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1. Can you briefly describe your social prescribing program and the communities it serves?

Who we are, who we serve: A 501c3 nonprofit based in Oakland, CA, Open Source Wellness (OSW) was founded to address the stark reality that our healthcare system predictably fails members of our most vulnerable communities who suffer the greatest health disparities and inequities and, in turn, face the greatest barriers to access to services that can support them in having good health. 

Our vision is to create a world in which everyone experiences abundant health, wellbeing, and human connection, especially those who have been historically excluded and marginalized. 

Our mission is to create Community as MedicineⓇ (CAM) by partnering with communities and healthcare systems and providers to deliver joyful, trauma-informed, and culturally-relevant health coaching programs that promote health, wellbeing, and human connection.

Social Prescribing Program: OSW’s CAM group health coaching model advances health equity and improves physical, mental, and social wellbeing by breaking down silos and power structures, and engaging the communities served in co-creating solutions. A transdiagnostic, equity-centered, trauma-informed, and experiential model, CAM supports participants with physical activity, healthy nutrition, social connection, and stress reduction. CAM’s social prescribing focuses on addressing the underlying social determinants of health (SDoH) that residents of low-income underserved communities experience – lack of safe housing, transportation, nutritious food, social support, etc. – and that are associated with poor health and wellbeing. 

How it works: In our direct service program, we co-design CAM programs for and with residents of low-income communities of color in Alameda County, CA. We deliver CAM programs via partnerships with Recipe4Health, an award-winning, nationally-recognized Food As Medicine initiative of Alameda County Health and Federally-Qualified Health Centers (FQHCs) that refer their patients. We address the healthcare system's deficiencies by supporting individuals who have (or are at risk for) chronic conditions to realize their own health and wellness goals by participating in accessible, inclusive, and experiential community-centered health coaching groups. 1,500 patients participate in CAM groups each year; this is projected to double by 2029. Our CAM group health coaching sessions span 12 weeks of weekly 1 - 2 hour sessions. They are attended by 15-20 participants. They are offered both virtually and in-person and there are groups in English and Spanish. (Note: We are currently working to raise funds to expand to offer groups in other in-demand languages including Cantonese and Farsi.) 

When offered in conjunction with a clinical partner (e.g., an FQHC), the session includes a brief 1:1 visit for each patient attendee with a clinical provider (including MD, RN, or FNP) to monitor vitals and key metrics (e.g., bp, weight) and is defined as a group medical visit (GMV). GMVs are reimbursable under Medi-Cal, California’s Medicaid program. (See below: #3 - Funding).

2. What types of social prescriptions (e.g., arts, nature, volunteering) are referred, and who serves as the connector?

CAM participants, with support from their health coach, determine their goals or their prescription for health. OSW’s social prescriptions include those related to good nutrition, physical activity / movement, social connection, and mindfulness. The health coach supports participants in setting their goals and provides encouragement. Groups are experiential, which means that participants engage in these activities together, forming new habits, encouraging each other, and having fun together. Over time, the participant’s goals may change as they develop new habits and set new goals for themselves. These may include eating more fresh produce, increasing the number of minutes they walk each day, etc. The health coach serves as a sounding board and provides ongoing support - such as, through text messages - during the course of the program. Fellow participants become a supportive community, sharing lessons learned and often connecting with each other outside of the formal CAM sessions. Graduates of the 12 week program can continue to engage with CAM via OSWx, a weekly online CAM session open to all graduates of CAM. OSWx is led by peer leaders, graduates of CAM, and is overseen by a CAM health coach.  

3. How is your program funded?

Open Source Wellness (OSW) is funded through a combination of earned revenue and philanthropic revenue. The majority of the earned revenue supports OSW’s direct service program and a portion (via registration fees) supports the CAM health coach training program. Philanthropic revenue makes up the difference and funds most of the expenses associated with OSW’s CAM Learning Collaborative (CAMLC), which is an intentional strategy to spread and scale CAM via partnerships with organizations across the US. The direct service program also serves as an innovation laboratory for this strategy. 

