“Food as medicine” solutions are based on widespread recognition that nutrition is foundational to health.
Health plans have long offered home-delivered meals to post-acute members and access to food for chronic disease management; and, for decades, community organizations have led interventions that help alleviate hunger and food insecurity. Today, new technologies and payment mechanisms make it possible to take such programs and efforts to another level.
Food as Medicine 2.0 offers nutrition at scale while personalizing preferences and engaging individuals in journeys that enhance their health, wellness, and self-sufficiency. As a society, it gives us the potential to address some of the most daunting challenges of our time, including nutrition security, health equity, and spiraling healthcare costs.
Poor diet is the primary cause of death in the U.S., according to a 2018 study published in JAMA. Dietary risks accounted for over 500,000 deaths in 2016, more than COVID in 2021. This trend continues today, though the devastating impact is under-appreciated.
Fortunately, policymakers, health plans, researchers, and other stakeholders are taking action. Since 2020, Medicare and Medicaid health plans have been given more flexibility to offer supplemental food and nutrition benefits. In 2023, 1,717 Medicare Advantage (MA) plans offer expanded food, grocery and meal benefits, a tenfold increase since their introduction in 2020. CMS has also granted approval for three states to offer food and nutrition benefits in their Medicaid programs.
The Biden-Harris Administration added to that momentum in September 2022 when it convened a remarkable gathering of policymakers and leaders from healthcare and community-based organizations for its White House Conference on Hunger, Nutrition, and Health. Their strategic plan, the National Strategy on Hunger, Nutrition, and Health, included over $8 billion in public and private commitments to address health through food and nutrition, as well as incentives for payers and providers to screen for food insecurity, and a proposal to extend and expand MA’s Value-Based Insurance Design (VBID) model.
While important steps, more can be done to make a greater impact.
4 Steps for Enhancing Food as Medicine Effectiveness
By leveraging technology, data, and enhanced understanding of personal and social circumstances, health plans can engage members more effectively with greater impact on health outcomes and other measures. Specifically, health plans can:
1) Intervene earlier
Food as medicine programs are more successful when implemented earlier – before hospitalization, disease onset, or other medical events. Targeted preventive approaches do more to reduce admissions and readmissions than programs implemented post-discharge.
2) Make it Personal
While home-delivered meals and groceries are sometimes clinically tailored, there is great opportunity to enhance consumption, satisfaction, trust, and engagement by customizing food according to each member’s personal and cultural preferences, social circumstances, and available resources.
3) Recognize Broader Needs
Members experiencing food and nutrition insecurity are more likely to also struggle with other socio-economic barriers to health such as adequate transportation, housing, and financial resources. Targeted food as medicine interventions help health plans identify and address other gaps in care, social barriers, and personal needs.
4) Think Nutrition Not Quantity
Over the past three decades, most food programs and policies emphasize access to quantity over quality and lack important nutrition education elements. While leading to declines in food insecurity, diet-related health conditions such as obesity and diabetes have increased significantly. The vast majority of screening tools used to assess food insecurity do not include questions about diet quality. Investment in nutritious foods, education, new screening tools, and interventions that reduce barriers to nutrition access will pay significant dividends.
These efforts can be supported by thinking outside the supplemental benefits box.
While food and nutrition offerings within government programs are typically implemented through benefits and covered services, there are other ways to fund interventions while also enabling more comprehensive, whole-person care. Within MA plans, these include:
- Leveraging flexible benefits within VBID programs
- Incorporating food as medicine approaches within disease management programs generally and into Quality Improvement (QI) and Chronic Care Improvement (CCIP) programs for diet-sensitive chronic diseases and conditions
- Designing Rewards and Incentives (RI) programs that offer nutrition education and meal and grocery delivery to specific populations
- Integrating food as medicine into Special Needs Plan (SNP) model of care initiatives
A Brighter Future
Food drives health and conveys care. With the availability of new technology and robust data, increased attention to social and health equity barriers, enlightened policy initiatives, and innovative approaches to funding, we are on the cusp of major advances in the effectiveness of food as medicine programs.
Health plans can now address their members’ nutrition needs in a person-centered way while using food as the entry point for addressing more comprehensive social needs. Most importantly, they can do so at scale while improving health outcomes, satisfaction, and engagement; reducing overall costs; and enabling sustained dietary behavior change.