One Year Later: FoodFARMacy Shows Sustained Health Improvements and High Retention Rates

A follow-up to October 2024 coverage reveals sustained health improvements and challenges that lie ahead.

In October 2024, the University Health FoodFARMacy initiative launched as an ambitious pilot program aiming to serve 150 participants across five community partner sites. The “food as medicine” approach seemed promising, but like many innovative health care interventions, the true test would come in the data.

One year later, the results demonstrate clear success.

The program ultimately enrolled 113 participants across six partner sites — falling short of the original 150-person goal but achieving something more significant: an extraordinary 81% retention rate over 12 months. In comparison, similar interventions typically see retention rates between 27% and 75%.

“We ended with six total sites and 113 participants,” explains Dr. Kelsey Gardiner, assistant professor of health studies at the University of Missouri-Kansas City, who leads the research evaluation. “That’s a lot for a pilot. It’s very common for a pilot to have 25 participants enrolled and just have one site included.”

The high retention rate becomes even more impressive when considering the complex circumstances participants face. “We’re seeing that half of our participants are reporting more than one of our chronic diseases listed, and we even had one person enrolled report up to six of the chronic diseases that we have on our list,” notes Gardiner. “So the medical need is high.”

The six partner sites included NurtureKC, University Health Behavioral Health, Guadalupe Center, University Health Women’s Clinic, KC Care Health Center, and Altruism, Inc. Four sites have completed the full 12-month program, with two ongoing through November 2025.

Transformative Health Outcomes

The program’s health impact data tells a compelling story of sustained improvement. Participants demonstrated statistically significant improvements in both food security and nutrition security measures over the 12-month intervention period.

Food Security Improvements:

• At baseline: 100% of participants were food insecure, with 78% in the “very low” food security
• After the 12-month intervention: 33% were considered food secure, meaning they no longer had food access issues
• Only 25% remained in the “very low” category, down from 78%.

Nutrition Security Gains:

• At baseline: Only 3% reported “high” nutrition security
• At 12 months: 38% achieved “high” nutrition security
• “Very low” nutrition security dropped from 46% to 18%

Health Metrics Show Promise:

• Emergency room visits decreased from an average of 0.77 to 0.37 visits per three-month period
• A1C levels improved from an average of 7.03 to 6.31, moving participants from diabetic to pre-diabetic ranges
• Cholesterol panel readings showed improvements across all measures
• Veggie Meter scores — which measure fruit and vegetable consumption through skin carotenoid levels — increased significantly from 244.7 to 277.5

“We saw statistically significant differences in food and nutrition security when we assessed it at 12 months. So that just means there, it’s more likely than not that those numbers changed because of our intervention and not because of some other external factor that’s happening,” Gardiner explains.

Perhaps most telling are the behavioral changes that extend beyond the participants themselves. “One of my favorite things that we’re hearing is how much it’s impacting their family unit. So their kids are consuming the foods that they’re bringing home and now have a preference for them. Hopefully, we’re able to make an impact generationally,” says Gardiner.

The Power of Community Partnership

What sets FoodFARMacy apart from other food assistance programs isn’t just the fresh produce — it’s the coaching model that connects participants with trained community health workers, social workers, and case managers who already serve these populations.

“The model is very intentional in that we wanted to find sites that are working with patients and clients in more of a case management capacity already,” explains Gardiner. “We intentionally were thinking about folks like social workers, community health workers, case managers that actually have already established relationships with people, and also have the time and capacity to dedicate what is needed to be a coach in the initiative.”

Janet Rhone, University Health’s director of community health strategies, emphasizes the importance of genuine investment: “I believe it is essential that anyone working with our participants has a genuine vested interest. We hold the belief that food is medicine, and because we approach families and participants with that mindset, they are able to receive and experience it in that way. Our belief in what we do is what makes the impact real.”

Real Stories, Real Impact

The data comes alive in individual participant stories emerging from focus groups, revealing transformations that extend far beyond statistical measures. Rhone shares the account of a cancer patient who entered the program weighing just 97 pounds, malnourished, and struggling with food preparation: “Now she just recently completed the program. She went from 97 to her normal weight again, 130. She made it through cancer and is cancer-free at this point. She has learned how to prepare some of the different vegetables that she did not know how to prepare previously.”

