Increasing Access to Healthy Food through Food is Medicine, 2020–2025: Blue Cross NC and the Blue Cross NC Foundation

Abstract

This article reviews Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and its Foundation’s efforts to improve health through food since “Healthy North Carolina 2030.” It highlights Food is Medicine investments, partnerships, and interventions. It also announces a new 5-year initiative to address nutrition-related chronic conditions and reduce healthcare costs across North Carolina.

Introduction

Nutritious food plays a vital role in lifelong health and is one of the most significant factors influencing the well-being of North Carolinians. Understanding the critical role of food on health, the ability to access healthy food was a key component of “Healthy North Carolina 2030: A Path Toward Health.”¹ Today, North Carolina continues to rank below the national average in nutrition security when using a composite measure of the food environment, which includes both food insecurity and access to healthy foods.²

Lack of access to healthy food comes with a cost. In North Carolina, heart disease is the leading cause of death, followed by diabetes as the 7^th leading cause.³ Approximately two-thirds of deaths in the state, 50,000 annually, are linked to chronic diseases.⁴ Chronic conditions are also the highest cost drivers for our state’s health care system, many of which are diet related.⁵ There are estimates that chronic illness could cost North Carolina $65.5 billion in medical costs and an extra $26.6 billion annually in lost productivity by 2030.⁶

When the “Healthy North Carolina 2030” report was released, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) had already spent many years investing in efforts to improve access to food.⁷ Traditional corporate support and employee volunteerism efforts to advance community-level solutions for food insecurity were increasingly complemented by innovative research and development-style efforts to identify and test nutrition-based interventions that could be deployed to improve member health. The center of this was the creation of a Drivers of Health Strategy Team that targeted non-medical drivers such as food insecurity, as well as Care Management Teams that connected members with community services for unmet social needs.

At that same time, Blue Cross and Blue Shield of North Carolina Foundation (Blue Cross NC Foundation) was also evolving, from supporting healthy eating and active living programs focused on combating childhood obesity to understanding food and nutrition security as a key driver of health and utilizing more upstream strategies to drive systemic change. This included supporting coalition and network development to drive policy and systems changes at both the local and state levels to increase access to healthy food and advance models to transform the state’s local food systems. A key grantee includes the NC Food Hub Collaborative, which supports the growth and sustainability of nonprofit, mostly rural food hubs across the state that create new market opportunities for small farms and increase access to local, fresh food for the community.⁸

Over time, our interest in the potential of Food is Medicine to improve health and well-being continued to grow alongside increasing interest from communities across the state. Food is Medicine refers to food-based health interventions prescribed by healthcare providers to help manage diet-related conditions and address nutrition insecurity.⁹ Nutrition security goes beyond not having enough food to consistently avoid hunger and includes inconsistent access, availability, and affordability of nutritious foods that support health and well-being.¹⁰ A growing body of evidence demonstrates the potential of various Food is Medicine approaches to improve health outcomes and reduce health care utilization and spending.^11–13

Healthy Food. Healthy People. Healthy Communities.

Our Food is Medicine strategy is focused on increasing the integration of food-based interventions into health care to prevent, manage, and treat diet-related conditions. To deliver these interventions, we value mutually supportive partnerships among health care entities and community-based organizations (CBOs) and the use of fresh, locally grown food to support health, local agriculture, and rural economies. Food is Medicine programs look different depending on available resources, partnerships, and context. They often take the shape of locally delivered programs and range from medically tailored meals and food boxes to vouchers for purchasing healthy food at retail stores and farmers markets.¹⁴

In the early 2000s, Food is Medicine gained ground as a clinical strategy to address diet-related conditions and food insecurity.¹⁵ It has since evolved into a broader movement, driven by mounting evidence and growing awareness that nutrition is central to managing chronic conditions.¹⁶ This momentum is fueled by the rise of value-based care models and a desire among hospitals, health systems, and insurers for upstream solutions that tackle high-cost conditions like diabetes and heart disease.^17,18

Since 2021, the Blue Cross NC Foundation has invested significantly in Food Is Medicine.¹⁹ This has reflected what we call a “generative” approach, where the vital roles of all entities involved—including community-based organizations —are valued and supported to do what they do best.²⁰ Key approaches have included:

A statewide scan of healthy food prescription programs in North Carolina, to identify active programs, understand the diversity of approaches, and identify barriers and opportunities for further development. This became our roadmap for a multi-year effort to grow this work statewide.¹⁴

Grantmaking to community-based Food Is Medicine models, to support their infrastructure and capacities to strengthen and grow their Food Is Medicine programs and health care partnerships. This includes 9 organizations representing a range of models (Table 1).²¹

Table 1. Food is Medicine Grantees.

