When a patient at M Health Fairview can’t afford food, Mang Vang can help

Imagine going to your annual checkup. You describe your symptoms, and the doctor writes a prescription or gives you a referral to a specialist.

Now, M Health Fairview patients may leave their appointment with a different kind of referral. If you “test” positive for food insecurity, you’ll get a phone call from a food navigator.

The call usually goes something like this:

Mang Vang, who joined Fairview Health Services in March, assures the patient that she can help them at no cost. Then they chat about options based on where the patient lives, their other medical conditions and their government-assistance status.

A patient may say that she hadn’t been able to get to her local food shelf during open hours. Here, Vang will reassure them that she can get a hold of a food shelf to make an appointment and help them through the process.

The patient may chat about other options, then, including a service that drops groceries at a home doorstep. Another service, called Veggie Rx, connects patients with boxes of culturally specific fresh produce from local farms.

At the end of a call, patients usually express immense relief, Vang said.

M Health Fairview created the food navigator position in response to the rising number of food-insecure patients who struggle to navigate food shelves and government assistance. The program also represents a growing recognition of how nutrition affects conditions such as Type 2 diabetes, asthma, obesity and high blood pressure.

Vang works with the hospital system’s neediest patients across five clinics in the east metro, connecting them to M Health Fairview’s Food Is Medicine program and external resources such as food shelves and government benefits. A second food navigator recently began work in the west metro.

The hospital believes the program is the first food-specific, one-on-one navigator model in Minnesota. But it’s part of an expanding health effort to go beyond offering simple health literature, said Dr. Diana Cutts, a pediatrician at Hennepin Healthcare and a nationally recognized expert in the health impacts of food insecurity. (Dr. Cutts is not involved in the M Health Fairview effort.)

“We have learned, painfully, that giving families a printout sheet or pamphlet isn’t enough. Way too many don’t make the connections that we’d hoped they might,” Dr. Cutts said.

The network of government and nonprofit assistance is confusing. Application procedures vary from program to program. One-on-one assistance can help patients break through these barriers.

Since the time of Hippocrates, practitioners have recognized that nutrition is a fundamental part of good health, Cutts said. More recent research has focused on how much food security affects health in positive ways. Yet helping patients access healthy food hasn’t consistently been a role of the medical system.

According to the nonprofit Hunger Solutions, Minnesotans made more than 7.5 million food-shelf visits in 2023 — a record number. And at any given time, one in nine Minnesotans experience food insecurity.

Public policy should be the route to change, Cutts said. For example, “there should not be an eligible pregnant person who hasn’t been enrolled in WIC” — that is, the federal nutrition assistance program for Women, Infants and Children. “And yet that happens often.”

Now, health care systems are stepping in to fill the gaps.

How do doctors diagnose food insecurity?

In a recent survey of health-care providers, 99% said that it’s important to screen for food insecurity in health-care settings; most said that at least some patients are screened at their hospital. But only 55% said that their hospital had systems in place to help hungry patients.

Food insecurity refers to households that don’t always have access to food; as a result of food insecurity, individuals can experience hunger.

In fall of 2023, primary-care providers at M Health Fairview started formally screening for food insecurity by asking patients to agree/disagree with two questions used by the United States Department of Agriculture.

• Within the past 12 months we worried whether our food would run out before we got money to buy more.
• Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.

Prior to this screening process, many doctors informally talked about food resources and helped patients through the hospital system’s Food Is Medicine program, which began in 2016. Over the past few years, however, doctors and clinical staff have increased the call to find stable, dignified food access for patients, said Terese Hill, M Health Fairview’s supervisor of Community Advancement Food System Strategy.

Now, if a patient agrees with either or both of those statements, a provider can flag Vang in the patient’s electronic health record.

Keeping track of food-shelf hours, so patients don’t have to

Vang has a background working with communities in the east metro. Most recently, she’s worked for the state health department helping to ensure that people get screened for cancer.

Patients respond to her soothing demeanor.

“I’ve been advocating for them, teaching them and helping them navigate in this really complex health-care system,” Vang said. “So when I saw [the] Food [I]s Medicine [position] open up, I’m like, ‘Hey, I love food.’ I didn’t know the whole realm of food insecurity, but when you put the two and two together, it’s like, ‘You know what? I can help you fight for that.’”

Vang usually starts her day at the Food Is Medicine offices, housed in the Fairview Community Health and Wellness Hub in downtown St. Paul. She’ll read through providers’ patient referrals and learn about the person seeking support. Doctors will note things like whether a patient is pregnant and needing food, or a parent of five kids who just lost a job.

If the patient speaks English or Hmong, Vang talks to them without an interpreter. She’s already found that some patients need much more hand-holding than others. One patient, for example, explained to Vang that her family suddenly had less access to food because the state had cut their food assistance.

The woman spoke Karen, so Vang asked her to call a Ramsey County benefits office to speak with a Karen-speaking benefits representative. But when the patient sounded deflated, Vang realized it was unlikely that she would place the call. So Vang connected her with a Karen-speaking culture broker — another new position at M Health Fairview — who could help call the county.

“The patient was very happy,” Vang said. But these interventions are most effective as a first step. The goal, she said, is  “How can we help you to help you?”

Vang can seemingly rattle off all the food-shelf hours and transportation options in the east metro. If a program involves filling out a form, she usually does that for the patient. She also has an array of low-cost grocery options to offer, including $40 gift cards to Cub, funded through external partnerships.

Patients can receive $80 vouchers to shop at the Twin Cities Mobile Market , a converted bus that stops near clinics to distribute produce and staples such as canned soup, bags of rice and cereal.

Salaries for Vang and the program’s other food navigator are funded through a partnership with UnitedHealth Group. Fairview funds the vouchers through its Fairview Foundation.

In 2023, about 500 M Health Fairview patients enrolled in food-voucher programs, according to an internal review. The hospital system found that food insecurity decreased by almost 10% among those patients; self-reported “good, very good, or excellent” health increased 13%.

Although there are no standard best practices among hospitals, one-to-one assistance makes sense, Dr. Cutts said.

Shopping at the mobile market

On a recent Wednesday afternoon, a small crowd stood in line to shop the bus parked near the Rice Street Clinic. One customer (and patient) today was Stephanie Anderson, a 51-year-old mother who recently moved to the Twin Cities to stay with a friend after losing her housing in Northfield.

New to the Twin Cities, Anderson hasn’t been able to find her desired fruits and vegetables at the local food shelf near her friend’s home. She’s overweight and knee problems hinder her mobility. After a doctor connected her with Vang, Anderson came to check out the mobile market holding a new voucher.

Anderson walked down the aisle of the “market,” where bus seats have been replaced with refrigerators. She carefully examined each shelf, and chose $6.64 worth of bananas, apples and butter.

“I’m real big on fruits and vegetables,” she said. “And it can’t always be canned.”

Struggling to find decent food adds to the stress of being homeless with health issues, Anderson said. With Vang’s help, she said, she’ll be able to eat healthier, cutting out a lot of the chips and processed meals she’s been relying on. She’s planning some InstaPot meals.

“You put a stack of carrots in a slow cooker there for like 20 minutes and you’ve got the best carrots you’ve ever had,” she said.

When Anderson checked out, the cashier wrote down her credit and let her know she still has $73.36 on the voucher. She’ll be back soon, she said, to spend it.

As Anderson headed to her car, Vang called out, “Remember, you can call me anytime!”

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