Earned revenue: OSW is funded approximately 60% via earned revenue. Most of this is generated via our partnerships with FQHCs and other clinical partners and community-based organizations; a small portion is generated from the tuition for our CAM health coach training program (CAMTP) and from speaking engagements and consulting other organizations in developing CAM programs. Most of the earned revenue is from Medi-Cal, California’s Medicaid Program, which currently reimburses a portion of OSW’s direct service costs via the 5-year CalAIM pilot initiative that includes coverage of CAM under the Community Supports category of funding and, specifically, as a “Medically Supportive Food and Nutrition (MSF&N) intervention.” Some FQHCs reimburse OSW directly, in recognition of the net positive revenue generated by group medical visits (GMVs). 

Note: Explanation of how the GMV generates revenue for the FQHC clinic:  In a two-hour period, the typical length of a GMV with OSW’s CAM program integrated into it, providers at most can see 8 patients for 15 minute 1:1 visits. At best, patients come into the clinic once every 6 months for a 1:1 visit; most come at far less frequency. In a GMV, each patient steps away from the group for a brief 1:1 clinical visit with the provider. When CAM is integrated into a GMV, participants have this type of brief visit every week over the 12-week period. Both the 1:1 15 minute visit and the 1:1 visit during the GMV receive the same amount of reimbursement from Medi-Cal. In the 2-hour GMV, the provider can see up to 16-18 patients, a much higher number than in the same 2-hour time frame of individual visits.

Philanthropy: The remaining 40% of OSW’s funding comes from philanthropy; most of this is from philanthropic foundations (private, community, family). A small portion is from individual donors and sponsors of our annual fundraising walk. Philanthropy funds OSW’s direct services to some extent but primarily funds our work to spread and scale CAM across the US via partnerships with mission-aligned organizations including YMCAs through ourn CAM Learning Collaborative (CAMLC), described above.

4. How has social prescribing impacted the health and well-being of the people you serve and which outcome measures do you use to measure that impact? 

 Evaluation is a top priority for OSW. CAM has a documented positive impact on participants’ health and wellbeing. Through our research partnerships with Stanford University and University of California San Francisco (UCSF) we engage in rigorous research to measure the impact of CAM on participants’ health and well-being. Studies have documented the positive impact of our CAM group health coaching program on mental, physical, and social wellbeing. Key findings include: 

• 43% decline in depression

• 32% decline in anxiety

• 31% decline in social isolation

• 20% improvement in self-reported wellbeing

• Increased physical activity: 39+ minutes more/week

• Increased consumption of fruits and veggies: 0.8 servings more per day

• 32% with prediabetes/diabetes show meaningful improvement in sugar control

• 19-point decline in systolic blood pressure

•  77% decline in emergency department visits (comparing visits six months prior to attending group medical visits and six months after)

5. What advice would you give to others looking to start a social prescribing program?

• Consider what is important to those you are serving - what types of social prescriptions will help address the population of focus’ needs? What’s important to the individual patient? 

For example, perhaps even more than the general population, the population OSW serves experiences high levels of loneliness and isolation, and has a significant need for social connection. One of the greatest benefits of OSW’s Community As MedicineⓇ model is its focus on creating a safe place for people to come together to experience social connection. 

Other questions to consider include: Is the social prescription culturally-relevant to the individual/population of focus. Related to this, consider whether the prescription may unknowingly trigger past traumas? For example, a prescription to a solo activity, like a hike, may not be helpful for the person who has no-one to go with and fears being in nature alone. 

• As an organization serving underserved populations, OSW is focused on ensuring equitable access to the resources that are prescribed. Consider whether those given prescriptions actually have access to the resource they are referred to. For example, a prescription for a visit to a museum is not helpful for an individual who has no transportation or who has physical limitations that prevent them from driving or taking public transportation; or who does not have funds to pay for entrance to the museum.

• Make sure that the prescriptions given are realistic – for example, a prescription for daily walks in a park is worthless for a person who lives in an unsafe neighborhood with no parks nearby and who lacks transportation (a car, bus fare) to a safe place to walk; a prescription for healthy food is not useful for the person who lives in a food desert with no fresh produce available. 

Ask for input / feedback from participants. Make sure that those who are served by the social prescription program are engaged in co-creating it.