Reprinted with AIS Health permission from the Nov. 4, 2021, issue of RADAR on Medicare Advantage
The delivery of prepared meals, often triggered by a hospitalization, has played a steadily increasing role in Medicare Advantage plans’ efforts to manage members’ chronic conditions, but now the more nuanced area of nutrition is starting to gain traction as a supplemental benefit offering. Nutrition services vendors say offering healthy food options and education to at-risk members can result in major medical cost savings for plans.
According to a recent Avalere Health analysis of selected non-medical benefits offered by MA plans in 2022, 30% of plans will feature a nutrition benefit next year, compared with 17% of plans in 2021. For that analysis, Avalere focused on four benefit categories — meals, transportation, nutrition and in-home support services — differentiating nutrition as “general education and nutrition counseling from a practitioner (e.g., dietitian)” as opposed to pre-made meals that may be delivered to a patient’s home. The firm found that meals will be offered by 68% of MA plans next year, compared with 55% this year. The analysis excluded Special Needs Plans, many of which are promoting enhanced food benefits for 2022.
Avalere also examined the relationship between premiums and the number of plan offerings for certain non-medical supplemental benefits and estimated that in 2022, 89% of MA beneficiaries will have access to a $0 plan with nutrition benefits, compared with 67% for 2021. Moreover, 19% of $0 premium plans will feature such benefits, compared with 9% in 2021 (see infographic).
That last statistic is particularly striking, says Avalere Senior Consultant Tom Kornfield, one of the report’s authors. And that increase may be partly due to plans’ rising comfort level with offering these benefits, he suggests. “I don’t want to say COVID necessarily influenced [the increase], since these bids were submitted this year, but it might have [highlighted] an unmet need given challenges stemming from the impacts of COVID-19 — whether it’s isolation or lack of mobility — [but] I think it has more to do with plans becoming more comfortable with the benefit,” he tells AIS Health, a division of MMIT. “And maybe some of the vendors that are out there expanding their relationships with the plans.”
Project Well Addresses ‘Nutrition Insecurity’
From the impacts of COVID-19 — whether it’s isolation or lack of mobility — [but] I think it has more to do with plans
Using a more “proactive rather than reactive” approach, Project Well is seeking to be a nutrition partner to MA plans serving at-risk members. “We see a huge opportunity to drive an ROI for health plans by being very targeted and supplying food to members in advance” of a health event, explains Lauren Driscoll, founder and CEO of Project Well. The company provides unique meal plans, meal prep kits, produce boxes, gift cards and other services to members, with a focus on seniors who may be at risk for food insecurity and malnutrition.
Driscoll says what sets Project Well apart from other food vendors is that it recognizes the “complexity of nutrition insecurity” and the importance of personalization. “There’s the reality that people have individual taste preferences, individual food preparation preferences…and then there are cultural cuisine preferences, and so if we’re going to really try to help someone shift their diet, we have to personalize the food so that it’s food that they want to eat and will enjoy eating,” she tells AIS Health.
Coupled with that challenge is the issue of driving long-term behavior change, points out Driscoll. She gives the example of heart failure, which is the No. 1 driver of hospital admissions for older adults. “If someone has heart failure and has been eating fast food hamburgers for decades, it would be very hard for us to shift them to a plant-based diet overnight, so we nudge people along the continuum to healthier food. And so we’ll provide the food and the education, encouragement and active listening,” she explains. Project Well uses an omnichannel platform to guide members along that continuum in the way they prefer to communicate (e.g., text, email, app or snail mail), and if a need arises for a remote consultation with a registered dietitian, that can be arranged, she adds.
Project Well launched in the second quarter of 2019 with support from the University of Columbia School of Public Health and has preferred vendor designation from the Association for Community Affiliated Plans. The Stamford, Conn.-based company is currently working with two government-sponsored health plans, with additional contracts starting in January. Driscoll estimates that plans can achieve a medical savings of four to five times the cost of the program.
Mom’s Meals, which has been providing home-delivered meals to government-sponsored programs since 1999 and now markets itself as a national nutrition solutions provider, credits the CHRONIC Care Act with driving growth in this space, as it allowed MA plans to begin offering a broader range of supplemental benefits in 2019. “But it really wasn’t until 2020 when we saw the introduction of Special Supplemental Benefits for the Chronically Ill [SSBCI] that we saw plans really start to innovate,” said Mom’s Meals Senior Vice President, Healthcare Strategy and Chief Nutrition Officer Catherine Macpherson during a Sept. 24 session of AHIP’s 2021 National Conference on Medicare, Medicaid & Dual Eligibles. Also enabled by the CHRONIC Care Act, SSBCI refers to benefits that MA plans can tailor to certain individuals without having to offer them uniformly. As a result, plans can “provide more robust supplemental benefits to the highest risk folks who are going to benefit most from those particular benefits,” she stated. In 2021, meals were the most commonly offered SSBCI, followed closely by food and produce, according to a Faegre Drinker analysis of CMS data. Data for 2022 on SSBCI has yet to be released.
Since the introduction of SSBCI, Mom’s Meals has seen many plans layer on condition-specific meal benefits to their existing post-discharge offerings aimed at preventing readmissions. The Faegre Drinker analysis observed that meals was the fourth most common condition-specific benefit this year. But nutrition and healthy foods are also becoming increasingly important to plans, said Macpherson, as they recognize that not eating the right foods over time can exacerbate or accelerate the onset of certain conditions. As plans consider what members to target with SSBCI, Mom’s Meals advises them to utilize their internal analytics team or work with their external analytics partner to identify their highest risk population and highest cost population (e.g., diabetes, heart disease, chronic obstructive pulmonary disease) as well as “emerging risk individuals…who could benefit from a preventative approach.”
Mom’s Meals hopes that the trajectory of targeted meal and nutrition benefits continues as more data demonstrates their value. “I just think we’re at the starting point here for what we’re going to see health care do to go beyond the medical and the pharmaceutical care for that whole-person approach to care,” said Macpherson.
— Lauren Flynn Kelly