FarmboxRx CEO Ashley Tyrner on Blue Cross Blue Shield of Tennessee Partnership

FarmboxRx, which describes itself as a “food-as-engagement company,” recently announced a  partnership with Blue Cross Blue Shield of Tennessee (BCBST) that aim to address statewide food insecurity while improving health outcomes and preventative care participation. BCBST members will receive deliveries of healthy food with condition-specific health education shipped directly to their doors after completing preventative health screenings. FarmboxRx CEO and founder Ashley Tyrner recently spoke with Healthcare Innovation about the key to her company’s growth and its impact. 

Since its founding a few years ago, FarmboxRx has shipped millions of pounds of fresh produce, healthy grocery items, and medically tailored meals to members of managed care organizations nationwide in all 50 states, and developed partnerships with more than 90 health plans.

Healthcare Innovation: Before we talk about this new partnership in Tennessee, could just tell the origin story of your company?

Tyrner: FarmboxRx is founded truly on my back story. Fourteen years ago, I was pregnant with my now 13-year-old daughter. I was on Medicaid, food stamps, living in a rural food desert in Arizona, and at that time the SNAP and EBT card couldn't be taken as a form of payment online. You can imagine all of the socioeconomic issues you face. Trying to eat healthy in a rural food desert is incredibly difficult when you lack transportation access as well. 

Ten years ago, I started Farmbox in New York City as a D-to-C business. We've always worked to eradicate the food desert problem America faces. We actually pioneered shipping produce to your door via FedEx or UPS. The Obama Administration had heard what I was doing. Michelle Obama's main initiative was to eradicate food deserts. So I started working alongside Sam Kass, who was the senior policy advisor to the Obamas, and the executive director of Michelle Obama's “Let's Move” campaign. We worked to push through the USDA getting SNAP and EBT to be accepted as a form of payment online. In my food policy work, I found out that the Center for Medicare and Medicaid Services in 2020 was going to allow food and produce to be offered as a benefit to members who had a chronic condition. I went out and found a health plan to work with in 2020. We really pioneered this category in healthcare. 

HCI: Which health plans did you work with first?

Tyrner: The first health plan was Vibra Health in Pennsylvania, which is owned by Capital Blue Cross of Pennsylvania. We then did a pilot program in 2021 with Molina Healthcare of New Mexico, and that pilot actually changed us as a company. We actually became a member engagement company. We knew coming into this market in healthcare, there was only going to be one winner that really mapped out how health plans should offer food to their members. The strategy for us coming out of this pilot was that if you offer food to individuals, they will do tasks that the health plan needs them to do as a managed care organization, per the Center for Medicare and Medicaid —  things like getting your mammogram, getting your diabetic eye exam, getting your flu shot, preventative measures like that. And there are Star ratings in Medicare and HEDIS scores in Medicaid, where the plan is judged and paid on how well they manage the care of individuals by getting them to do these really difficult tasks.

HCI: Are most of the plans that you're working with Medicaid managed care, or are you also working with Medicare Advantage plans?

Tyrner: We work with both. Most of the Medicare members are actually duals members. They're both Medicare and Medicaid.

HCI: How does an insurer like Blue Cross identify the population within its overall membership that it wants to reach out to with this offer?

Tyrner: If they're trying to engage the diabetic population, which is what the Blue Cross Blue Shield of Tennessee program is doing, they will look in their data for members who have had claims for Type 2 diabetes. They may even look at certain areas where they're having a really hard time engaging people in care management. Then they send us a list of these members, and that's basically our chase list that we send our boxes out to. And then we begin with outbound callings and and following up. 

HCI: Are there some agreed-upon goals that you and the health plan set ahead of time?

Tyrner: We definitely have benchmarks. We will tell the plan that we believe we can engage something like 30% of these members, which really boils down to data that we pull from CMS’ publicly available data of where the health plan is lacking in different measures. Some measures are harder to move the needle on than other measures. If we’re trying to get somebody in for their bone density screening or their colonoscopy, those are two really hard-to-move measures for health plans. So those would have a lower rate of engagement than, say, getting somebody into their primary doctor or  completing a health risk appraisal where they don't have to leave their home. 

HCI: Any next steps you want to talk about?

Tyrner: We're really focused on furthering our engagement piece in the box. We will begin to ingest claims data, where we will be able to use AI to do predictive modeling for explaining to the health plan through a data lake of members that they need to focus on, so the members that don't engage with their health planning, care management, or don't go do tasks, like their mammogram, their diabetic eye exam. It’s getting those members to engage, because they're typically the most sick and the most costly for the health plan to treat. That’s really our future: how can we use all of the data that we get on these members? At the end of the day, the populations that we're serving are typically low-income, so they're making very hard choices of if they're going to pay for their medication or food; are they going to pay for their food or their housing, right? Explaining to the plan about benefits that they need to give and how they need to engage populations is actually our end goal, because we really believe that there is no such thing as food as medicine in healthcare. If you don't have engagement for these populations, you can eat healthy all day long, but if you don't go get your mammogram done, you could still end up with breast cancer, right?

HCI: Is there anything else CMS or the state Medicaid agencies could do to make this work more efficient or easier for the people trying to engage in it?

Tyrner:  I think that they're on the path there. They're now really starting to look at whole-person health. This has survived two administrations. The idea of looking at the social determinants of health and the whole-person health of a member actually began in the Trump Administration under Seema Verma at CMS. Right now it's under the Biden Administration, with Chiquita Brooks-Lasure and she's doubled down on it. She said, we're not doing anything unless we look through the lens of health equity for these members that we serve.

I think just pushing more benefits around that whole-person health, like transportation, utilities, housing is key. I mean, they even have pet food now, because someone's pet can combat loneliness, so they'll give a pet food benefit. At the end of the day, we would love to see there be an actual budget for food for those who have chronic conditions — that the plan has to spend a certain amount of money on food for a member, just like they have to spend a certain amount of money for their overall care under their medical loss ratio. We would love to see that someday. We're a ways from that, but I think we're on the path.