FIM Community Action Plan

FIM Community Action Plan

The Food Is Medicine Community Action Plan (CAP) builds on Food & Society at the Aspen Institute’s Research Action Plan by translating the evidence for Food Is Medicine into practical, community-driven strategies that improve health, strengthen local food systems, and advance equity. Developed through multi-year convenings with clinics, community organizations, food producers, researchers, payers, and program implementers, the CAP highlights real-world innovations, elevates what works in diverse settings, and offers actionable guidance on designing, funding, evaluating, and scaling Food is Medicine interventions. Centering the community is essential because Food is Medicine programs succeed only when they reflect the lived experiences, cultural foodways, economic realities, and structural barriers of the people they aim to serve. When community voices shape design and governance, programs are more trusted, accessible, and sustainable, and they yield stronger health outcomes—bridging Food is Medicine as a clinical intervention with a community-anchored movement for long-term well-being and food sovereignty.

Food affects our physical and emotional health. In the US, there is a growing conversation about how best to involve food in our health care as a potent healing or preventative intervention. The phrase Food Is Medicine (FIM) has become shorthand for a set of practices involving the intentional application of food to prevent, manage, treat, or reverse disease. FIM is a trending phrase, but there is a meaningful history of FIM work by communities. For many years, communities have developed and implemented innovative initiatives to provide healthy meals and groceries to people experiencing health challenges. These initiatives’ successes have led health care systems, payors, and policymakers to look for ways to scale FIM to serve more people. Increased interest (and the potential for increased investment) has created a FIM implementation landscape where community-engaged initiatives share space with large established businesses and new technology-based companies. In many cases, community-engaged initiatives anticipate competing for FIM dollars earmarked to serve the same communities that these initiatives are already serving. The guide you are reading exists to remind readers of the broad range of community-based organizations and community champions working in FIM, to highlight the valuable contributions they make, and to explore why and how funding can flow to them.

Why FIM?

People in the United States eat a lot of unhealthy food. If there were such a thing as the average diet for an average person in the US, the diet would include many ultraprocessed foods and fall well short of doctors’ and scientists’ recommendations. At the same time, many people in the US worry about their households’ ability to afford enough food. Around 13% of US households in 2023 reported food insecurity at some point in the last year–meaning they had difficulty providing enough food for the household due to a lack of resources. Many of the people reporting food insecurity–and others who did not report food insecurity–would also meet the criteria for nutrition insecurity. People experiencing nutrition insecurity have difficulty consistently accessing affordable foods that promote health and prevent (or treat) disease.

Low quality diet, food insecurity, and nutrition insecurity are associated with the likelihood of having diet-related chronic diseases. In other words, diseases like diabetes, high blood pressure, and heart disease are more common among people with low quality diet, food insecurity, and nutrition insecurity. Diet-related chronic diseases are dangerous and expensive. TheyDiet-related chronic diseases are among the leading causes of death in the US, and estimates suggest that the US spends over $1 trillion per year treating diet-related chronic diseases. Prevention and management of these diseases has become a political, economic, and health care priority.

Food is Medicine (FIM) has become an umbrella term for food-based approaches to address specific health needs. FIM encompasses several categories of interventions, including medically tailored meals, medically tailored groceries, and produce prescriptions. Because FIM interventions are prescribed to improve the health of people with specific health conditions, they are different from–but complementary to–food and nutrition assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). 

FIM approaches show strong evidence of effectiveness, particularly for improving participants’ diet quality and food security. Likewise, FIM approaches have shown strong evidence of effectiveness in improving clinical indicators like HbA1c and blood pressure. In addition, in simulations and in practice, FIM approaches have shown potential for lowering the cost of health care over time. (For a deep dive summary of the state of peer-reviewed FIM research through 2024, see Food & Society at the Aspen Institute's Food Is Medicine Research Action Plan). 

The current evidence base highlights FIM’s promise of improved health to participants, lowered costs of chronic disease management to society, and economic benefits to producers and distributors of healthy foods. However, the general public–including health care workers–is not yet familiar with FIM. A 2025 public opinion survey showed that awareness of FIM is relatively low among the US public (13% had heard of FIM) and among health care workers (32% had heard of FIM). However, when survey respondents were provided with an explanation of what FIM is, more than 80% of the general public believed FIM could improve health in the US. This belief was shared across political affiliations by more than 80% of Democrats and more than 80% of Republicans. Likewise, when health care workers learned about FIM, more than 80% were enthusiastic about recommending it. These survey results suggest that now is the time to plan for how–and where–FIM is going to grow.

