When I was in clinical practice, there were certain patients I thought about in the middle of the night. Many of them lived in poverty, were socially vulnerable, and were both medically and behaviorally complex. When they came to me for care, I often asked about the food they had at home—often, I heard that they didn’t have enough.
This lack of food forced them to make difficult choices and come up with creative ways of dealing with hunger. One woman ate mostly cookies since they were calorically dense and relatively less expensive. Others prioritized paying for food over paying for medicine.
Pictured at right: Lori Wiviott Tishler, MD
As a physician, I know that access to food is vital to health. I also believe in innovative care delivery and management models that focus on providing appropriate long-term services and supports to help patients stay healthier and engaged in their care. But providing services and supports that reduce food insecurity doesn’t happen in a bubble. Provider organizations and health plans can be successful at these programs by partnering with community-based organizations, both large and small, that already are working to address food-access issues.
A wonderful example is a program at Commonwealth Care Alliance (CCA), the not-for-profit, community-based health plan in Massachusetts where I work. Most of our members are dually eligible for Medicare and Medicaid, and food insecurity is a significant factor in their health outcomes. To address this issue, CCA started a program to bring home-delivered meals to members who need them.
Like the patients who kept me up at night, these members tend to be medically complicated, disabled, and isolated, among other challenges. Key to this program is our partnerships with several community organizations that provide home-delivered meals. Some of the organizations provide medically tailored meals—serving foods appropriate for a member’s specific dietary needs—while others provide meals that are nutritious but not medically specific.
Analyzing the Benefits
Although there is consistently good data to suggest that health care can be improved and costs can be decreased by providing food to people who are dealing with food scarcity or food insecurity, we at CCA wanted to dig deeper. We wanted to know whether our food delivery program was helping to improve the health outcomes of our members and whether the content of the food made a difference. To answer this question, CCA and several partners conducted a study that asked, “For people in food delivery programs, do medically tailored meals have a different impact on health compared with standard nutritious meals?”
Somewhat to my surprise, the answer is yes. This study found that meals tailored to the specific medical needs of our members decreased utilization of healthcare services more than did standard meals—making them high-value even though they cost more. In fact, members who received medically tailored meals had fewer emergency department visits, emergency transports, and inpatient admissions. Not only that, providing these meals saved CCA about $200 per month, according to a study in Health Affairs .
Non-tailored meals also decreased ED visits and emergency transports but did not decrease admissions. Among both groups, members generally loved the meals.
This finding wasn’t unique to CCA’s food delivery program. Numerous other organizations have had similar results: Project Angel Heart in Colorado demonstrated a 13 percent decrease in hospitalizations and a marked decrease in readmissions, especially when meals were accompanied by a nursing visit. Other studies have shown similarly positive trends.
Worth the Effort
Why such positive results? There is little question that adequate nutrition is key to good health, but these studies also suggest that specific contributions to a healthy diet provide more benefit than sufficient calories alone and that patients don’t have to make tradeoffs between healthy foods and other expenses. In some settings, connecting a patient or member with home-delivered meals can open connections with social services and care management, which can contribute to additional outcome improvements and lower healthcare costs.
Consider the economics: One day of home-delivered meals costs less than $25, but one day in the hospital costs upwards of $3,000.
As a duals program, CCA does benefit from the ability to use Medicaid dollars to help pay for this high-yield, low-cost intervention. It may be more complicated for commercial plans to provide similar services. However, the benefits—which include member satisfaction—seem entirely worth the operational, organizational, and cultural challenges. It’s common sense to provide meals to support patients who need them.
Lori Wiviott Tishler, MD, is senior vice president of medical affairs, Commonwealth Care Alliance, Boston.