美国国家公共电台 NPR Fresh Food By Prescription: This Health Care Firm Is Trimming Costs — And Waistlines

DAVID GREENE, HOST:

And when we go to the doctor, often we leave with a prescription 1 for medicine. But with the skyrocketing costs of treating lifestyle diseases, like Type 2 diabetes 2, some health care providers are rethinking how they use that prescription pad. Today in Your Health, NPR's Allison Aubrey is going to tell us about a large health care company in Pennsylvania called Geisinger Health System. They've started prescribing fresh food.

ALLISON AUBREY, BYLINE 3: This is a story that begins with a toe, a left pinky toe to be specific. It belonged to 56-year-old Tom Shicowich.

TOM SHICOWICH: One day, I looked down. It's a different color, and it started getting infected and felt really bad and septic. I thought I was coming down with the flu.

AUBREY: Twenty-four hours later, he was on an operating table. A surgeon amputated his toe, and it took two weeks of IV antibiotics 4 to treat the infection. He spent a full month in the hospital and in a rehab facility. He says the whole ordeal 5 was frustrating 6 and terrible.

SHICOWICH: Oh, I tell you - it was a bad year.

AUBREY: But the reality is, this was somewhat predictable. Shicowich has Type 2 diabetes, and he wasn't managing it well. Toe infections due to a loss of blood flow are a common complication, and they can be incredibly expensive. He racked up more than $200,000 in medical charges from his toe emergency. And the portion he had to pay out of pocket completely emptied his savings 7 account.

SHICOWICH: I did shell out to the hospital, like, $23,000 of my savings, and that was a big kick in the head.

AUBREY: It was also a wake-up call. Shicowich knew his health was failing. In addition to the toe, he was more than a hundred pounds overweight. He was fighting nerve damage, high blood pressure and kidney problems - all complications of diabetes. And he was feeling rotten.

SHICOWICH: So, you know, I knew it was a time for a change.

AUBREY: But he really didn't know what to do - until a year ago.

(SOUNDBITE OF ARCHIVED RECORDING)

SAM BALUKOFF: Folks, good morning, and welcome. I'm excited to be able to welcome you here to the ribbon cutting and opening of the Fresh Food Pharmacy 8.

(APPLAUSE)

AUBREY: Shicowich is one of about a 180 Type 2 diabetes patients who are participating in an intensive program aimed at getting them to change their diets and lose weight. Every week, he shows up at this pharmacy-turned-grocery-store located at a Geisinger hospital in central Pennsylvania. Here, he picks up a very different kind of prescription. He goes home with a week's worth of free, fresh food, everything from fruits and vegetables to whole grains, lean meats and fish. Shicowich says it's a huge change compared to the way he used to eat.

SHICOWICH: I'd stop at a Burger King or a McDonald's or buy a frozen Hungry-Man dinner, you know, basic quick bachelor food, you know, heat and eat.

AUBREY: But those days are over. He and his girlfriend now cook meals at home, and he's lost about 45 pounds. His blood sugar and blood pressure have dropped so much he's on course to reduce his medications. Now he can climb a flight of stairs or take a walk with his girlfriend, which would have been really difficult a year ago.

DAVID FEINBERG: Oh, my God. It's life-changing.

AUBREY: That's David Feinberg, a physician who is CEO of Geisinger Health System. He says, as he looks at Shicowich's progress, one thing stands out, a dramatic drop in his hemoglobin A1C. This is a widely used blood test to track how well patients with diabetes are controlling their blood sugar. A year ago, Shicowich's A1C was close to 11. Now it's down to 6.7. And this means, going forward, he has a much better chance of avoiding many diabetes complications if he can stick with the healthy diet.

FEINBERG: He won't go blind. He won't have kidney disease. He won't be impotent. He won't have neuropathies. The list goes on and on.

AUBREY: Shicowich's A1C level is important for another reason, too. When this program first started, some people questioned the whole premise 9, giving away free fresh food, a thousand dollars' worth per person? But Feinberg says as his team has tracked the hemoglobin A1C levels of the patients in the pilot program, they're also assessing medical visits, sicknesses and the cost of caring for these patients. It's still early days, but here's what they estimate so far.

FEINBERG: A decrease in hemoglobin AlC of 1 point saves us 8,000. As you heard this morning, almost every patient has gone from double-digits hemoglobin A1C down to 6 or 7, so 3 or 4-point decrease. That's $24,000 that we're saving in health care costs. And it's costing us about a thousand dollars. It's a really good value.

GREENE: Listening to that story there from NPR's Allison Aubrey who is with us to talk a little more about this.

Hey, Allison.

AUBREY: Hey, David.

GREENE: So I just want to make it clear here. I mean, doctors who treat diabetes - they have always tried to get patients to diet better and lose weight. And it's so hard. I mean, so is this just emphasizing that more? Or what is the difference here?

AUBREY: The difference is that what they've realized here is that you've got to support people in so many ways to help them make this change of eating better. So in this program, they're meeting one on one with registered dietitians. They're getting help on how to prepare food. They have support classes to help motivate them, phone calls to check in, you know, all kinds of social support and financial support. I mean, remember, they're getting all this free, fresh food, and these folks are all low income. So until now, the cost of the food had been a real obstacle.

GREENE: Well, if doctors are getting behind this - if the health care industry sees a way to save money, are we going to see more programs like this popping up?

AUBREY: I'd say there is a ton of interest in scaling up programs like this one. I mean, we're living in a time when about one out of every two deaths - from heart disease, from stroke, from Type 2 diabetes - is linked directly back to a poor diet. I mean, that's about a thousand deaths a day. And we spend $240 billion on diabetes-related costs. A lot of folks look at this and say, look, we have a health care system that really is more of a disease care system. We wait until people get sick, and then we try to fix them.

Our system pays for amputations, for scans, for ER visits, for dialysis. But we don't do very well at addressing the very root of the problem, which in so many cases, as we've just heard, is poor diet and lack of physical activity. So I'd say that's what Geisinger and lots of other folks are trying to change. At this moment in time, as our nation grapples with, you know - how do we insure people; how do we pay for health care? - pilot programs like this are very important because they start to put evidence behind the idea that prevention can pay.