Value-Based Care: The Essential Foundation for Food is Medicine

The Food is Medicine (FIM) movement has made remarkable strides in demonstrating how food can be a powerful intervention in healthcare. However, for these initiatives to be financially viable and sustainable, they must use the Value-Based Medicine (VBM) model. Without this shift, we risk setting up promising programs that ultimately fail due to financial constraints.

Why Value-Based Medicine is Essential for FIM

The traditional fee-for-service model in healthcare is not built to support multi-disciplinary or food-based interventions. A bundled payment structure is a far better fit because:

1. FIM initiatives involve multiple key players working together.

2. Some essential team members are not reimbursed by insurance, making their work financially unsustainable under traditional healthcare payment models.

A Warning Sign We Can’t Ignore

As FIM programs begin to quantify dose, duration, and FTE (full-time equivalent) needs, I worry. Why? Because without a value-based structure, we’ll face the same challenges community health workers who work in this space have already experienced. A community health worker recently told me:

“When a new financial officer came into the hospital, I was no longer allowed to go out into the community. Now, I have to sit at my desk.”

This is the danger of trying to fit Food is Medicine into a system that only values reimbursable tasks. If we fail to secure a sustainable funding model, we will see food-based interventions cut or de-prioritized when budgets tighten.

The Essential Players in Food is Medicine

Through my decades of practice as a Public Health Nutritionist, and my past four years of research in Food is Medicine and Culinary Medicine, I’ve identified core roles required to successfully implement FIM:

1. The Doctor is the gateway to the intervention. Physicians provide credibility and access to prescriptions, such as produce prescriptions or medically tailored meals. They do not have to have an expanded education in nutrition, although I applaud those that do take this step.

2. The Dietitian is the clinically trained expert in medical nutrition therapy on the team. They step in when a prescriptive nutrition intervention is required. A recent FIM recommendation proposed that a dietitian can manage a panel of 1000 patients.

3. The following are essential tasks that one person can be trained to do.

a. A care coordinator role to makes sure the process (from prescription to food) flows smoothly for the patient (typically a care or case coordinator)

b. Connecting the patient to resources in the community especially if food insecurity has been flagged (typically a Community Health Worker)

4. The missing team member is someone who teaches patients how to integrate nutrition recommendations into their daily lives (culinary medicine steps in here). This is the skill builder, which currently does not exist in the care team unless a dietitian has the time, has been trained in culinary techniques, and has been assigned to the patient, which is unlikely due to the size of their panel.

It is essential to provide hands-on support to the patient in the community where they live. This role is critical because healing happens at home—not in the clinic. These workers help bridge the gap between knowledge and action, ensuring sustainable, real-world impact. I developed and train Food Coaches to fulfill this role as they are trained in - food-coaching techniques using a research based modular approach, motivational interviewing, basic nutrition, and culinary training.

It is going to take more than a visit to the office to provide what is needed to support sustainable dietary changes. It will take trust and connection as well (we certainly learned this during COVID). This is what Food Coaches, and culinary-trained Community Health Workers and Health Coaches can provide.

The Call to Action: Value-Based Care is the Answer

If you’ve been on the fence about value-based care, now is the time to take the leap. The Food is Medicine movement is the perfect place to start. A bundled payment model allows for a collaborative, multi-disciplinary approach that ensures every essential team member is funded—not just those with existing reimbursement structures.

Let’s not fail before we’ve even begun. Let’s build FIM on a foundation of financial sustainability, collaboration, and true health impact. The time for Value-Based Medicine in Food is Medicine is now.