Using Medically-Tailored Meals to Boost Chronic Disease Care

May 16, 2019 - Chronic diseases are both costly and prevalent, with the healthcare industry shelling out billions each year to manage and treat these conditions. Although illnesses like diabetes, heart disease, and hypertension are preventable, many individuals face barriers that hinder their ability to keep healthy.  

Poor nutrition due to a lack of education or access to healthy food is a leading cause of chronic disease. People experiencing food insecurity often have poorer health outcomes and higher care costs.  

As vice president of clinical programs for Medicaid and CHIP at Health Partners Plans (HPP), a non-profit health maintenance organization in Philadelphia, Cathy McCarron understands these issues all too well.   

"In handling all case management services, I see member struggles and barriers to care – their social determinants," she said. "I have an understanding of what members need to address their healthcare needs, and food is definitely up there.”

In early 2014, HPP aimed to develop programs centered on fitness and nutrition education, with only modest results. Around this time, the Metropolitan Area Neighborhood Alliance (MANNA) of Philadelphia was achieving success with its medically-tailored meal and nutrition counseling program, called the food as medicine model.

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“In 2015, MANNA published a study that tracked average monthly healthcare expenditures of their clients before and after receiving MANNA medically-tailored meals. The program reduced clients’ monthly healthcare costs, with their average monthly visits to the hospital and length of stay decreasing significantly,” McCarron said.

"Our CEO William George attended a MANNA event and heard about this research. He committed to partnering with MANNA on the spot, and we soon piloted the medically-tailored meals and nutritional counseling program with a small group of diabetic HPP members.”

HPP and MANNA’s Food is Medicine program initially targeted 200 HPP Medicaid diabetic members. Program participants were in case management, and HPP worked to ensure that every participant was a good fit for the project.

“We assessed members for certain factors — high HbA1c, a new change in diet, or high utilization — and then we were able to determine if the member was ready for this dietary change. We made sure they understood that their diet was impacting the severity of their disease,” McCarron said.

"If the member agreed to participate, MANNA would reach out to the member, explain the delivery of the meals, and conduct a nutritional assessment. Members received three meals a day, seven days a week for six weeks, with the idea to renew two or three more times depending on the severity of their condition and their progress."

Since the HPP-MANNA partnership began in 2015, the program has expanded to serve 2,789 members. The program includes Medicare beneficiaries with chronic conditions and also serves members with illnesses such as heart disease, malnutrition, and kidney failure.

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Twenty-five percent of diabetic Medicaid members have seen their glucose levels drop since participating in the program. Their inpatient admissions and ER visit rates also decreased, and HPP saw a 20 percent reduction in overall medical costs per member per month.

The program increased member compliance with key HEDIS measures as well. In 2017, members with MANNA services complied with adult BMI assessment, annual Rx monitoring, and comprehensive diabetes care.

The key to these results, McCarron said, is the intersection of meal delivery, member education, and regular engagement.

“There are so many factors that contribute to the program’s success,” she said. “Is it the meal that helps make the change? Is it the conversation with the case manager? Is it the member deciding to go for a walk every afternoon? It's hard to pinpoint, but I think it’s a combination of all the above.”

“Some of the stories we hear from members are that their spouse has died, and they don’t even know how to go food shopping. Or, that they now understand portion control because of the program, and they’re starting to lose weight.”

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Comprehensive support is also a crucial element of the program, McCarron noted. HPP care managers consistently talk with members to understand the factors that influence their health and resolve the barriers that could slow members’ progress.

"We want to make sure that we have a comprehensive partnership with the member," she said.

 "For example, if a diabetic member tells MANNA that he or she is a parent, we will also provide meals for their children, because we found that parents often share their meal or give their meal up."

Additionally, because both partnering organizations are looking to achieve the same goals — improving health outcomes and reducing costs — the entities worked together to ensure the program would work.

“There was a big learning curve for us and for MANNA to make sure that we understood how we could both fit together,” McCarron said.

"It's not a vendor relationship. It's a true partnership. That's what's strong here because there are a lot of vendors in the managed care space, but this is different. We are both trying to address a need," she said.

McCarron added that health plans and community organizations need to understand the potential risks involved as well as the needs of each participating entity if they want to partner for a similar program.

"Health plans have to be willing to make the leap because this was a risk," she said. “We decided to try something that would benefit members that isn't in the usual package of what we offer.”

“From MANNA’s perspective, it was about understanding how to talk to a managed care. We want to hear that you're interested in metrics, that you understand the struggles of working with a Medicaid base. Because we're conscious of the limited funds and how best to use them, we want to hear that you're with us on that. MANNA has fully embraced that.”

Going forward, HPP will continue to connect with its members and determine the best ways to address food insecurity for all who experience it.

“We are constantly thinking about where this program will go next,” McCarron said.

"Since we partnered with MANNA, we've looked at food insecurity across our entire plan. It's happening across our entire membership, and we now know how we can support these individuals. That's the beauty of this partnership. It's brought the issue of food insecurity to light.”