Perhaps more impactful from a policy standpoint was the pilot’s impact on birth outcomes. Fresh Rx lowered the rate of babies born too early (before 37 weeks) from 14.2 to 13.3 per 100 births, resulting in a savings of $15,400 within the Fresh Rx pilot and nearly half a million dollars ($461,000) when applied to the Medicaid population of St. Louis.
Cost savings from lower birth weights were even more significant. The rate of babies being born at 5.5 pounds or less dropped from 16.3 to 11.0, resulting in savings of $189,100 within the pilot, and more than five million dollars ($5,341,800) when applied to St. Louis’ Medicaid population.
“Those savings come from what we know of what it costs when a low birth-weight baby is born,” said Trina Ragain, Director of Policy and Innovation at Operation Food Search. “They end up in neonatal intensive care, which is expensive.”
The formal study will place women into three cohorts, including a control group, another group that will receive nutritious food plus consultations, and a third that will get all the nutrition benefits plus support from a licensed clinical social worker. By including social worker services, Fresh Rx is acknowledging that food insecurity often occurs alongside other barriers to healthy living.
So far, two of the state’s three health insurance plan providers have agreed to perform the Hunger Vital Signs food insecurity screening as part of their enrollment, which will provide a flow of participants, and Fresh Rx is working to add the third. Fresh Rx will examine the costs and returns of the three types of treatment by looking at the related health care claims. The program is the first of its kind to study pregnant women. “It’s on the cutting edge,” Perry noted.
In striving to prove an economic return on treating food insecurity, Operation Food Search is making its own investment, largely funded by partners, including the Bayer Fund. It currently has five full-time employees working on Fresh Rx and is getting ready to hire more. Current employees include a registered dietitian, a trained chef, a social worker, a member of the policy team, and a community health worker who is also a graduate of the pilot.
Fresh Rx anticipates investing an average of $1,000 to $1,200 per household to cover case management and provide three complete meals a week (including four to six servings for the entire household per meal) over the course of at least half a pregnancy and 60 days postpartum. “We’re trying to fill the SNAP gap,” Ragain said.
By conducting a randomized controlled study—considered the gold standard in determining whether a treatment will be effective—the food bank hopes to demonstrate a sustainable path forward for treating food insecurity through policy change. “The question is, can we get to a place where the savings analysis is appealing to all the stakeholders,” Ragain said.