The ripple effects reach entire families. Participants describe children who now prefer the fresh fruits and vegetables their parents bring home, creating generational changes in eating habits. One participant spoke about helping her elderly mother through cancer treatment, crediting the nutrition education and fresh produce with supporting both their health journeys.

Other participants report dramatic lifestyle changes that surprised even themselves. “People saying, ‘I used to drink multiple sodas per day. Now, I don’t drink any soda at all. I’m trying new fruits and vegetables that I always thought that I didn’t like, and now it’s a staple that I buy at the grocery store,” Gardiner notes from focus group feedback.

Beyond food distribution and nutrition education, the FoodFARMacy program incorporates individualized goal-setting as a core component of its coaching model. Participants work with their coaches to establish personal objectives during bi-weekly sessions, recognizing that sustainable health changes often require addressing multiple life challenges simultaneously.

The personal goals participants set often extend beyond nutrition, revealing how food insecurity intersects with broader life barriers. The program’s coaching model acknowledges that sustainable health changes require addressing multiple obstacles that may seem unrelated to food but directly impact a person’s ability to maintain healthy behaviors. Some participants focused on organizing their living spaces, building social connections, or addressing other life challenges, with coaches supporting these broader wellness objectives through SMART goal methodology.

“We had participants with goals as simple as ‘I want to clean my closet because it’s so cluttered,'” Rhone explains. “That sense of accomplishment – we all know what that feels like.” These seemingly small victories build confidence and self-efficacy that participants then apply to nutrition and health behaviors. The holistic approach acknowledges that someone struggling with basic organization or mental health challenges may find it difficult to meal plan or prepare fresh vegetables, regardless of access.

Coaches help participants break down overwhelming lifestyle changes into manageable steps, celebrating achievements that might seem minor but represent significant progress for individuals facing multiple stressors. This comprehensive support model helps explain the program’s impressive retention rates and sustained behavior changes.

Recent assessments revealed one participant achieved a Veggie Meter score of 577 — considered excellent — after consistently eating more fruits and vegetables throughout the program, demonstrating measurable biological changes from dietary improvements.

Growing Movement Faces Policy Headwinds

The success comes at a critical time for food assistance programs. The FoodFARMacy model is part of a growing “food as medicine” movement that has identified 11 different organizations running unique programs within the Kansas City metro area alone. Statewide data collection through CDC grants is expanding this understanding across Missouri.

However, the field faces significant challenges. Recent federal policy discussions around cutting SNAP funding and expanding work requirements create additional barriers for the food-insecure populations these programs aim to serve.

“There’s a ton of data that exists on the importance of those programs and the support that they provide for food-insecure populations. We know that food-insecure populations have a much higher burden of disease than the general population,” explains Gardiner.

The connection between food insecurity and chronic disease burden makes programs like FoodFARMacy particularly relevant for health care systems focused on cost-effective interventions and population health management.

The Business Case for Food as Medicine

The FoodFARMacy team is working to build a compelling financial argument for insurance coverage of food-as-medicine interventions. While the decrease in food insecurity and emergency room visits alone suggests there could be potential cost savings for health care systems and insurers, the financial impact remains to be quantified.

“We’re also doing some additional research on potential cost savings to try to build that case for this model to be financially viable for health insurers, regardless of if it’s public or private,” explains Gardiner.

Insurers are already demonstrating recognition of nutrition’s importance in health outcomes. Some Medicare Advantage plans now provide supplemental benefit cards with monthly allowances — typically ranging from $50 to $200 — specifically for healthy food purchases through programs like UnitedHealthcare’s “UCard” or similar offerings from other insurers.

These programs, which vary by plan and are often targeted at members with specific chronic conditions or dual Medicare-Medicaid eligibility, operate through partnerships with major retailers. The cards automatically restrict purchases of items like candy, soda, chips and other ultra-processed foods while approving fresh fruits, vegetables, lean proteins, whole grains and other nutritious options. Some plans also allow the benefits to cover hygiene products and over-the-counter health items.

The supplemental benefits are authorized under federal Medicare Advantage regulations that allow plans to offer additional services beyond traditional Medicare coverage, but implementation varies by individual insurance companies and their specific plan designs.

