UPMC Health Plan's Food as Medicine Pilot for Members With Diabetes

As health plans look for ways to address rising rates of type 2 diabetes and the social factors that complicate its management, UPMC Health Plan launched Fresh Funds in 2024: a food as medicine pilot in Allegheny County, Pennsylvania, that pairs grocery stipends with community health worker (CHW) support for members with unmanaged diabetes. Joan Eichner, DrPH, MPH, senior director of operations and evaluation at the UPMC Center for Social Impact, discusses how the program works, the social needs it has uncovered along the way, and early signs of its impact on participants' glycemic control and well-being.

What is Fresh Funds, and why did UPMC Health Plan focus on members with diabetes and an HbA_1c level above 7%?

In 2024, UPMC Health Plan launched Fresh Funds in Allegheny County, Pennsylvania, as a food as medicine pilot program. Fresh Funds targets UPMC Health Plan members who have been diagnosed with unmanaged diabetes and who are experiencing unmet social needs. The program's goal is to provide 200 eligible participants with a grocery stipend and community health worker (CHW) support for 6 months, free grocery home delivery through Instacart for 12 months, and optional support from a certified diabetes education specialist and/or health coach. Grocery stipends may only be used on diabetic-friendly food options approved by a registered dietitian, and stipend amounts increase with household size. UPMC Health Plan focused on members living with type 2 diabetes because of the condition's high prevalence and the substantial opportunity to improve participants' health through diet and lifestyle changes. The program targeted members with a recent hemoglobin A_1c (HbA_1c) level above 7% to reach those whose condition was rising in severity or already at higher risk.

How does the program work in practice, and what role do community health workers play?

The first step is an outreach call from a CHW to eligible members, during which the CHW shares basic information about the program, including that it provides one-on-one, in-person meetings to support participants in achieving their health goals. The goal is for participants to leave the program feeling more in control of their health and more confident in managing their diabetes.

When a member enrolls, the first meeting includes a review of program expectations, data privacy policies, and consent forms; education on UPMC's certified diabetes educators and health coaches; registration for an Instacart account; and assistance placing a first grocery order. That first order includes education on diabetes-friendly food alternatives and how to read nutrition labels. CHWs continue to provide in-depth education and recommendations during follow-up meetings, which occur approximately weekly for the first 2 months and biweekly for the remaining 4 months.

During follow-up meetings, the CHW and participant discuss unmet social needs, UPMC and community resources, and lifestyle management, including physical activity and nutrition education. CHWs also encourage and support members in regularly attending primary care, endocrinology, dental, and optometry appointments, and they remain available by phone to answer questions between scheduled meetings.

Beyond groceries, what other needs did the program uncover, and how were they addressed?

CHWs have identified and helped address unmet health-related social needs among participants, including unstable housing, utility bills, transportation, and social isolation. Support has included help completing housing applications and applications for county assistance programs, as well as applications for UPMC Transportation Services and the Medical Assistance Transportation Program. CHWs have also connected participants with community resources, including the UPMC Neighborhood Center and the Allegheny County Senior Center, both of which offer on-site and in-home activities for members experiencing social isolation. Many participants have self-reported that regular meetings with a CHW significantly decreased their feelings of loneliness and despair.

To help participants prepare healthy meals at home, some were also provided basic kitchen supplies, including a mini refrigerator with a freezer, a hot plate, and a starter set of cookware. Grocery home delivery has proved especially helpful for participants with mobility challenges, difficulty carrying heavy groceries, or transportation barriers.

What outcomes have you seen so far, and how are you measuring success?

UPMC Health Plan is evaluating the program's impact on participant health (HbA_1c levels and body mass index), participant experience (what worked, what did not, and what could improve), participants' ability to choose and prepare diabetes-appropriate food, and pre/post changes in health care utilization and cost. This evaluation combines participant surveys, interviews, health records, and health care claims data.

A midpoint review of participant health records has shown HbA_1c levels trending downward, and participant feedback about the program—particularly CHW support—has been positive. CHWs report that participants have shown increased confidence in day-to-day diabetes management, including reading blood glucose levels and establishing a routine for attending medical appointments. CHWs have also observed positive lifestyle changes among participants, such as increased physical activity, whether at home or at a local gym, and healthier grocery substitutions.

UPMC expects full program evaluation results within the next month. Those findings will be used to modify and improve Fresh Funds before expanding it to more participants and additional areas.

Participant Impact

The following examples, shared by Fresh Funds CHWs, illustrate the program's impact on participants.

One CHW has been working with a participant on incorporating more physical activity into her routine. The participant, who has anxiety and depression, often finds it difficult to get out of bed and move her body; during their meetings, she and her CHW have been taking walks together outside. The participant said she has felt more energized and was proud of how far she was able to walk. The two have also begun incorporating short workout videos into her routine, and she has continued to increase her physical activity while noting its positive effect on her mood.

Another participant described the healthier food swaps she has been able to make using her Fresh Funds stipend. "In the past, I never [chose] the healthy alternatives because I did not have the extra money to risk not liking the alternative, but now I feel more comfortable buying the healthy alternatives, and I have found that I like those alternatives," she told her CHW.

A third CHW has been working with a participant on medication adherence. At their first meeting, the participant said, "I know that this is a life-sustaining medication, and yet I still cannot remember to take it." She now reports being fully compliant with her medication regimen and does not anticipate any barriers to continuing to do so.