Building Cross-Sector Partnerships to Address Food Insecurity

December 24, 2019 - Food insecurity is one of the biggest social determinants of health. It affects over 19 percent of United States adults, according to data from the Centers for Disease Control and Prevention.

The effects of food insecurity spread across multiple sectors, impacting an individual’s health status, educational achievement, and employment status. 

While many insurers are starting to address the social determinants of health in their member populations, they understand that truly overcoming these challenges requires cross-sector partnerships.

Centene, a national managed care organization (MCO), recently teamed up with Feeding America to address food insecurity.

“We clearly recognize the importance of food security for our members,” said Laura Sankey, vice president of product strategy and social determinants of health at Centene. “We’ve got a lot of folks that are in need. Very quickly we started to think about this partnership with Feeding America and how we were going to do something a little different.”

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“There’s a lot of folks that understand the importance of actually providing food, whether it’s through a food bank or food pantry, but we were really trying to take a step back and figure out how to create something that is more sustainable to move the industry forward,” Sankey continued.

The partnership, Food for Today and Food for Tomorrow, will aim to create, test, and evaluate best practices and guidelines for medically tailored meal boxes. The goal is to understand the dose, duration, and frequency of the food needed for culturally sensitive meal boxes.

“We’re going to create definitions and the appropriate medically tailored meal boxes for adults with chronic diseases,” Sankey stated. “If you’re going to ask somebody to change the way that they’re eating, you need to make sure that you understand what types of foods this particular person wants and make sure that if there’s any cultural sensitivities, you’re including that.”

Centene’s de-centralized model emphasizes the importance of local partnerships, so the program will be piloted across several different communities beginning in 2020.

“Thinking about cultural sensitivity, we don’t want to pilot test in one area where there might be a certain dynamic and avoid someplace else,” Sankey noted. “We need to test within a couple of different locations so that we can understand cultural sensitivity and address the needs of specific regions.”

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Many MCOs and health plans are seeing the importance of investing in the social determinants of health, Sankey emphasized. But, oftentimes, that investment comes in the form of referrals to outside organizations that do not have the resources to accommodate an increased need.

“The people catching patients on the other end, meaning the folks at the food bank, are seeing a surge of referrals but not necessarily a funding stream. We wanted to solve that as well,” Sankey said. “We wanted to think of a way to move the industry towards value-based arrangements to include those community benefit organizations, such as a food pantry or a food bank.”

When deciding who to partner with for this initiative, Sankey said it came down to an alignment of goals that emphasized improving health long-term. 

“There’s a lot of folks that are out there who want to do good work, and certainly putting food in somebody’s hands is good work. But, we want to make sure that they understand how to do this in a way that’s going to also improve the health of that particular member,” she noted.

“It really has to start with a conversation, thinking about what you’re trying to solve, thinking about who else is trying to solve that same problem, and thinking about shared missions and goals,” Sankey furthered.

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The partnership did not happen overnight, she articulated. Discussions lasted over six months to establish clear goals and objectives for the collaboration. The two organizations had to make sure they were speaking a common language.

“While we’re talking about our regulations from the federal agencies and what we need to abide by, Feeding America has USDA regulations they need to abide by,” Sankey pointed out. “It’s a matter of really stopping and clarifying the language that one another is using.”

The partnership was able to grow as each player clearly understood the needs of the other after these conversations. Centene had conversations with many potential partners, but their missions or the timing did not align, Sankey said. Open and up-front conversations about missions, language, and goals can help ensure the success of the partnership.

“The term I always ask people to clarify is ‘capacity.’ When you talk about capacity or capacity-building with food banks and food pantries, capacity-building could be a need for a full-time employee to actually do some of the work.  It could be just needing another refrigerator or freezer to take on more food or a computer system so that they can document some of their work and communicate effectively,” Sankey noted. “Capacity-building is one of those terms that, depending on the sector that you’re talking about, you really want to define so that you’re all speaking the same language.”

Like all good things, these cross-sector partnerships take time, Sankey said.

“It takes time with these partnerships, but the end result is maximized,” she said. “When you have two large companies like Feeding America and Centene bringing their resources together, the end result is going to be fantastic because we have that shared mission and are trying to do good by the communities in which we’re serving.”

The partnership does not end with the development of the medically tailored meal kits. Feeding America and Centene will continue to work together to disseminate the results of their work.

“We see two different ways of dissemination. Feeding America and the network of food banks that they have within their association is one channel that will be disseminating this information,” Sankey explained. 

“Then, Centene is going to share it as well. We would be sharing the work with not only our health plans but our network partners as well,” she furthered. “That’s how you get to make sure that those medical providers really understand what we’re trying to achieve.”

Having multiple channels of dissemination means that the work will be spread across communities impacting patients at the food bank, when talking to their health plans, in their providers’ offices, and through public knowledge.

“We will publish the information for public use. It’s not just going to be a Centene solution,” Sankey asserted. “We’re setting our sights high to be thought leaders in that space. Ultimately, if we get the results that we’re expecting, then everybody will have this information at their fingertips to figure out how to do this consistently.”

“People are ready for this. They’re all starting to do this work but in a very non-standardized way. So, for somebody to collectively pull it all together and say, ‘Here’s how we should be doing it consistently in order to make sure we get the right outcomes,’ the time is right,” Sankey furthered.

Evaluation of their work will be multi-leveled, Sankey explained. Measurement for the effectiveness of addressing food insecurity is currently disjointed. One provider might ask a patient to fill out a screening form while another might look at where a patient lives compared to the nearest grocery store.

“What we started talking to Feeding America about was how to create a standardized methodology for this. It’s meant to equip those network food banks and Centene’s health plans with best practice guidelines,” Sankey said.

Future conversations between the partners will outline explicit measures of success, but in the meantime, Sankey is optimistic the partnership will help individuals lead healthier lives.