Grantee	Area Served	Food Intervention	Health Care Partners	Food Sources
ASAP (Appalachian Sustainable Agriculture Project) Asheville, NC	Western NC	Farmers market voucher Produce box	Community health center	Local farms
GRRO (Green Rural Redevelopment Organization) Henderson, NC	North Central NC	Fresh food boxes Produce boxes Medically-tailored meals	Hospitals Health insurer Health systems Councils of Governmenta	Local farms Food banks Food retailers
Conetoe Family Life Center Conetoe, NC	Eastern NC	Fresh food box Mobile market	Community health center Hospital Outpatient practice/clinic	Local farms Food bank Food donations
R.A.M.S Kitchen, Highland Neighborhood Association Gastonia, NC	South Central NC	Prepared meals Medically-tailored meals Produce boxes	Community health center Health insurer Health system	Local farms Regional and national broadline distributor
Feast Down East Wilmington, NC	Eastern NC	Mobile farmers market voucher	Health system	Local farms Food hubb Local aggregatorc
Hunger and Health Coalition Boone, NC	Western NC	Fresh and pantry food boxes Medically-tailored meal boxes	Health insurer Health system Outpatient practice/clinic	Local farms Food hubb Local aggregatorc Food bank Food donation Caterer and restaurant Regional broadline distributor
Nourish Up Charlotte, NC	South Central NC	Fresh food box Pantry box	Hospital Community health center Outpatient practice/clinic	Food bank Food donations National broadline distributor
Reinvestment Partners Durham, NC	Statewide	Prepaid debit card Healthy meals Produce prescription box	Hospitals Health system Health insurer Free clinic Community health center Outpatient practice/clinic Community service sites	Local and national grocery retailers Food vendors
TRACTOR Farm & Foods Spruce Pine, NC	Western NC	Produce box Fresh food box Pantry box Customizable CSA (community supported agriculture) share	Health insurer Community health center Health system Outpatient practice/clinic County health department and social services Addiction treatment services and rehab facility	Food hubb Local aggregatorc Local farms

^a Councils of Government provide regional opportunities for local governments to enhance and improve the quality of life for citizens through the effective delivery of services and programs.

^b Food hubs are entities that connect local farmers to markets and consumers by providing services like aggregation, processing, distribution, and marketing of locally produced food.

^c A local aggregator is an agricultural business or cooperative of growers that consolidates and distributes agricultural products for local or regional markets.

Community of practice coordination and technical assistance, to support peer learning among grantees and provide individual and shared training and technical assistance to maximize their impact.

Evaluation, to better understand the key components of effective Food Is Medicine partnerships between CBOs and health care entities.²²

Food hub infrastructure, to support connectivity among food hubs and cross-regional sourcing of fresh food to increase their ability to serve as a key source for Food Is Medicine programs.

The first North Carolina Food Is Medicine Symposium, featuring national and local experts highlighting the state’s unique community-based approach to Food Is Medicine, which is pointed to as a model by others across the country.²²

Food is Medicine Grantees

During this same time, Blue Cross NC tested various types of food interventions, including produce prescriptions, medically-tailored groceries coupled with health coaching, and Supplemental Nutrition Assistance Program (SNAP) application assistance. In 2021, the company collaborated with the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill to conduct a randomized clinical trial to determine the difference in food intervention with and without nutrition counseling.²³

A pivotal moment for us emerged through the favorable quantifiable evidence generated through the Food Delivery Health Coaching Pilot. Published in the New England Journal of Medicine, this research not only influenced the broader industry but also laid the foundation for scaling Food is Medicine through our health plan.^24,25 This led to the development of Feed Your Health, through which Blue Cross NC became one of the first health plans in the country offering a Food is Medicine program to commercial members living with uncontrolled diabetes. By integrating CBOs, the program also advances nutrition-focused care models and strengthens the role of local partners.

Our approach to Food is Medicine has evolved over time, based on our learning. This includes the understanding that providing healthy food may not be sufficient to drive meaningful health outcomes. The company’s initial focus on food security broadened as we learned that many of our members were also facing nutrition insecurity. According to internal Blue Cross NC data, nearly half of members with uncontrolled type 2 diabetes participating in a Food Is Medicine program were experiencing food insecurity, and more than half lacked consistent access to the nutritious food needed for health—a condition known as nutrition insecurity. Contributing factors include the affordability of healthy food, limited health literacy, and lack of cooking skills. Inspired by industry trends and the rise of culinary medicine, we have recently begun piloting experiential learning through cooking classes—commonly known as teaching kitchens—which empower individuals with practical skills and hands-on learning.

