Medically Tailored Meals Cut Inpatient Admissions, Healthcare Costs

May 06, 2019 - Participating in a medically tailored meal delivery program was associated with fewer inpatient admissions and lower healthcare costs, demonstrating the potential for these programs to improve health outcomes for vulnerable patients with complex medical conditions, according to a study published in JAMA Internal Medicine.

While a healthy, balanced diet is an important part of maintaining health and managing illness, the researchers noted that dietary adherence can be difficult for those with complex medical conditions. These difficulties are exacerbated for socioeconomically vulnerable individuals, who may not have the ability to access healthy food choices.

Medically tailored meal (MTM) programs offer a possible solution to these issues. MTM programs involve the home delivery of meals prepared under the supervision of registered dietitians. The meals are created to meet the specific needs of patients with complex conditions.

Although MTMs have the potential to boost patient outcomes, researchers stated that these programs may not completely eliminate the impact of socioeconomic challenges on a patient’s ability to maintain wellness.

“By helping to improve nutrition, MTMs may improve health and thus lower healthcare use and cost,” the team said.

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“Alternatively, it is conceivable that MTM delivery provides limited measurable value given the challenging circumstances of potential recipients. These issues often include poverty and attendant health-related social needs, such as lack of adequate housing and transportation, which MTM delivery may not address.”

Researchers set out to determine whether MTM delivery participation is associated with lower healthcare costs, fewer hospitalizations, and better outcomes. The group linked data from the 2011-2015 Massachusetts All-Payer Claims database with that of a non-profit MTM delivery organization.

The team found that when comparing MTM-eligible recipients to non-eligible individuals in the same area, recipients had significantly higher rates of healthcare costs and more comorbidities than nonrecipients.

Mean healthcare costs were $80,617 for eligible recipients, compared with just $16,138 for non-eligible adults. MTM-eligible individuals also had higher rates of cancer and diabetes than those not eligible for the program: 37.9 percent of eligible recipients had cancer, and 33.7 percent had diabetes.

Researchers then matched MTM recipients to nonrecipients based on their demographic, clinical, and neighborhood characteristics.

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They found that participation in the MTM program was associated with significantly fewer inpatient admissions, as well as fewer skilled nursing facility admissions.

Participation in the program was also associated with lower healthcare costs. The team estimated that if every individual in the study participated in the MTM program, average monthly healthcare costs would be $3838. If none of the individuals in the study had participated in the program, researchers estimated that average monthly healthcare costs would be $4591, representing a difference of approximately 16 percent lower healthcare costs.

The results show that participation in an MTM program was associated with fewer hospitalizations and lower healthcare costs. However, the researchers noted that it is unlikely that similar results would be seen in a healthier population, as the study participants had high rates of comorbidities and healthcare utilization.

In addition, MTM program participants had clinical, social, and nutritional risk factors that combined to produce a high, short-term risk of clinical deterioration if they did not receive some sort of intervention. While the combination of these factors isn’t unusual, the researchers cautioned against overgeneralizing the results to other contexts.

“For example, programs to reduce hospital readmissions or reduce healthcare costs among individuals with high past-year costs often include those with heterogeneous reasons for use of healthcare services,” the team said.

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“Because healthcare use in many of these cases may not be driven by the combination of clinical, nutritional, and social risk factors that MTM programs address, we would not expect to see the results observed in this study when applied to a more heterogeneous population.”

The group also pointed out that MTM programs may not be the best option for all patients.

“Individuals whose needs can be met with less-intensive activities (e.g., navigation into the Supplemental Nutrition Assistance Program or community resources such as food pantries) may not require MTMs. Conversely, individuals with high health care expenditures that are not driven by nutrition are unlikely to benefit,” the researchers said.

“A rigorous evidence base that elucidates when MTM programs are needed will be necessary for efficient use of healthcare resources.”

There were several limitations to the study. The researchers noted that while they knew that individuals in the control group didn’t receive MTMs, they didn’t know whether they received other nutrition interventions, such as Meals on Wheels or the Supplemental Nutrition Assistance Program.

Additionally, the study only provided data on patients from Massachusetts, so it is unclear whether these results would generalize to other states that have different levels of services and insurance.

Despite these limitations, the results demonstrate the potential for MTM programs to boost health outcomes among patients facing socioeconomic challenges.

“As the focus of healthcare in the United States turns to population health, the ability to intervene on health-related social needs will become increasingly important for improving both health and the value of healthcare,” the team concluded.

“Medically tailored meal programs represent promising interventions and deserve further study as we seek to improve health for all Americans, particularly the most vulnerable.”