Health plans are under scrutiny to address social determinants of health, which include food insecurity and poor housing.
The idea that what you eat affects your health is as old as the first mother who said, “Eat your vegetables!” But modern healthcare is finally coming around to the fact that it costs far less to make sure high-risk patients have the right food than it does to keep readmitting them to the hospital.
With new studies appearing—including one in The American Journal of Managed Care® (AJMC®)—and new programs capitalizing on the idea, the “Food Is Medicine” movement is an idea that has arrived, in part because there’s finally a way to pay for it, says Brenda Schmidt, founder and CEO of Solera Health, the integrated health network known for connecting partners to deliver the National Diabetes Prevention Program.
For patients with chronic illnesses like diabetes or heart disease, “There’s a recognition that what is happening between doctors’ visits is more important than what is happening at the doctor,” Schmidt said in an interview with AJMC®. Having healthy food is a big part of that equation, and Solera is using its experience in connecting highly fragmented parts of the health system to help deliver medically tailored meals to high-risk patients.
In April, Solera formed a major partnership with Feeding America to help health plans address food insecurity, and more recently the network was selected by the California Food Is Medicine Coalition as a partner for a $6 million pilot program to scale their medically tailored meals for chronically ill Medicaid patients.
What’s driving it all? Health systems are on notice to address social determinants of health—things like food insecurity or lack of housing that cause the chronically ill to land in the emergency department or have higher medical costs. And because of that, CMS in May finalized a rule that allows Medicare Advantage plans to be reimbursed for supplemental benefits that can boost health outcomes, like providing specialized meals or Uber rides to patients likely to miss a medical appointment.
Schmidt explained that the rule allowing Medicare Advantage plans to supply appropriate food came after Congress passed the CHRONIC Act, which allowed Medicare to pay for these kinds of social supports.
“If food were a drug, it would be a first-line therapy,” she said. Trying healthy food before moving on to expensive drugs makes sense and costs less. “These low-cost solutions should be part of standard practice.”
That’s certainly what program directors from Maine found when they set up a pilot program to delivery medically appropriate meals to high-risk seniors recently discharged from the hospital. In results reported in the current issue of AJMC®, the authors found their program resulted in a 387% return on investment. (To hear a podcast with study co-author Katlyn Blackstone, click here).
The AJMC® study authors noted that today’s meal programs have evolved from the carbohydrate-heavy “comfort food” seen in Meals on Wheels programs of the past, which makes sense, as brand-new research appearing in BMJ Open shows how much dietary quality and quantity matter in treating chronic disease. These authors conclude that the rise of high-carbohydrate diets—and the decline of physical activity—in industrialized nations is directly linked to the current epidemics of obesity and cardiometabolic disease. Disrupting this pattern is essential, as people with diabetes should eat fewer foods that boost postprandial blood glucose.
Solera, Schmidt explained, can document both the cost and the quality of the food in medically tailored meals, which is important to health plans.
She noted that the movement toward Food Is Medicine has allowed entities like Feeding America, which began as a program to address hunger by eliminating food waste, to make the shift to addressing the obesity epidemic. Solera is working with food banks in the eastern United States to transform their programs along evidence-based disease prevention models.
Health plans and food delivery partners have joined forces elsewhere. MANNA, a meal-delivery program that sprung up during the AIDS crisis, is presenting results of its work with the managed care organization Health Partners Plans (HPP) this week in New Orleans at the meeting, “Health Meets Food: The Culinary Medicine Conference.”
“Food insecurity remains a substantial barrier to healthcare for far too many people,” said HPP President and CEO William S. George in a statement. “We are proud to be a national leader in the battle against food insecurity and other social determinants for the most vulnerable healthcare recipients.”