Collectively, our work has helped to cultivate a deeper understanding of several aspects of Food Is Medicine we believe are essential considerations for Food is Medicine programs and the field. This includes the critical role of CBOs in North Carolina’s Food is Medicine ecosystem and what it takes to build and sustain a Food Is Medicine partnership between nonprofits and health care entities (Table 2).

Table 2. Key Insights from Food is Medicine Community Investments, 2021–2025.

Much of the success of Food Is Medicine in North Carolina is made possible by CBOs, many of which are the driving force for these programs in their communities. CBOs are central to developing Food Is Medicine partnerships with health care organizations, securing funding, designing programs, and procuring and delivering food to participants.
North Carolina’s emphasis on the value of CBOs and local food in Food Is Medicine is unique and an important perspective to elevate as the movement grows and venture-backed approaches increase.
CBO partnerships with health care providers in Food Is Medicine are often fragile, despite a shared belief in their value. CBOs often receive no or inadequate compensation for their efforts.
Given their strong community roots, CBOs are uniquely positioned to provide services in a way that preserves client dignity through deeply relational interactions. These relationships help build trust and identify other challenges clients face, leading to increased connections and utilization of additional social services.
Both CBOs and health care partners need more data and support to illustrate the importance of Food Is Medicine efforts and facilitate new and sustained health care partnerships.

Looking to 2030

Building on more than 20 years of commitment to food and nutrition security and years of investing in Food is Medicine, Blue Cross NC and the Blue Cross NC Foundation have seen firsthand the impact of this work. In fall 2025, Blue Cross NC launched Health Through Food, a long-term commitment to expand access to nutritious food, reduce diet-related chronic conditions, and lower health care costs. The initiative’s five-year time horizon parallels the march toward the realization of “Healthy North Carolina 2030” and the goal of increased access to healthy food.

We are leveraging the power of food to double down on our commitment to:

• Equip individuals to make healthier food choices.

• Further integrate Food is Medicine into health care practice.

• Expand access to nutritious food.

We see this initiative as a key driver in helping North Carolinians become and stay healthy by reimagining the role food plays in health care. By seeking to create an impact on individual, community, and system levels, we aim to improve health outcomes, prevent and manage chronic diseases, and make health care more accessible and affordable for all. Through grantmaking activities by the Blue Cross NC Foundation and initiatives through Blue Cross NC, we are working together to advance Food is Medicine (Table 3).

Table 3. Future Focus: Advancing Food is Medicine in North Carolina.

Multi-year grantmaking to 9 community-based Food is Medicine approaches. Each has a proven track record of successful implementation and robust health care partnerships and a commitment to sourcing from local farms or food hubs. There’s also a planned assessment of how these models impact local farmers and food systems.
Exploring the design and capacity building requirements for a regional, centrally administered Food is Medicine “hub” that will reduce the burden of contracting with multiple organizations for both health care providers and nonprofits. This intent is to expand access to food-based care and streamline the flow of resources to community organizations, food providers, and producers, with potential for replication in other regions.
Leveraging the success of the June 2025 Food Is Medicine Symposium to explore the development of a multi-sector North Carolina Food Is Medicine network. To foster collective learning, collaboration, and coordinated action across the state. To more fully integrate Food Is Medicine into health care practice in North Carolina.
Enhancing training and support for health care providers inside and outside Blue Cross NC’s provider network. Help identify patients who could benefit from food-based care. Engage patients in nutrition education. Facilitate referrals to appropriate services.
Broadening Food is Medicine programming to reach more Blue Cross members diagnosed with nutrition-related chronic conditions through a variety of delivery models.
Accelerating adoption of the company’s nutrition counseling benefit by showcasing the value of dietitian-led care and deepening engagement between members and providers.
Expanding teaching kitchens across the state, in partnership with community organizations, to reach more people across North Carolina.
Leveraging Blue Cross NC employee expertise through skills-based volunteerism with nonprofits that promote healthy food consumption.

Conclusion

Across all 100 counties in North Carolina, diet-related chronic conditions are among the most pressing health challenges we face. As we respond, we’re guided by a core belief—food isn’t just fuel; it’s a vital foundation for living a healthy, full life and preventing the chronic conditions that cost individuals and the system the most.

As North Carolina’s only homegrown health insurer and the foundation that it funds, we recognize both the opportunity and the responsibility to lead, not just by financially supporting initiatives, but by transforming approaches that shape health. We are in a position to help break down barriers, build lasting infrastructure, and make Food is Medicine not just a promising idea, but a sustainable reality. As we look toward 2030, we’re building on the success of pilots, programs, community-based investment, and multi-sector collaboration to create a statewide system where nutritious food is central to preventing, managing, and treating chronic conditions.

Disclosure of interests

The authors declare no conflicts of interest.

Correspondence

Address correspondence to Merry Davis (merry.davis@bcbsnc.com).