Blue Cross and Blue Shield of North Carolina:
Scaling FIM Through a Vendor-Led Model
Blue Cross and Blue Shield of North Carolina (BCNC) serves members across a geographically diverse state with significant variation in food access, chronic disease burden, and community resources. Like many payers, BCNC recognized that for members with uncontrolled type 2 diabetes, traditional clinical care alone was insufficient to drive sustained improvement, particularly for those facing nutrition insecurity.
Rather than building food and logistics infrastructure internally, BCNC made a strategic decision to procure a FIM solution that could operate at scale across the state, adapt to different community contexts, and integrate with existing care management efforts. That decision led to a partnership with NourishedRx, a vendor that delivers an extendable operating system for FIM programs.
The Operating Model
BCNC’s approach reflects a vendor-led, configurable operating model, in which the health plan defines goals and target populations, and the vendor delivers and adapts interventions on the plan’s behalf.
NourishedRx operates nationally, combining technology infrastructure, food sourcing, and nutrition education into a single platform. This allows BCNC to reach members across the state while still activating local food ecosystems where member concentration allows.
“The national partnership gives us reach to every single zip code… but where we’re really differentiated is when we have a concentration of members in a particular geography. That enables us to source directly from farmers and the local food ecosystem.”
Lauren Driscoll, NourishedRx CEO
At the core of the model is a technology platform that supports:
- Member screening and stratification using validated tools, including the Nutrition Security Screener
- Longitudinal engagement and multi-channel communication
- Collection of patient-reported outcomes over time
- Analytics that support personalization and escalation to care management when additional social risks are identified
Matching Interventions to Member Needs
The program, Feed Your Health, is flexible by design, allowing BCNC to tailor interventions to clinical goals, budget constraints, and member preferences.
Food offerings may include one or more of the following:
- Registered dietitian-directed prepared meals
- Meal kits or groceries
- Produce prescriptions
Members often progress through different food programs over time. Some who started with prepared meals may graduate to meal kits or medically tailored groceries. Shifting between intervention types is desirable when it supports a member’s changing health care needs and when the program budget can bear it.
Alongside food provision, BCNC’s program includes nutrition education to support sustained dietary change. Experience across FIM programs shows that participation in nutrition education is highly sensitive to how education is delivered, not simply whether it is offered. To address this, BCNC’s partner, NourishedRx, delivers nutrition education through multiple formats, including one-on-one coaching, group sessions, and digital messages, allowing members to choose how they participate.
Measurement and Accountability
Vendors should track engagement, satisfaction, and clinical outcomes aligned with longitudinal payer reporting. NourishedRx collected patient-reported outcomes at baseline, midpoint, end of program, and 12 months post-program. These were compared to changes in health care utilization as analyzed by the plan.
BCBSNC observed these outcomes for commercially-insured members with diabetes:
- Improvements in glycemic control that appear during the program’s enrollment period. These were shown to be sustained for several months after enrollment ended.
- Changes in patient-reported health status
- Medical cost trends compared to matched controls
- Improved retention and quality metrics relevant to payer performance
A Patient Experience with FIM
Learn about one patient’s experience with BCNC’s Feed Your Health FIM program here.
Why This Model Matters
BCNC’s experience illustrates how a vended operating model can enable rapid deployment of FIM programs without requiring health plans to build food, technology, or education infrastructure internally.
Key advantages include:
- Speed to launch and statewide reach
- Predictable cost structures aligned with payer budgets
- Ability to personalize interventions at scale
- Robust data collection to inform future benefit design
The BCNC Foundation has long supported FIM programming in the Carolinas region. To learn more about other programs at BCNC, visit here and here.