Cabbage is good for you.

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Prescribing Food Like Medicine Would Save Medicare Millions

March 12, 2014

In the continuing debate about how to control soaring healthcare costs, poor nutrition and lack of access to healthy food are routinely ignored.

This is the case despite the fact that in a country as wealthy as the United States, one in three patients nationwide enters the hospital malnourished, adding a host of additional health challenges to patients’ prognoses and millions in additional health care costs.

Malnourished patients are significantly more likely than well-nourished patients to be re-hospitalized and suffer poor outcomes. Malnourished patients’ medications do not work as effectively. They often remain in the hospital longer and in many cases cannot continue critical treatments such as chemotherapy because they are not getting proper nutrition.

Simply put, there is a direct and important connection between nutrition and disease treatment and management. Food is medicine.

Making sure patients have enough of the right kind of food to eat at home — meals that will help them heal — makes economic and social sense. A recent study estimated that if all states had increased by one percent the number of adults age sixty-five or older who received home-delivered meals in 2009, annual savings to states’ Medicaid programs could have exceeded $109 million. However, the problem goes beyond just food-insecurity — many medically prescribed diets are very complex to produce at home and expensive for a low-income household to afford. By tailoring home-delivered meals to individuals’ medical needs and expanding the program to the non-elderly critically ill, the potential for health care savings is vast.

So why aren’t we doing more?

Part of the challenge comes in recognizing patients who are undernourished. A second but equally important challenge is our failure to develop both public and private health insurance financing mechanisms that support programs with the skill and capacity to provide food that meets the nutritional needs of chronically and critically ill people who need help in obtaining sufficient amounts of healthy, nutritious food.

Take for instance home delivered meals programs — particularly those that offer disease-tailored diets such as renal, diabetic or low sodium — have been incredibly successful. To provide individuals with nutritious meals at home costs about $20 a day, compared to a hospital stay of up to $2,500 a day on average in a Massachusetts nonprofit hospital. One study estimates that the cost of treating nutrition-risk patients is 20 percent higher than treating a well-nourished patient with the same disease.

Patient outcomes also have been impressive. Studies show that patients with access to meals have fewer missed medical appointments, enhanced medication adherence, reduced trips to the emergency room, and lower rates of hospital readmissions.

A recent survey of healthcare workers conducted by Boston-based food and nutrition nonprofit Community Servings and Daniel J. Cohn, an Emerson National Hunger Fellow at the Congressional Hunger Center, found an overwhelming majority of respondents (96 percent) reported that medically tailored home-delivered meals improved their clients’ health.

Researchers at the OMG Center for Collaborative Learning tracked average monthly health care expenditures of clients of the Metropolitan Area Neighborhood Nutrition Alliance, or Manna, a Philadelphia-based medically tailored home-delivered meals program. The research showed that after 12 months, mean monthly health care costs for Manna clients were at least 37 percent lower than costs for the comparison group.

Given this success, it does not make sense that these programs rely largely on funding from discretionary government programs and private fund raising, which does not come anywhere close to meeting the demand for services, which have grown six-fold over the past year alone.

To better address the needs of our sick patients and expand access to medically tailored meals programs, we need to put a greater focus on making them an integrated part of the healthcare delivery system. Patients who are too sick to cook or cannot afford to buy enough food should be written a prescription for meals and it should be paid for through public and private health insurance.

In some hospitals, nurses and social workers are providing discharged patients with meals services – when they recognize a problem and resources are available. A few insurers have also begun covering meals services. But more providers and insurers should do so.

Meal services for the chronically and critically ill should also be a priority at the federal level. The U.S. Department of Health and Human Services could require states to include medically-tailored food and nutrition services as part of the Affordable Care Act’s Essential Health Benefits Package although there has been little action on this front. Every state can, and should, also take action to require adequate food and nutrition services in Medicaid and in private insurance plans within the state.

The good news is that there are now more incentives to act. Under healthcare reform, providers with high levels of preventable readmissions face losing a portion of their federal payments. More than 2,000 hospitals were penalized for preventable readmissions last year. As malnutrition is a major factor in preventable readmissions, hospitals have good reason to work to make medically-tailored food available to more patients.

The U.S. spends more than $3 trillion annually on healthcare. The penalties for failing to address this crisis will continue to grow more severe for our wallets and our health if we do not begin to acknowledge and act on the understanding that food can be a low cost intervention for the critically and chronically ill.

Robert Greenwald is director of the Center for Health Law & Policy Innovation at Harvard Law School. David B. Waters is CEO of Community Servings, a Boston nonprofit.
 

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