About Food & Society

Food & Society at the Aspen Institute brings together public health leaders, policymakers, researchers, farmers, chefs, food makers, and entrepreneurs to find practical solutions to food system challenges and inequities. Our goal is to help people of all income levels eat better and more healthful diets – and identify and nourish the leaders from all realms who will help them do that.

Food & Society’s Food is Medicine Research Action Plan, published in 2022, quickly became the definitive go-to source for FIM research—it is the only comprehensive overview of all peer-reviewed nutrition intervention studies. The revision, published in 2024 with continued support from the Walmart Foundation, fully updates the rapidly evolving body of research and authoritatively describes the opportunities as well as the challenges of scaling, evaluating, and delivering health-promoting food where it is most needed. 

This Community Action Plan is our next step in furthering FIM.  It facilitates community involvement, underscores the need for local voices and implementers, and highlights those in the field who are working effectively and innovatively to operate strong programs and access diversified funding. Ultimately, the aim is to have food be reimbursed, and this Community Action Plan is another tool to guide policy makers, implementers, and researchers in that direction.

Why focus on communities?

Community-based organizations (CBOs) and community leaders have been responsible for implementing FIM interventions for decades. As far back as the 1980s, CBOs across the US led the way in implementing the home delivery of meals and groceries to people living with HIV/AIDS. CBOs soon began to provide food services to people living with cancer, heart disease, and other conditions. CBOs–particularly including faith-based organizations–have also taken on much of the challenge of distributing food to people experiencing food insecurity. Local and regional food banks, medically tailored meal providers, and community-engaged health care champions have been vital partners in groundbreaking FIM research showing FIM’s potential to support improved health and food security outcomes among people living with a wide range of health conditions.

The success of community-engaged FIM initiatives can be attributed to CBOs’ and community leaders’ enduring presence, trust, and know-how. When CBOs’ and community leaders’ FIM initiatives succeed, it is often because these organizations and leaders have developed strong relationships with the people the health care systems serve. Successful community-engaged FIM initiatives often rely on leaders, staff, and volunteers from the communities served by the initiatives. These CBOs and community leaders have taken time to build formal and informal connections needed to serve as intermediaries among community members, health care systems, and food systems. To survive, CBOs and community leaders also evolved the ability to provide FIM services in environments where funding is inconsistent or comes from multiple sources that must be braided into a sustainable organizational budget. 

The most effective CBOs and community leaders consistently treat the communities they serve as more than a collection of consumers, health care patients, app users, or statistics. They understand that communities’ food preferences reflect culture, place, and shared memories. Effective CBOs and community leaders have invested the time necessary to understand the emotions and histories behind communities’ choice of foods for a 4th of July meal. Effective CBOs and community leaders embrace communities' lived experiences and understand that food is not only medicine. Communities do not gather at holidays to eat hypertension pills or inject GLP-1s.

Increased intake of healthy foods is an essential component of most FIM interventions.  However, simply making healthy foods available at no cost or reduced cost to FIM participants is not sufficient to achieve desired impact. Effective CBOs and community leaders use their knowledge, experience, and trust to engage communities as active ongoing participants in FIM initiatives. These CBOs need adequate reimbursement for the effort required to get nutritious, culturally relevant food to those who need and want it. Adequate reimbursement enables FIM growth and reach that is otherwise unattainable.  The next section of this guide describes what we heard from CBOs, health care payors, and others about important opportunities and challenges confronting CBOs’ and community leaders’ reimbursement for FIM. The guide will conclude with a series of impactful stories from the FIM field demonstrating how CBOs and community leaders promote increased engagement, duration, and dosage necessary to support community members’ health journeys.

