Health Equity

Loren Bonner

Patients who come into a clinic at San Francisco Health Network (SFHN) can see fresh food displayed in a designated area. Sometimes it’s farmers market style or pre-bagged. But it’s there for them to take home along with cooking equipment, recipes, and even cooking demonstrations.

Food pharmacies began as a San Francisco Department of Public Health (SFDPH) pilot program within SFHN in 2015 and today have evolved into a multisector coalition in San Francisco of over 20 organizations including community clinics, nonprofits, and food businesses, working together to be a connector between food systems and health systems.

“A big part is connecting a patient to the health system—that’s why it [food pharmacy] is in the clinic,” said Erin Franey, MPH, who spoke during an APhA2024 session on this unique model that includes pharmacists. “Some patients get seen during food pharmacy models.”

The ultimate goal, said Franey, director of the multi-sector coalition Food as Medicine Collaborative within SFDPH, is to advance health equity and improve nutrition security and health outcomes through integrating healthy food into health care. SFDPH noticed disparities in patients’ hypertension control rates and wanted to do something about it. BP control rates in 2015 were 8% less for Black patients compared to overall rates.

In the United States, the concept of food as medicine is taking off and food pharmacies are one initiative that can reduce social barriers to healthy eating. According to a 2020 article in the American Journal of Lifestyle Medicine, food pharmacies can provide more accessibility to healthy foods as well as increase patient knowledge about food, health, and skill in preparing healthy meals.

Building relationships

“A big part of food pharmacy is really about that relationship building,” said Franey. “We want the space to feel welcoming. Folks can meet each other and share ideas.”

At food pharmacies in SFHN, patients can also be connected to food assistance programs and other health care providers.

Pharmacists’ roles

Program staff in food pharmacy models typically include health workers, nutritionists, and pharmacists who are meeting with patients, most often one-on-one in a community environment, taking BP reading and adjusting patients’ medications.

Currently, there are five food pharmacies at SFHN and pharmacists are involved in all of the settings to varying degrees.

Anusha McNamara, PharmD, is an ambulatory care pharmacy supervisor at SFDPH who sees patients in this model. Pharmacists practice under a comprehensive collaborative practice agreement, which means the patient just need to be diagnosed with a chronic disease for a pharmacist to manage the disease and prescribe medication, order labs, or make referrals.

“It’s a very high-level comprehensive practice and that sets us up to have this really great collaboration,” said McNamara during the annual meeting session.

Pharmacists in the practice don’t bill because the reimbursement for Medicaid—which most patients they see are covered under—is capitated.

“It doesn’t matter if we bill, it’s per member,” said Franey. “It’s more about the health care we provide and the metrics, and that’s what the health system recognizes in supporting our salaries.”

Many state Medicaid programs, including San Francisco’s, include waivers to pilot innovative programs, like food pharmacies. Franey believes that as the concept of food as medicine continues to grow, more state Medicaid programs will be looking to include these models as part of their health care offerings.

“Food pharmacy has been a space where pharmacists have been able to engage and build relationships with patients, and provide them resources to improve their health,” said Franey. ■