If nutritious meals can provide the same kind of benefit as medication, then why don’t health plans cover the cost of medically tailored meals, just as they cover prescription medications? It’s a question my colleagues and I at Community Servings, a nonprofit organization that provides nutritious meals for people with critical illnesses who are too sick to feed themselves or their families, have been wrestling with for years.
The meals we provide keep people alive. Community Servings started in 1990 at the height of the AIDS crisis with meals for those living with HIV/AIDS. At the time, many people with this disease died of malnutrition as lean body mass was consumed to fight the virus. Today it serves people with a broad cross section of diseases, including cardiovascular disease, cancer, diabetes, and kidney disease. Community Servings now makes and delivers about 2,500 meals a day for as many as 15 different diets specially designed for particular illnesses or, in some cases, combinations of illnesses. Essentially, we manage complex dietary restrictions for people who are unable to do it on their own.
A new study published in JAMA Internal Medicine provides added validation of the medical and economic benefits of medically tailored meals. Using data from Community Servings and a statewide claims database from Massachusetts, the researchers found a 16% reduction in health care costs among patients who received medically tailored meals. The savings were attributed to a reduction in admissions to hospitals and nursing homes.
An earlier study, published in Health Affairs, found an almost identical reduction in health care costs among people receiving medically tailored meals compared to those not receiving this intervention. The savings in the study were due to fewer ambulance trips, emergency department visits, and hospital admissions.
With these two rigorous, peer-reviewed studies, there is now ample evidence for health plans across the nation to consider including medically tailored meals as a service for their members living with chronic illnesses. Poor nutrition and food insecurity are increasingly recognized as key social determinants of health. In other words, if someone does not have enough to eat, or their daily diet is inappropriate for a certain chronic illness, then it could be detrimental to their health.
Community Servings partners with the Commonwealth Care Alliance, a Boston-based community health care organization that provides coordinated care management to individuals living with a range of complex medical, behavioral health, and social needs who are dually eligible for Medicare and Medicaid. It has also entered into a partnership with Blue Cross Blue Shield of Massachusetts to provide medically tailored meals to its Medicare Advantage members who need post-acute care for congestive heart failure.
The Medicaid program in the state has transitioned to a new model in which accountable care organizations are paid a fixed fee for providing all care to their members. Next year, accountable care organizations will be required to address social determinants of health by offering services that can improve health, even though they are not services that have been traditionally reimbursed by health plans.
Nationally, value-based payment and other innovative models are emerging in New York, North Carolina, and Colorado. The Centers for Medicare and Medicaid Services plan to more broadly integrate social determinants of health into Medicare and Medicaid design. The commercial market will also likely adopt coverage as plans become convinced of the potential.
A few years ago, there was no reimbursement for medically tailored meals, and Community Servings and similar organizations nationwide operated entirely on donations and grants. The addition of reimbursement is substantial, though it falls short of a universal recognition of the value that medically tailored meals provide, both in improved medical outcomes and decreased costs.
The Food is Medicine Coalition is working to change that. The coalition, of which Community Servings is a member, is a national group of 15 nonprofit providers of medically tailored meals. These organizations are thriving in the greater metropolitan areas of New York City, San Francisco, and other cities in between.
The nutritionally tailored meals these organizations deliver help patients overcome four common barriers to achieving health: They improve access to healthy food; make it easier to change dietary behavior; remove the uncertainty of food supplies so individuals can focus on other aspects of disease management; and free up money for medications that would otherwise be spent on food.
All of this hews to Hippocrates’ edict to “let food be the medicine” while acknowledging the reality that by addressing nutrition first-hand we are addressing — and alleviating — illness and improving lives.