Perspectives from the Field

A series of one-on-one interviews was conducted with representatives from five CBOs and six health care payer organizations, with the overarching purpose of identifying challenges and opportunities for FIM collaborations between CBOs and health care. Semi-structured interview guides–one for each group–were co-developed by Food & Society at the Aspen Institute and the Center for Nutrition and Health Impact. For the purposes of these interviews, we defined CBOs as regional or local organizations that provide medically-tailored meals, provide medically-tailored groceries (which includes some food banks and charitable food system organizations), or administer a produce prescription program.

Key topics explored with CBO representatives included characteristics of successful CBO-health care partnerships; types of involvement from payers that are most/least helpful in FIM work; challenges to working with payers; ideas for bridging gaps in CBO-health care partnerships; what CBOs would like to better understand about payers; what CBOs think health care organizations may misunderstand about them; and what makes CBOs appealing to payers. Key topics explored with health care payer organization representatives included the most important roles of CBOs in FIM work; how CBOs can best coordinate with payers and systems to engage in FIM initiatives; challenges to working with CBOs; what payers think CBOs may misunderstand about them; and how CBOs can make their case to work with payers. Both sets of interviews explored examples of successful CBO-health care FIM partnerships; systems-level supports needed to make CBOs more competitive in the FIM space. Below are key takeaways from the interviews, organized by the main topics discussed. 

Insights shared by CBOs

Characteristics of successful CBO-health care partnerships

• Partnerships that are a natural, rather than a forced fit
• Asset-based partnerships (e.g., partners are close in proximity, are “champions” in their respective spaces)
• Often include FIM initiatives that start with Medicaid, as its beneficiaries are often included in the initiatives’ intended populations

Most helpful types of involvement from payers in FIM initiatives 

• Sustainable funding and infrastructure – CBOs often spend time in constant grant writing cycles that can take away from capacity to implement FIM initiatives
• Data sharing/analysis – CBOs often lack HIPPA-compliant data infrastructure and/or lack research and evaluation expertise/capacity, so CBOs look to payer partners to fill this role
• Trust building in the intended impact community
• A demonstrated whole-patient care approach

A demonstrated whole-patient care approach

• Forced use of FIM initiatives where they do not make sense. For example, in some scenarios, leveraging SNAP, WIC, or other programming might be more relevant than a FIM initiative
• Unwillingness to take a risk and try something innovative themselves, and instead waiting for their payer peers to innovate first and/or waiting for a mandate from Centers for Medicare & Medicaid Services (CMS)
• Lack of understanding, appreciation, and/or willingness to provide funding or infrastructure for wraparound services (e.g., enrollment in federal assistance programs, homelessness prevention, transportation, etc) as part of FIM initiatives

Challenges to working with payers, from CBO perspective 

• Lack of consistent technology across FIM partners and inability for different technology systems to “talk” to each other
• Lack of uniform model or streamlined workflow for FIM initiatives
• Lack of sustainable and reliable funding source
• Payers’ lack of understanding/awareness of how FIM fits within the larger framework of social determinants of health
• A “push-pull” between pressures to both scale up and provide more tailored programming (e.g., interventions that are culturally relevant; serve pediatric populations; serve pregnant populations). CBOs may end up providing tailored programming not because they have the right experience or ability, but because they are responding to a guaranteed funding source. This ultimately does not benefit the intended populations

Ideas for bridging gaps in CBO-health care partnerships 

• Investment in a streamlined technology system (e.g., Coding4Food project), which aims to create new Healthcare Common Procedure Coding System (HCPCS) codes to integrate a spectrum of FIM interventions into the health care system

What CBOs would like to better understand about payers/health care entities 

• What are payers’ priorities for funding/programming that would allow CBOs to best position themselves to be a community partner for health care providers?
• What are the barriers to health care providers being authentically invested in FIM initiatives (e.g., time and training), and how can they be bridged?
• What tools exist to create projections of reduced health care costs and utilization, and how should CBOs be leveraging them? Related, due to lack of understanding of these types of data, CBOs may overpromise on outcomes that are not reasonable

Payer misunderstandings about CBOs (from CBO perspective) 

• Payers may perceive that CBOs have more flexibility than they often do
• Payers often want programs that run for longer periods of time, which is generally impossible without significant funding, or payers want programs to show dramatic change (e.g., in biomarkers or health care cost) within a very short period of time
• Payers do not understand or appreciate the full scope of what CBOs can do: outreach, engagement, nutrition education, follow-up, and quality improvement, to name prominent examples
• A related problem is payer ambitions vs. CBO realities of scope and scaling – CBOs cite payers as sometimes wanting an “Amazon.com” model of scope and scale

