marion, Maura McClain, Susannah Spratt","doi":"10.1377/hlthaff.2024.01404","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01404","url":null,"abstract":"<p><p>The Food Is Medicine movement integrates food-based interventions into health care to address diet-related health conditions and food insecurity. Both the food and health systems that are a part of Food Is Medicine, however, have a history of contributing to health inequities through discriminatory policies and practices. Community-based organizations (CBOs) play a vital role in bridging these systems with their communities by centering their cultures, histories, and relationships in their Food Is Medicine programs. This Commentary highlights the work of six North Carolina CBOs that emphasize cultural safety and authentic relationships. By integrating local traditions, such as Black cultural heritage and Southern Appalachian farming, these organizations foster belonging and trust while addressing systemic inequities. As Food Is Medicine expands, larger businesses and institutions are delivering services that often prioritize efficiency and standardization over cultural and care-centered approaches, threatening to sideline the essential contributions of CBOs. Policy makers and health systems must ensure that CBOs remain central to the movement, preserving their role in delivering holistic Food Is Medicine solutions that honor local histories and truly serve the unique needs of their communities.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 4","pages":"492-497"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mary Kathryn Poole, Matthew M Lee, Sara N Bleich, Erica L Kenney
{"title":"Understanding And Comparing Economic Assistance Models To Improve Food Security And Diet Quality: A Rapid Review.","authors":"Mary Kathryn Poole, Matthew M Lee, Sara N Bleich, Erica L Kenney","doi":"10.1377/hlthaff.2024.01352","DOIUrl":"10.1377/hlthaff.2024.01352","url":null,"abstract":"<p><p>Food insecurity and poor nutrition afflict millions of Americans with low incomes. Three policy approaches to address these challenges are widely debated: modifying existing cash-like food assistance programs (that is, increasing benefits with or without imposing nutrition restrictions) or introducing new cash-like food assistance; incentivizing fruit and vegetable purchases; and providing unconditional cash transfers. This rapid review synthesized experimental and quasi-experimental evidence of how these approaches affect food security, diet quality, and dietary intake. Included studies evaluated modifications to cash-like food assistance benefits, nutrition incentives, and cash transfers. Increasing benefits without imposing nutrition restrictions for cash-like food assistance programs has the strongest evidence for improving food security and has mixed evidence for dietary outcomes. Adding nutrition restrictions to such benefits inconsistently improves diet quality and may reduce program participation. Nutrition incentives prompt small increases in fruit and vegetable intake but inconsistent reductions in food insecurity. More research is needed on cash transfers. As the evidence base for the optimal design of economic assistance programs evolves, continued investment in existing food assistance and nutrition incentive programs with strong evidence for effectiveness is essential.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 4","pages":"449-457"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Modeling The Value Of 'Food Is Medicine': Challenges And Opportunities For Scaling Up Medically Tailored Meals.","authors":"Kartika Palar, Chesa Cox","doi":"10.1377/hlthaff.2025.00161","DOIUrl":"10.1377/hlthaff.2025.00161","url":null,"abstract":"<p><p>As medically tailored meal (MTM) programs rapidly expand across the US and increasingly are adopted by health care payers, understanding their cost-effectiveness is critical to informing policy. In this Perspective, we explore implications of the cost-effectiveness simulation model by Shuyue Deng and colleagues. That model, which used state-specific data to examine how nationwide implementation of MTMs among adults with diet-sensitive health conditions would reduce health care use and costs, found that MTMs would be cost saving in nearly all US states. Building on these promising results, we argue for integrating real-world variations in MTM program design into future models, including dose, duration, and ancillary services. We underscore the importance of quality (informed by evidence-based standards) and of advancing patient-centered, equity-oriented approaches to intervention. Expanding the analytical perspective beyond the health care system to include societal costs and benefits, including for patients and nonprofit MTM providers, could broaden understanding of the value of MTMs. Models that reflect the complexity of MTM interventions are needed to inform their equitable, cost-effective integration into health care policies.