Operational Lessons and Adaptations

The FoodFARMacy pilot has generated valuable insights for scaling food-as-medicine interventions. Initially, challenges included the training burden for FoodFARMacy coaches, such as the  CITI training requirements for research ethics and IRB processes, but these have become standardized procedures that coaches now view as valuable professional development.

“At the time, it was a huge hurdle to get through, but now we have a process, and coaches are saying we love the training, we think it was value-added professional development,” notes Gardiner.

The team is analyzing feedback from participants and coaches to identify potential improvements for future iterations. Focus groups and coach surveys are providing insights into program design, duration and delivery methods that could enhance effectiveness and accessibility.

“We saw that people jump from being food insecure to being food secure throughout the entire year. We’re also seeing with our nutrition security measure that they are reporting having the nutritional quality of food that they need to live a healthy life,” Gardiner explains.

Data gaps in electronic health records have highlighted the need for on-site biometric collection in future iterations. “We were relying on electronic health record data for some biometric data, and that’s something we for sure plan to change in the model the next time around to get higher quality readings,” Gardiner notes.

Demographic Impact and Health Equity

The program successfully reached populations most in need of intervention across both urban and rural settings, addressing food insecurity in communities often described as food deserts — areas with limited access to affordable, nutritious groceries. The addition of Altruism, Inc. in Lexington, Missouri, as the fifth partner site extended the program’s reach into rural communities, where food insecurity intersects with broader health disparities and transportation challenges that can make accessing fresh produce particularly difficult.

Urban food deserts present different but equally significant challenges, often characterized by an abundance of fast food options and convenience stores selling processed foods, while lacking full-service grocery stores with fresh produce sections. According to the U.S. Department of Agriculture Economic Research Service, food insecurity affects one in eight Americans, with rural areas typically facing higher rates than urban regions.

FoodFARMacy participant data reveals the program’s success in reaching underserved populations: 44% of participants identify as Hispanic or Latino, 35% as Black or African American, and 22% as white. Language barriers were addressed with 32% of participants primarily Spanish-speaking, demonstrating the program’s cultural accessibility.

Income data underscores the program’s focus on food-insecure populations: 43% of participants reported annual household incomes under $10,000, with another 38% earning between $10,000 and $24,999. Education levels varied, with 19% having eighth-grade education or less and 34% holding high school diplomas or GEDs.

The chronic disease burden was substantial, with mental health disorders (37%), hypertension (32%), and obesity (32%) being the most common conditions. High-risk pregnancy represented 17% of participants, highlighting the program’s potential impact on maternal and infant health outcomes. The complexity of participants’ health needs — with half reporting multiple chronic conditions — reinforces the program’s potential impact on health care utilization and costs.

Research Recognition and Dissemination

The program’s measurable success has attracted attention from the health care and research communities. The initiative has received nominations for MOCAN Healthcare Professional and Student Awards and recognition from America’s Essential Hospitals through their Gage Awards, which honor outstanding programs that improve health care quality and population health among marginalized populations. America’s Essential Hospitals represents over 300 hospitals nationwide that specifically serve low-income and underserved communities.

The research team has presented their findings through multiple academic venues, including four poster presentations at University of Missouri-Kansas City conferences with one second-place winner, two presentations at Society for Public Health Education conferences, and a presentation accepted by the American Public Health Association.

This level of academic engagement is notable for a pilot program, suggesting that the FoodFARMacy model offers insights for health systems seeking evidence-based approaches to food insecurity and chronic disease management. The comprehensive data collection approach has positioned the research to contribute meaningfully to the growing body of evidence supporting food-as-medicine interventions, with findings that can inform both program design and policy decisions at local and national levels.

“Because of the size, we have a ton of data and did a lot of learning,” reflects Gardiner. “We did surveying with our coaches about their experience being a coach and the training they received. We’re doing focus groups with both participants and coaches to not only learn about their experience in the program and health impacts that we couldn’t capture in the surveys, but we’re also asking things like what about the duration — would you prefer a six-month versus 12-month intervention?”

A Model for Replication

For health care systems and community organizations interested in replicating the model, the FoodFARMacy team is eager to share its experiences and emphasizes two critical elements: robust data collection and strong community partnerships.