What makes CBOs (vs. large or for-profit vendors) appealing to payers (from CBO perspective) 

• CBOs often run high-touch, tailored programming, rather than the one-size-fits-all approaches that larger entities are inclined to operate
• CBOs have built durable trust and rapport in intended impacted communities
• CBOs can address more than just nutrition in their programming – CBOs can also address equity, cultural relevancy, provide wraparound services and referrals, and more. CBOs have the ability to support meaningful, population-wide effects
• From a public relations perspective, CBOs tend to be good at storytelling to diverse audiences

Insights Shared by Health Care Payer Organizations

Most important roles of CBOs in FIM work

• Provision of services that improve health care costs
• Fulfillment of food benefits; responding to community needs
• Partnerships with local and regional health care payers and systems

How CBOs can best coordinate with payers and systems to engage in FIM initiatives

• Show that they can improve total cost of care
• Collaborate with multiple CBOs to engage collectively with payers and systems to cover larger regions
• This remains a challenge—there may be no easy roles in the current system for CBOs at large scale

Challenges to working with CBOs

• Gaps in CBOs business capacities, including data security, contracting, and food sourcing
• Missing system-level infrastructure, including infrastructure to support data sharing and management
• Missing system-level entities to ease payers’ burden of contracting, referrals, and billing with multiple CBOs
• CBOs’ small or moderate scale often requires payers to contract with multiple CBOs to serve all members at scale

CBO misunderstandings about payers

• CBOs may not perceive that payers care about other metrics beyond per member per month (PMPM) cost
• CBOs may not perceive that many health care systems are losing money
• CBOs may not perceive that payers are experiencing significant financial challenges. Some payers are struggling to make payroll
• CBOs may not perceive that many payers believe the business case for FIM from a payer perspective is not yet made
• If a FIM service is not improving health outcomes and lowering cost of care, then that service is adding cost to health care by offering that service. CBOs may not perceive that additional money must be introduced in the system to pay for that service, which could include higher premiums in commercial insurance
• Among people with diabetes, there is an association between food insecurity and higher health care costs. CBOs may not perceive that data showing only that FIM services reduce food insecurity by itself does not convince payers that providing food to reduce food insecurity will necessarily reduce health care costs
• CBOs may not anticipate that establishing contracts with payers is a slow process. When payers contract with multiple CBOs, establishing contracts becomes even slower

How CBOs can make their case to work with payers

• Show that the CBO can help control payer cost
• Show the full cost to the payer of the CBO’s service at scale
• Show that the CBO can partner with others to provide services over a wide geography
• Nuances of case-making depend on which health insurance line of business is being discussed (e.g., Medicaid vs. Medicare vs. commercial insurance). In addition to cost, indicators relevant to case-making can include improvements in Healthcare Effectiveness Data and Information Set (HEDIS), quality “star” ratings, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, and more.
• Insurance data is not perfect, but there is only so much case-making that a CBO can do without access to data that most insurance companies consider to be proprietary. Rather than each CBO trying to prove cost-savings for the payer, an alternative approach to case-making may be to show that a CBO is part of a collective that can provide efficient and high-quality service across an entire geography of interest to the payer.

Putting It All Together

Below are summarized examples of successful CBO-HC partnerships, systems-level supports to make CBOs more competitive in the FIM space, and dissemination strategies that emerged across CBO and payer interviews. Case studies presented later in the report will provide deep-dive examples and further elucidate many of these findings. 

Examples of successful CBO-HC partnerships

Nourished Rx

Manna

State Health Alliance for Records Exchange

Reinvestment Partners

Systems-level supports to make CBOs more competitive in the FIM space

• Improved data infrastructure and data standardizations
• A technology bridge so that CBOs and health care systems can “talk” to each other or, better understand of how CBOs can best integrate into existing systems
• Intermediary organizations between payers and CBOs to assist with contracting, referrals, and billing
• Later, referral infrastructure and patient-facing service selection system
• An evidence base demonstrating the importance of CBOs in FIM systems