Several research studies have shown the health and cost benefits of the “food as medicine” movement. Those leading the effort are eager for more payers to recognize the impact. In an interview with Healthcare Innovation, Sue Daugherty, CEO of Philadelphia-based MANNA, an organization dedicated to providing medically tailored meals to people with chronic illnesses, discussed efforts in the Pennsylvania Legislature to fund a statewide pilot project.
Daugherty started at the nonprofit MANNA as a registered dietician in 1989 and held several positions before moving into the CEO position in 2012. It was founded as an HIV/AIDS support organization.
With the advancements of HIV medications and anti-retroviral therapies, its patients began living much longer, but still with serious consequences and side effects from the medications. In 2006 MANNA expanded beyond HIV/AIDS to serve all illnesses and went from being a supplemental meal program to a complete nutrition program three meals a day, seven days a week.
Today, the organization serves about 150,000 meals per week to approximately 1,600 households. Its staff of 55 is supported by an army of volunteers.
Here are some excerpts from our conversation.
Healthcare Innovation: Can you talk about the challenges you face with getting reimbursed for the work you do?
Daugherty: Over the years we've really tried to do everything we can to advocate for policy changes to get medically tailored meals recognized as a mandated covered benefit. I've had many, many frustrating conversations with health systems, with payers over the years. Folks are constantly saying they need data, so we're really proud of the research that we published in 2013, which was the first of its kind research that showed not only the incredible impact on health and improved health outcomes, but significant reduction in healthcare costs. In 2019, we launched a research and evaluation arm, because unfortunately, although there is much more data in this space now, there is this call for continued data on medically tailored meals and nutrition.
HCI: Have you had some success working with payers?
Daugherty: In 2015, after our research was published, we signed our first contract with Health Partners Plans to reimburse for a select population for medically tailored meals and nutrition education just like they would for any other prescription. Since then, we now have contracts with all the Southeastern Pennsylvania Medicaid payers. That is probably making up about 50 percent of our funding at this point. The other 50 percent is through grants, individual giving and fundraising events.
HCI: How do the patients connect with the organization? Do hospitals contact you when someone is being discharged or do the payers make the connection?
Daugherty: Most of our patients come to us through referrals from social work or dieticians sometimes. Some individuals will self-refer and if they're not in care, we will help connect them to care. We don't get many directly at discharge. We wish we were getting more at discharge. In the payer space, those patients are coming to us mostly through their health coaches and case management teams.
HCI: As accountable care organizations begin to be responsible for total cost of care, it seems like they'd have incentive to use this to lower costs.
Daugherty: Pennsylvania is certainly encouraging these value-based care arrangements. We have our first value-based arrangement with Crozer-Keystone. A big barrier is how people think about food and how long they will pay for the interventions. I've been at national conferences where the heads of payer organizations are on stage next to me and they're presenting case studies and saying, ‘Mr. Smith, who was on insulin for 15 years, was able to come off of insulin, control his blood sugars through an oral hypoglycemic and a medically tailored meal plan and access to education.’ While they would pay for insulin forever, they'll only pay for the medically tailored meals for 12 weeks. When you think of this as treatment, we're very affordable. It is an affordable intervention. There's just this disconnect that happens.
HCI: Are there organizations like MANNA in a lot of U.S. cities? And are they formed into a network for sharing best practices or policy goals?
Daugherty: There are about 13 of us across the country —mainly East Coast, West Coast and in Colorado. There is a coalition called the Food is Medicine Coalition, and we do meet regularly. There's an advisory board that I sit on, and on a national level we are trying to build policy and advocacy momentum.
HCI: Are there states or regions where these organizations are having more success working with payers?
Daugherty: I would say California. They had a statewide pilot program that they launched a few years back that was actually modeled after MANNA and our research.
HCI: Tell me about this proposed legislation in the Pennsylvania House. What would it do?
Daugherty: It has just been introduced. It would set up a statewide pilot program that would allow health systems to refer high-risk individuals for a medically tailored meal program, and pay for that. We're excited about the legislation. The state has been extremely supportive of the services. I always say, ‘Why can't this just become a mandated cover benefit?’ It goes back to the data. There was an article published in JAMA that looked at medically tailored meals and found that if everyone who needed a medically tailored meal had access to it, the projected cost savings was like $13.6 billion per year. Wow. It would offset something like 1.6 million hospitalizations. The other great thing about the intervention is that from the data that we receive from our payers, the ROI is quick. It is not an intervention that you need to wait years to see the ROI. Readmission within 30 days is a big deal. We're seeing a significant reduction in 30-day readmissions.