Connecting Communities with Resources: Updates on PCIC’s Partnership with Houston Food Bank ^Featured

Community Assistance Program: Meeting Immediate Needs

Houston Food Bank partners submit referrals on behalf of clients using the online referral form.

The Community Assistance Program (CAP) connects patients identified by healthcare providers as food-insecure to Houston Food Bank’s vast network of resources. Through PCIC’s technology platform, referrals move seamlessly from clinics and hospitals into Houston Food Bank’s FIRST Link referral system, giving families faster access to food assistance, public benefits like SNAP, housing support, and other stabilizing services.

This quarter, CAP was strengthened by updating how providers, patients, and partner agencies access Houston Food Bank’s resource directory. Everyone can now work from the same, up-to-date list of community services, which reduces duplication and wasted effort. These improvements mean care teams can connect families to food assistance and other supports more quickly and reliably.

Medically Tailored Meals: Preparing for Launch

Later this year, Houston Food Bank will launch its Medically Tailored Meals (MTM) program, powered by PCIC’s Community Care Coordination (CCC) platform. MTM is a first-of-its-kind program in Houston designed to provide medically appropriate meals to patients living with complex, severe, or chronic illness such as diabetes and heart disease, designed by a Registered Dietitian.

How It Works

• Healthcare providers refer patients who qualify based on diagnosis-specific criteria.
• Referrals are processed through CCC, which manages enrollment, consent, and delivery scheduling.
• Patients receive meals tailored to their medical and dietary needs and are connected to a Registered Dietitian to support nutrition goals and overall health.

Impact on Patients and Providers

• Patients: Consistent access to medically appropriate meals, reducing readmission risk and improving quality of life.
• Providers: Clear visibility into participation and outcomes, supported by integrated reporting tools.
• Community: A holistic care model where nutrition is treated as a vital part of healthcare delivery.

Why This Partnership Matters

• For healthcare providers: CAP and MTM offer proven models for addressing social determinants of health, improving outcomes, and reducing uncompensated care.
• For community-based organizations: Integration with PCIC’s platform streamlines referrals and reduces administrative burden, enabling staff to spend more time serving clients.
• For funders & policymakers: Technology-enabled collaboration that scales impact—tackling food insecurity while improving health equity across Greater Houston.

Looking Ahead

In Q3, PCIC and Houston Food Bank refined enrollment workflows, meal scheduling logic, and data reporting functions to prepare for MTM’s launch while also enhancing CAP’s capacity to manage growing referral volume. These improvements reflect not only operational progress but also a shared commitment to creating replicable models of care coordination that other communities can adopt.

At PCIC, we believe technology should be more than a tool—it should be a bridge. By partnering with Houston Food Bank, we’re building bridges between healthcare and community services, ensuring that no patient has to choose between food and health.

If your organization is exploring ways to integrate healthcare and social care, we invite you to connect with us. Together, we can design solutions that are scalable, sustainable, and transformative for the communities we serve.

Learn more about Houston Food Bank’s programs: