Meal Delivery Programs Reduce The Use Of Costly healthcare In Dually Eligible Medicare And Medicaid Beneficiaries

Berkowitz SA. Terranova J, Hill C, Ajayi T, Linsky T, Tishler LW, DeWalt DA
Source: Health Affairs
Publication Year: 2018
Patient Need Addressed: Food insecurity
Population Focus: Dual eligible, Vulnerable/disadvantaged
Intervention Type: Best practices
Study Design: Pre-post with Comparison Group
Type of Literature: White
link: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0999
Abstract

Delivering food to nutritionally vulnerable patients is important for addressing these patients’ social determinants of health. However, it is not known whether food delivery programs can reduce the use of costly health services and decrease medical spending among these patients. We sought to determine whether home delivery of either medically tailored meals or nontailored food reduces the use of selected healthcare services and medical spending in a sample of adults dually eligible for Medicare and Medicaid. Compared with matched nonparticipants, participants had fewer emergency department visits in both the medically tailored meal program and the nontailored food program. Participants in the medically tailored meal program also had fewer inpatient admissions and lower medical spending. Participation in the nontailored food program was not associated with fewer inpatient admissions but was associated with lower medical spending. These findings suggest the potential for meal delivery programs to reduce the use of costly healthcare and decrease spending for vulnerable patients.

Insights Results

Overview of article

  • To determine whether home-delivered meal interventions reduced ED visits, “big ticket” services, such as inpatient admissions and emergency transportation, and overall medical spending, researchers examined claims from the Commonwealth Care Alliance (CCA), a non-profit community-based health plan that manages care for dual eligibles. Claims were included for patients who received 6 continuous months of 1 of 2 meal delivery services during the 2 year study period

Methods of article

  • A random sample of patients who did not receive such services were selected as controls. The first meal delivery programs was medically tailored based on patient needs (e.g., diabetes, renal) and customized by a registered dietitian. It provided 5 days’ worth of meals and snacks throughout enrollment. The second was not tailored, but it did provide nutritious meals. It provided 5 days’ worth of lunches and dinners only. Researchers included 133 participants as cases and 1002 as matched controls for the tailored program. The non-tailored program included 624 cases and 1318 matched controls

Results

  • Participation in the tailored meals program was associated with fewer ED visits (adjusted incidence rate ratio: 0.30; 95% confidence interval: 0.20, 0.45), inpatient admissions (aIRR: 0.48; 95% CI: 0.26, 0.90), and uses of emergency transportation (aIRR: 0.28; 95% CI: 0.16, 0.51). Participation in the nontailored food program was associated with fewer ED visits (aIRR: 0.56; 95% CI: 0.47, 0.68) and uses of emergency transportation (aIRR: 0.62; 95% CI: 0.49, 0.78), but not with fewer inpatient admissions (aIRR: 0.88; 95% CI: 0.69, 1.11)
  • Participation in the medically tailored meals program was associated with lower medical spending, compared to not participating (difference: −$570; 95% CI: −931, −208). Participation in the nontailored food program was also associated with lower medical spending (difference: −$156; 95% CI: −308, −5)
  • The average monthly program costs per participant were $350 for the medically tailored meals program and $146 for the nontailored food program. Subtracting the program costs from the estimated savings yielded a net savings of $220 for the medically tailored meals program and $10 for the nontailored food program
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