PROJECT SUMMARY/ABSTRACT In the previous period, we have used national and state microsimulation modeling, cost-effectiveness analysis, legal and policy analyses, and real-choice experiments to elucidate the health, equity, and cost impacts of specific nutrition-related policies for reducing cardiometabolic diseases (CMD). Our work has identified among the most promising interventions to be Food is Medicine (FIM) strategies: incorporation of food-based nutritional interventions into healthcare to improve food and nutrition security, treat disease, and reduce health disparities. Such programs include medically tailored meals or produce prescriptions for patients with specific disease conditions, complemented by nutrition and culinary education, and often focused on populations with adverse social determinants of health (SDOH) from low-income or racial/ethnic minority backgrounds. Yet, critical questions remain, each identified and crystalized by our findings and interactions in the prior project period with key stakeholders such as healthcare sector leaders; government officials; patients, doctors, and other care providers; and FIM non-profit providers and private sector entrepreneurs. This new project will leverage the deep learnings and networks established in our prior project period to address the following critical aims: 1) to estimate the health, equity, and cost impacts of varying FIM program design options, including key elements of dose ($/mo), food groups, duration, and disease targets; 2) to assess intersections of FIM with other levels of healthcare interventions including (a) coordinated food insecurity screening and SNAP enrollment, and (b) new clinical drug treatments; 3) to investigate the administrative and legal feasibility of pathways for scaling FIM; and 4) to disseminate top findings to relevant scientific, healthcare, legislative, agency, and advocacy stakeholders. To achieve these aims, we will leverage our prior work on the etiologic effects of dietary changes and our validated national microsimulation model to estimate CMD benefits, costs, and cost-effectiveness, and further develop and validate our model to incorporate (a) food insecurity as a risk for health and cost outcomes, (b) the additional, non-CMD QALYs and costs of BMI as a risk; and (c) the health and cost effects of novel drug treatments (e.g., GLP-1 agonists). Effects on health disparities will be estimated using both difference-in-difference measures and semi-quantitative measures of disparity. We will perform new landscape, stakeholder, and legal analyses of (a) reimbursement coverage of FIM in Medicare and Medicaid; (b) integration of FIM into rapidly accelerating SDOH modules in EMR and clinical care pathways; and (c) pathways to align consumer education and communication, like SNAP-Ed and FDA food labeling, with a FIM approach. This will include qualitative research into legal authorities and limitations; and research among key stakeholders (e.g. patients...