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 4","pages":"443-448"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Food Supply And Dietary Guidelines Mismatch: Policy Recommendations To Improve Human And Planetary Health.","authors":"Ilana Fischer, K M Venkat Narayan, Karen R Siegel","doi":"10.1377/hlthaff.2024.01339","DOIUrl":"10.1377/hlthaff.2024.01339","url":null,"abstract":"<p><p>At this time, global agricultural policies encourage the growing of crops that are detrimental to human and planetary health. In 2019, the EAT-<i>Lancet</i> Commission on Food, Planet, Health published dietary guidelines to promote human and planetary health, but it is unknown whether countries currently provide enough of these recommended foods. To fill this knowledge gap, we used Food and Agriculture Organization food availability data from the period 2016-20 to compare food supplies from twelve countries against the EAT-<i>Lancet</i> guidelines. Our findings indicate that there is an oversupply of grains, animal products, and sugar, while no country's food supply offers enough vegetables or nuts, and many countries lack fruit and seafood. We recommend four agricultural policy actions to address this disconnect: redirect direct agricultural subsidies from commodity crops to specialty crops, increase the presence and scale of crop insurance subsidies for specialty crops, increase investment in research and development for specialty crops, and reduce tariff levels.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 4","pages":"467-474"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marissa B Reitsma, Stacie B Dusetzina, Jeromie M Ballreich, Antonio J Trujillo, Michelle M Mello
{"title":"Estimated Savings From Extending Prescription Drug Inflationary Rebates To All Commercial Plans.","authors":"Marissa B Reitsma, Stacie B Dusetzina, Jeromie M Ballreich, Antonio J Trujillo, Michelle M Mello","doi":"10.1377/hlthaff.2024.00724","DOIUrl":"10.1377/hlthaff.2024.00724","url":null,"abstract":"<p><p>The inflationary rebate provisions of the Inflation Reduction Act (IRA) of 2022 require pharmaceutical manufacturers to pay money back to Medicare if they raise prices faster than the rate of inflation. Opportunities now exist for Congress and the states to extend inflationary rebates to commercial plans. We demonstrate the potential savings from applying inflationary rebates to prescriptions filled in commercial plans by simulating savings under several policy design options. We estimate that a policy mimicking the IRA's design could have saved as much as $8.1 billion in 2021 by imposing rebates on 1,100 drugs. To minimize the administrative burden of assessing inflationary rebates, Congress or states could restrict rebates to certain high-cost drugs and still garner substantial savings. For example, including only drugs costing more than $830 per month or ranked in the top 300 drugs by total spending could halve the number of rebate-eligible drugs yet capture 96 percent of estimated savings that could be available under a policy that mimics the IRA design ($7.7 billion). Restricting eligibility to the top 300 drugs by total spending could capture 85 percent of those potential savings ($6.9 billion), imposing rebates on just 194 drugs.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 3","pages":"256-264"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julia D Interrante, Jessica L Liddell, Emily C Sheffield, Hailey A Baker, Danielle Gartner, Katy Backes Kozhimannil
{"title":"The Indian Health Service Is Associated With Higher-Quality Perinatal Care For American Indian And Alaska Native People.","authors":"Julia D Interrante, Jessica L Liddell, Emily C Sheffield, Hailey A Baker, Danielle Gartner, Katy Backes Kozhimannil","doi":"10.1377/hlthaff.2024.01165","DOIUrl":"10.1377/hlthaff.2024.01165","url":null,"abstract":"<p><p>American Indian and Alaska Native (AI/AN) birthing people are twice as likely as White birthing people to experience maternal morbidity and mortality. AI/AN people, especially rural residents, face pervasive barriers to perinatal care. Access to health insurance (including Medicaid) and the Indian Health Service (IHS) may mitigate barriers. We used 2016-20 data from the Pregnancy Risk Assessment Monitoring System to examine associations between health insurance and IHS access (before, during, and after pregnancy) and perinatal care use and quality (receiving 75 percent or more of recommended care) among AI/AN people. Most respondents reported Medicaid access and one-quarter reported IHS access during the perinatal period. Among AI/AN people who were uninsured before or during pregnancy, IHS access was associated with 16- and 7-percentage-point higher care use, respectively. Among AI/AN people who attended prenatal or postpartum visits, those with IHS access more often received high-quality care. Overall, those with IHS access had greater utilization and higher quality than those without. Policy efforts to address maternal health inequities for AI/AN people should honor federal trust responsibilities to Tribal nations via sufficient investment in Medicaid, the IHS, and other programs to support high-quality perinatal care.