Mid-Ohio ‘Farmacy’ principals encountered several surprising challenges trying to combat food insecurity

• The Mid-Ohio “Farmacy” (MOF) is an effort to establish a partnership between a large food bank and Ohio State University Wexner Medical Center, according to a Health Affairs article.
• The goal is to establish linkages between government and community food banks with hospitals and other healthcare providers to address one social determinant of health — food insecurity.
• Just some of the challenges the MOF encountered, and had to develop workarounds for, were privacy issues, barriers to capturing, storing and sharing data as well as funding and legal obstacles.

A recent Health Affairs article details the efforts and challenges for establishing linkages between government and community food banks with hospitals and other healthcare providers to address one social determinant of health (SDOH) — food insecurity. 

The Mid-Ohio “Farmacy” (MOF) is an effort to establish a partnership between a large food bank and Ohio State University Wexner Medical Center so that primary care providers who identify patients considered clinically high-risk and at risk for food insecurity have access to fresh produce from a local food pantry. However, in embarking on this venture, complexity in the legal and regulatory framework for sharing information and setting up a system to track and exchange data between the two organizations created several surprising challenges. Privacy issues, barriers to capturing, storing and sharing data as well as funding and legal obstacles required innovative thinking and workarounds. The authors of the article, who were directly involved in MOF, relay that their experience serves as a useful example of how others may approach forming linkages between providers and community-based organizations. Their experience is particularly relevant in this time where health systems are forming more community partnerships to address SDOH in their patient populations.

Takeaway

The MOF effort echoes what HFMA heard from participants at its recent Thought Leadership Retreat and highlights the complexities in the healthcare system for establishing these partnerships and evaluating effectiveness. These complexities include:

• Lack of standardization for SDOH data: Screening for and documenting SDOH information is new for many providers; however, many efforts are underway to provide solutions to standardize screening tools, data elements and coding. As a side note, while many plans/stakeholders are working to develop CPT codes to document SDOH information, this is probably an area ripe for cross-discipline collaboration to develop standards for capturing this type of data.
• Capturing and sharing data in the EHR: The MOF team faced limitations within their EHR system because they did not have a specific data field that would allow for capturing the information and using it for tracking referrals and quality improvement. While they were able to find a workaround by repurposing fields, documenting SDOH data in the EHR is an identified challenge. Then once documented, the sharing information between health systems and the community providers of services is cumbersome given the lack of infrastructure and data sharing capabilities. 

One effort to overcome this challenge is happening in North Carolina where there is a progressive effort with NCCARE360, the first coordinated statewide network working to unite healthcare to community resources and social service agencies. There are a number of smaller efforts being led by health plans to do something similar.

• Privacy, and regulatory issues: Because the food bank is not a covered entity under HIPAA, the MOF requires patients to be in-person to authorize a release of information that drives a referral to the food bank, limiting access for some patients to the program. In addition, the MOF faced concerns under Stark regulations regarding inducement of patients; but were able to find a path forward by using a waiver granted through Ohio State University Wexner Medical Center’s ACO. As linkages between health systems and community-based providers continue to develop, more flexibility is needed to allow for partnerships and delivery of services that address social determinants of health. Proposed changes to Stark and Anti-kickback regulations may help to facilitate this effort.

• Finding sustainable funding: Food referrals are not a benefit covered under Ohio Medicaid. Currently, the program uses internal funding with plans for seeking grant or foundation sources. Ultimately, Medicaid funding is a long-term goal. As the industry shifts to value and addressing SDOH is recognized as an effective strategy for lowering costs of care, more sources to fund effective intervention strategies are needed.