How Payers Can Address Food Insecurity among Plan Beneficiaries

May 09, 2018 - Payers are constantly challenged to provide their health plan beneficiaries the best possible healthcare experiences, but may have trouble doing that if members experience food insecurity.

Food security is just one lifestyle need that plays into a member’s social determinants of health. Beneficiaries may have housing, transportation access, and additional socioeconomic challenges that make it more difficult for members to prevent or manage chronic diseases.

Poor nutrition and inadequate food access affecting an alarming number of Americans, and can lead to the development of chronic diseases that are costly to treat. Beneficiaries may also live in areas called food deserts where the only food sources are fast food or similar meal options with poor nutritional value.    

How can healthcare payers address food insecurity among their beneficiaries to improve wellness and decrease costs around chronic disease care?

How prevalent is food insecurity?

The most recent information from the USDA indicates that millions of Americans experience issues with food insecurity and accessing nutritional meal options.

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In 2016, 12.3 percent of the US population was food insecure (51 million people). In the same year, 16.6 percent of households with children were food insecure. Food insecurity rates barely changed from 2015 when 12.7 percent of the population was food insecure.

A small percentage of households with children experienced some of the most extreme cases of food insecurity. In 0.8 percent of households with children (298,000 households), one or more children experienced disruptions in food intake and eating patterns.

The USDA also found that food insecurity is more common in certain demographics. Higher than average rates of food insecurity were found in:

• Households with children and a single mother (31.6 percent)
• Households with children and a single father (21.7 percent)
• Households with incomes below 185 percent of the federal poverty level (31.6 percent)
• African American households (22.5 percent)

Data gathered by Feeding America found a greater number of food insecure areas in Southern regions of the US. An interactive map reveals that food insecure individuals may sometimes earn incomes that are just high enough to keep them from earning federal food assistance (SNAP benefits).  

In Mississippi, 20 percent of individuals are food insecure. In addition, 30 percent of all individuals earn incomes above 135-185 percent of the federal poverty level, making them ineligible for SNAP benefits and could overlap into food insecure populations.

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Similar food security barriers were found in Louisiana, Arkansas, and Alabama.

Food insecurity correlates to chronic diseases

Food insecurity has a strong relationship to the development of costly chronic diseases such as COPD, diabetes, and asthma, according to the USDA’s Economic Research Service.

The probability of developing a chronic condition in a food insecure household is 56 percent, compared to 37.4 percent in food secure households. Food insecure individuals also have double the incidence of terminal diseases such as cancer, stroke, and kidney disease when compared to individuals with higher levels of food security.

The research team determined that food insecurity is a standalone factor when determining a person’s likelihood of developing a chronic disease.

“Low or very low food security could make it that much more difficult to live with cancer or diabetes, all other things being equal,” the team said. “The effort to understand these correlations is also an effort to understand the extra challenges faced by low-income adults with any degree of food insecurity.”

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Food insecurity may also increase behaviors that lead to poor cardiometabolic health, an indicator of a person’s risk for developing diabetes, heart disease, and stroke.

Research conducted by the CDC and nutrition professionals at the University of Delaware nutritional experts found that food insecure groups were two times more likely to skip breakfast and 60 percent more likely to experience disruptive sleep patterns.

In addition, food insecure adolescents had a 65 percent increased likelihood of tobacco use compared to food secure peers. The findings indicate that food insecurity and nutritional issues may encourage individuals to participate in activities that negatively affect their health.

How payers can address food insecurity for their beneficiaries

Payers that want to address food insecurity need to partner with local organizations that specialize in food assistance for vulnerable individuals.

Local organizations may include food banks and pantries, farm sharing groups, advocacy groups, and related entities that provide meals to at-risk people. Payers could help these organizations by allocating payments and funding for meal sharing programs.

Health Partners Plans (HPP), a Philadelphia-area payer, developed the Food-as-Medicine program to address the relationship between chronic diseases and food insecure beneficiaries.

HPP partnered with a local group called Metropolitan Area Neighborhood Nutrition Alliance (MANNA) to provide food insecure members with 21 meals a week. HPP bundled the cost of meals per member based on expected healthcare outcomes.

The outcomes of the Food-as Medicine program included a 27 percent reduction in hospital admissions, a 6.9 percent reduction in ED visits, and a 15.9 percent reduction in provider visits.

For large commercial payers with millions of beneficiaries, community partnerships could help to identify and address the needs of members without regular access to nutritional choices.  

Food insecurity is a major part of Humana’s Bold Goal initiative, the payer’s long-term strategy to address community-level social determinants of health.

Humana found that food insecure older beneficiaries are 50 percent more likely to develop diabetes, 14 percent more likely to develop high blood pressure, and 60 percent more likely to experience a heart attack.

The organization implemented meal sharing programs and food bank partnerships to address food insecurity for senior members.

Food insecurity issues for a payer may also be related to an overwhelming amount of beneficiaries living in food deserts. Payers may wish to investigate partnerships with nearby farms and organic produce wholesalers to give members healthier food options.

BlueCross BlueShield of Arizona addressed food deserts in their member groups through a mobile produce program to offer beneficiaries more healthy eating options.

The Nourishing Arizona program has provided over 220,000 meal products and provides members with cookbooks and educational materials about healthy dietary needs. The service has expanded to nearly 1000 food deserts within the state of Arizona.

Managing food security issues is likely to help payers combat the development of chronic diseases, manage rising healthcare costs, and create better healthcare opportunities for their members.