For Maria Cancel, director of social services at Brockton Neighborhood Health Center (BNHC), the importance of stable access to food is exemplified by the case of someone who had long struggled to get her diabetes under control.

Cancel recalled that that person, a regular patient at tce health Center, would meet with providers and take all the right steps to help her diabetes, but despite the health center’s efforts to provide the best medical care, the patient’s progress was limited.

When they investigated further, they realized that it wasn’t a problem with the care. Instead, it was that the patient had to make some tough financial choices given her limited means.

“She revealed she was skipping meals because she couldn’t afford to buy food,” Cancel said. “She was trying her best to manage her condition, but she was constantly choosing between paying her bills and buying groceries”.

BNHC staff members were able to connect the patient with a pilot program that in turn connected her with food resources, which is when her diabetes started to move in the right direction. Called the Healthcare Partnerships program, it was launched in 2020 by the food security nonprofit Project Bread that provided nutrition support that allowed the patient to become more engaged with her care, Cancel said.

“It wasn’t a medication that [turned things around],” Cancel said. “It was having reliable access to food.”

That patient wasn’t the only one helped by the program. A new report from Project Bread found that over the past five years, the program had significant benefits for patients and the health care system at large.

“The research reinforces a sort of critical role that health care providers and the health care system can play in connecting people with food and nutrition resources,” said Laura Siller, senior director of research and evaluation at Project Bread.

The Project Bread program was built out of a MassHealth initiative called the Flexible Services Program. That initiative allowed the state’s accountable care organizations — doctors, hospitals, and other providers, including Project Bread — that are focused on high-quality care for Medicaid patients to provide goods and services to improve food and housing security with Medicaid support. Project Bread’s Healthcare Partnerships program was launched in partnership with the state as its approach to use the federal dollars to close food access gaps.

Through the Project Bread program, patients were able to receive gift cards to help access food, kitchen supplies to help in food preparation and nutrition education. Eligible patients were also helped in applying to the federal Supplemental Nutrition Assistance Program (SNAP).

Since its inception, the Project Bread program has served more than 15,000 people across the state.

“When folks think about food insecurity, oftentimes [they] think about only food access. This program goes beyond food access to support clients,” Siller said. The Project Bread program’s impact also extends to “healthier eating habits and a greater confidence in [people’s]nutrition knowledge,” she said.

Siller said the Project Bread program stemmed from previous efforts to provide medically tailored meals. While those tailored offerings can be beneficial for some patients, especially those who are facing health conditions or treatments that limit their ability to prepare their own food, the health care partnerships program aimed to tackle the issue in a different way.

“The goal is to support people making their own meals,” Siller said. The result is a program that Siller said provides greater access to culturally or personally relevant foods, as well as longer-standing benefits like education around nutrition and how to budget while shopping for food.

“Being able to create your own food … and with our registered dietitians, that component can help keep prolonged understanding of health and nutrition at the forefront when you’re shopping,” Siller said.

In its report, Project Bread found that 93% of participants reported an improvement in overall health, and 92% reported an increased ability to prepare meals. One partner organization reported that the program led to meaningful decreases in A1C levels — a test that measures the amount of glucose in blood — in patients with the most difficulty managing their blood glucose.

“Ultimately, the program helps address this basic need that’s fundamental to good health,” Cancel said.

It builds on a broader landscape of “food is medicine,” which looks at access to food as a factor to manage or prevent health conditions.

It’s also an important factor in the broader health equity landscape, Cancel said. She pointed to a host of barriers that keep patients from fully accessing or engaging in their care beyond food insecurity, like transportation access or housing costs.

“If we can support even just the food, that makes a big difference,” she said.

That point is illustrated by the fact that the program helped fill gaps in food assistance programs like SNAP.

But some participants through the Project Bread program weren’t eligible for federal benefits under the SNAP program, for example those whose immigration status disqualified them.

Siller said that Project Bread doesn’t track specific data on how many people in its program are immigrants, but said that the organization can use data regarding the language recipients speak to have a rough sense. According to the report, about a third of recipients primarily spoke Spanish, and overall, nearly half of recipients primarily spoke a language other than English. Nearly three quarters of the recipients were Black, Hispanic or Latino or a race or ethnicity other than white.

For other residents who do rely on SNAP, those benefits may often not be enough to cover all their food needs anyway. According to an April report published by the Greater Boston Food Bank, 75% of respondents who received benefits through SNAP said they still needed additional food support.

“I think you need both, I don’t think it’s an either or,” Cancel said. “What we’re seeing in the community is they need everything they can possibly get.”

The program has also led to health care cost savings, the report found. Patients in the program paid roughly 29% less in health care-related costs in the 12-month period after they enrolled with the program compared to the 12-month period before, for an estimated $6,360 in annual savings each and more than $10.3 million in savings across the program.

Participation in the program also seemed to lower emergency department visits, which tend to be a more expensive alternative when patients seek first-line care there. According to a community health worker quoted in the report, many of the patients who participated in the program would go to the emergency department looking for food and water. The report estimated $1,100 in savings per patient due to reduced emergency department visits.

As the program has grown, it has settled into more solid footing in the landscape of food access resources in Massachusetts.

But its status is far from permanent. In a statement, Leran Minc, director of public policy at Project Bread, said as a supplemental covered benefit under Medicaid, when the funding runs out for the state, the funding runs out. He said that through Project Bread’s experience with the program, they’d like to see it categorized as a covered benefit so that funding would be more flexible and stable.

That goal, he said, reflects a broader priority for the nonprofit to see nutrition services better incorporated into health care. Ideally, that expansion would mean support through the federal Medicaid system, Minc said.

“There is solid foundation of evidence, including through our program, that ensuring robust access to nutrition can make a huge difference in an individual’s health, particularly if they are lower income or suffering from a medical condition,” Minc wrote in the statement.

For BNHC’s patients, Cancel said that ensuring the program’s longevity would mean continuing to address the barriers that prevent them from engaging in their care.

“When they have food to eat and can take their medication, and they have those resources in place, they’re less likely to go to the emergency department, they’re less likely to delay care,” Cancel said. “They’re not ending up in the hospital because of circumstances out of their control.”