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 3","pages":"342-350"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Stronger Safety Net For The Nation's Workforce.","authors":"Kumara Raja Sundar","doi":"10.1377/hlthaff.2024.00796","DOIUrl":"10.1377/hlthaff.2024.00796","url":null,"abstract":"<p><p>A physician wrestles with the inability of existing labor protections to meet his patients' need for health-related leave.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 3","pages":"370-372"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam J N Raymakers, Victor L Van de Wiele, Aaron S Kesselheim, S Sean Tu
{"title":"Changes In Biologic Drug Revenues After Administrative Patent Challenges.","authors":"Adam J N Raymakers, Victor L Van de Wiele, Aaron S Kesselheim, S Sean Tu","doi":"10.1377/hlthaff.2024.00504","DOIUrl":"10.1377/hlthaff.2024.00504","url":null,"abstract":"<p><p>In 2012, the America Invents Act created a new administrative pathway called inter partes review to allow challenges to patents as being improperly granted, including patents associated with brand-name prescription drugs that block timely competition. Manufacturers of expensive biologic drugs often obtain large numbers of patents on drugs approved by the Food and Drug Administration, which can make it harder for other manufacturers to market their own biosimilar versions of the products. We found that biologic drugs were associated with forty-three administrative patent challenges via inter partes review during the period 2012-21 that resulted in final written decisions. Biosimilar manufacturers used this pathway in twenty cases to invalidate fourteen patents, typically directed to new methods of treatment. By contrast, biologic manufacturers selling competing brand-name products in the same drug class used this pathway to invalidate seventeen patents in the twenty-three challenges they brought, typically directed to active drug ingredients. After patent invalidation by biosimilar firms, revenues for the originator products tended to decrease, a signal of more effective competition making drugs more accessible for the benefit of patients and payers.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 3","pages":"274-279"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebekah I Stein, Yanlei Ma, Jessica Phelan, Eric T Roberts, Kenton J Johnston, E John Orav, José F Figueroa
{"title":"Growth Of Chronic Condition Special Needs Plans Among Dual-Eligible Beneficiaries, 2011-24.","authors":"Rebekah I Stein, Yanlei Ma, Jessica Phelan, Eric T Roberts, Kenton J Johnston, E John Orav, José F Figueroa","doi":"10.1377/hlthaff.2024.00651","DOIUrl":"10.1377/hlthaff.2024.00651","url":null,"abstract":"<p><p>Policy makers are actively investing in care programs that integrate Medicare and Medicaid benefits, with the goal of providing better-coordinated care for Medicare-Medicaid dual-eligible beneficiaries. However, nonintegrated plans have become increasingly popular among dual eligibles. One such plan type is the Chronic Condition Special Needs Plan (C-SNP)-a type of Medicare Advantage plan designed for people with specific chronic conditions. Using national Medicare data from the period 2011-24, we found that C-SNPs experienced modest enrollment growth among dual eligibles, with nearly 15 percent of C-SNP enrollees being full-benefit dual eligibles, who are eligible for Medicare and full Medicaid benefits. In 2024, among newly enrolled C-SNP full-benefit dual eligibles, 5.3 percent, 4.8 percent, and 14.9 percent were previously enrolled in plans with high, moderate, and low levels of Medicare-Medicaid integration, respectively. Among full-benefit dual eligibles qualifying for both C-SNPs and more integrated plans, those who were Black or Hispanic were more likely to enroll in C-SNPs rather than more integrated plans, which may have important implications for health equity. Policy makers should attend to these trends to ensure that both national- and state-level efforts to increase dual eligibles' enrollment in integrated plans are not significantly diluted.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 3","pages":"304-312"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}