Consider adjusting the dose to account for household size.

Food is often a shared resource within households. Patients who are caregivers in any capacity are more likely to share their prescribed food with household members, effectively not taking the optimal dose. Some programs have accounted for this by adjusting the monthly benefit amount to account for the patient’s household size.

It takes at least three months to see clinically significant improvements in HbA1C from a diet change; therefore, three months is the minimum recommended program duration for all FIM programs.

On the other end of the range, MTM programs longer than six months have been associated with greater impact on reduced healthcare utilization and cost. Associations between duration and outcomes for MTG and PRx are less studied.

Reassess patients at the end of the three-to-six-month period and continue enrollment if they continue to meet clinical risk factors and eligibility criteria.

“We insist on a 6-month minimum enrollment, because we think the data indicates that’s the minimum amount of time needed to see some meaningful efficacy.”

– Adam Shyevitch, About Fresh

About Fresh went from a single mobile food access truck to a national FIM vendor integrated in health care systems and retail settings nationwide.

Reassess patients regularly to escalate or de-escalate support as needed.

At the end of the three-to-six-month period, reevaluate patients’ program adherence, clinical outcomes, and social needs, then step up or down as needed.

For example, a patient receiving MTM may be stepped down to MTG or PRx after three or six months if an acute medical episode (e.g., hospitalization) or symptom (e.g., diabetes-associated neuropathy) has improved and they can now prepare their own meals.

Alternatively, a patient experiencing worsening diabetes control may benefit from stepping up from PRx to MTG tailored to their diet-related needs.

Design program food baskets with specific clinical outcomes in mind.

MTG programs will be most effective when foods provided are matched to the patient population(s) and health outcome(s) they aim to improve; and when they further consider what is replaced in the diet. For example, fruits and vegetables, rich in potassium and fiber, have well‑established benefits for blood pressure, but fairly small and inconsistent effects on blood sugar. For conditions and outcomes related to insulin resistance or adiposity, foods abundant in unsaturated fats such as nuts, seeds, plant oils, and avocados, and fermented dairy such as yogurt and kefir, may play a more important role, especially when consumed in place of refined grains, refined starches, and added sugars. Aligning food benefit design with the disease condition and clinical outcome of interest will help FIM programs maximize their impact on health.

Program design, including education, should also consider ways to ensure that the provided foods improve diet quality, rather than only replacing a participant’s usual food purchases. For example, an MTG debit card or digital wallet for fruits and vegetables may replace a participant’s existing spend on those items, reducing financial strain but without meaningfully improving dietary quality or clinical outcomes.

  PDF: Designing Medically Tailored Grocery (MTG) Benefits ▶

Select FIM service providers that prioritize food and nutritional quality.

The quality of the meals or individual foods provided directly influences clinical outcomes and patient engagement. For FIM interventions to achieve their intended effects, meals must be appealing and enjoyable for patients. Work with vendors that uphold rigorous food and nutrition standards, have a proven track record of delivering high-quality, nutrient-dense meals, and that encourage patient feedback when food quality falls short.

See how one organization describes characteristics of high quality FIM vendors, written for a California audience, but with national relevance.

Account for cultural preferences and food restrictions.

Cultural and religious food preferences, as well as food allergies or intolerances, influence the acceptability of a FIM intervention. Failing to recognize these factors may reduce consumption of foods provided, thereby reducing the intervention’s effectiveness. Incorporating patient preferences and dietary needs ensures that meals and foods are both culturally appropriate and safe, supporting engagement and positive outcomes.

When possible, source from local producers to enhance food quality and build social and economic value.

Values-based procurement that prioritizes local and regional food sources, along with production methods such as organic or regenerative practices, can enhance food quality through better agricultural standards and reduced transportation times. Local sourcing may also foster a sense of community connectedness for patients who receive foods grown by producers in their region.

   PDF: Designing Medically Tailored Grocery (MTG) Benefits ▶

FIM program delivery modes include home delivery; pick-up in-clinic or at a central community location such as a food pantry, school, or farmers market; or purchasing at a local or online food retailer. MNT and CM programs may be offered either in-person, virtually, or both.

Home delivery ensures near-universal receipt of food by eliminating transportation barriers and time constraints.

When available, financially feasible, and preferred by the patient, home delivery is valuable for patients that may be experiencing challenges related to access, time, mobility, or transportation.
Food hubs piloting MTG and PRx delivery have reported that FIM program participation is nearly 100% with home delivery, compared to as low as 65% when patients must travel to a central site to pick up food.

Learn why one supplier made the switch from pick-up to delivery. ▶

Pick-up at a central, community location can maximize patient access and minimize high program delivery costs.

If home delivery expenses are too costly or unavailable, a centrally-located, community pick-up site may be optimal. Pick-up at clinics, community-based distribution points (e.g., food pantries, schools, places of worship), or retailers work best when patients have regular access to these locations.

In-person delivery of complementary nutrition education programs may reduce barriers to technology access and promote interpersonal connection.

Patients with a lack of internet or cellular services or devices, low digital literacy, or who experience technological challenges may prefer in-person MNT and CM instruction. Additionally, some patients prefer in-person interaction, which may encourage engagement, adherence, and peer support.

Hybrid models that begin in person to build camaraderie and engagement, then transition to some virtual meetings, have also been shown to be effective and may encourage participation. Hybrid models also provide the opportunity for program staff to demonstrate how to access the virtual platform, which may preempt technological challenges.

Virtual access to MNT and CM programs may increase patient engagement.

Virtual nutrition and culinary education may be beneficial for patients with busy schedules, lack of transportation, or a preference for virtual interaction.

Clinical staff may also prefer to deliver nutrition and culinary education programs virtually, as virtual instruction reduces transportation time and enables flexibility if teaching kitchens are not available or co-located within the clinic.