“Make sure you have strong data, because people want to know about the outcomes. That’s honestly a gap that I see, especially in some of the community-based programs that are less funded,” advises Gardiner. “If you’re a nonprofit organization that’s just using your internal funds to do this, service is top of mind, as it should be. I think data collection is often a missing piece to build a strong case for getting additional funding or policy changes.”

Equally important is partnership selection. ”It’s important to work collaboratively and ensure you engage partners who bring the specific expertise needed,” emphasizes Rhone. 

The team’s collaborative spirit extends beyond their own partnerships to supporting others implementing similar programs. “This is ultimately their [partner organizations’] data, too. If that could help them get a grant to fund something in this space at their organization, we want them to be able to do that,” Gardiner explains. The researchers actively offer to analyze data for partner organizations and provide additional support for grant applications, demonstrating their commitment to expanding food-as-medicine interventions beyond their own pilot.

Building Awareness Through Education

The path forward for expanding food-as-medicine interventions involves both individual and systemic action. The research team emphasizes the power of sharing information and normalizing conversations about nutrition’s role in health.

“I think word of mouth is important. For those of us in this arena already, continue to talk to our coworkers, talk to people, share information,” suggests Rhone. “When you look at programming and research, education is key. Knowledge is power. As we continue to motivate, educate and teach participants about the importance of eating healthy, the importance of behavior change, how chronic disease is related to the food that we eat, I think that education makes a significant difference.”

The comparison to previous public health victories is apt. Just as children in the 1970s and 1980s went home to tell parents about smoking dangers after learning about tobacco’s health risks in school, today’s young people are learning about nutrition’s impact on health and carrying those messages to their families.

“When we go into schools and we’re teaching our curriculum, ‘Your Health is Your Wealth,’ and we’re teaching them about preventing chronic disease at an early age, these kids go home and start telling their parents about it,” Rhone explains. “Exposure is so important, starting young and going all the way through.”

Looking Ahead

The FoodFARMacy initiative stands at a crossroads. The pilot data demonstrates clear success, but sustainability depends on continued funding and supportive policy environments. The team is actively pursuing additional grants while contributing to statewide food-as-medicine advocacy efforts, including presentations at the Empower Missouri Advocacy Summit. Empower Missouri, the state’s oldest and largest anti-poverty advocacy organization, has been driving policy changes for over 120 years and operates a Food Security Coalition focused specifically on ensuring all Missourians can access nutritious food.

“The funding landscape moving forward remains the primary challenge,” Rhone acknowledges. “Are we hopeful? Do we think this has been a successful pilot? Yes, we are hopeful, and we think that it has been very successful.”

The program has demonstrated that food-as-medicine interventions can work in diverse community settings, from urban health centers to rural organizations, with populations facing complex health and social challenges. With proven results in hand, the imperative now is for health care systems to pilot similar programs, for insurers to recognize nutrition interventions as cost-effective preventive care, and for policymakers to prioritize funding that addresses the root causes of chronic disease rather than just treating symptoms.

The evidence is clear: investing in food-as-medicine programs yields measurable health improvements, reduces emergency room utilization, and creates sustainable behavior changes that extend to entire families. The choice facing decision-makers is whether to continue the expensive cycle of treating preventable chronic diseases or to invest in interventions that demonstrate both health impact and potential cost savings.

For the 113 participants who completed the program, however, the impact extends far beyond the pilot period. They’ve experienced not just improved health metrics, but transformed relationships with food, enhanced family nutrition, and — perhaps most importantly — proof that their health and well-being matter enough to invest in.

As health care costs continue to rise while food assistance faces potential cuts, research initiatives like FoodFARMacy point toward a different path forward — one where fresh produce truly becomes medicine, where community partnerships drive lasting change, and where the most vulnerable populations receive the support they need to thrive.

The question isn’t whether food-as-medicine works. The FoodFARMacy data makes that case clearly. The question is whether health care systems, insurers and policymakers will invest in scaling these interventions to reach the millions of Americans who could benefit from this approach.

 

To learn more about the University Health FoodFARMacy program, email chsi@uhkc.org or call 816.404.3320. Visit University Health’s Nutrition and Nourishment page for additional details.