One of the avenues health systems are exploring in terms of addressing social needs is nutrition. But is there research demonstrating that health systems paying for nutrition support leads to better health outcomes?
That’s what legislators in Massachusetts want to find out. Massachusetts Democratic State Sen. Julian Cyr and House Rep. Denise Garlick have introduced a bill that would establish a pilot program to give individualized nutrition services —including meals, groceries, or grocery money—to residents enrolled in Medicaid and then measure the impact of doing so on people’s well-being and the state’s bottom line.
The bill would require the Executive Office of Health & Human Services to implement a Food and Health Pilot Program to demonstrate the impact on health outcomes and cost effectiveness of medically tailored nutrition services for MassHealth enrollees diagnosed with diet-related health conditions. The medically tailored nutrition services include:
• Medically Tailored Meals: meals tailored to an individual’s medical condition by a Registered Dietitian Nutritionist. A medically tailored meal service consists of at least 10 meals per week.
• Medically Tailored Food: non-prepared grocery items selected by a Registered Dietitian Nutritionist or other qualified nutrition professional as part of a treatment plan for an individual with a defined medical diagnosis. A medically tailored food service consists of food and grocery ingredients sufficient to prepare 14 meals per week.
• Nutritious Food Subsidies: subsidies for free or discounted nutrient-dense food. A nutritious food subsidy is equivalent to $20 or more per week.
The bill calls for a Research Commission made up of experts to evaluate the medical nutrition services.
The pilot would focus on people with congestive heart failure, type 2 diabetes, chronic obstructive pulmonary disease, renal disease, obesity, pre-diabetes or hypertension.
A story in a publication called The New Food Economy quotes Sarah Downer, an associate director and law instructor at Harvard Law School’s health law and policy clinic, as saying that pre-made and delivery meals “are really for people who have …trouble shopping and cooking for themselves—it’s not the right nutrition intervention for everyone. This [pilot program] would look at the efficacy of a suite of those services, the ability to triage individuals and find the correct service for them, link them to it, and then see what the impact is on utilization and costs across the board.” The pilot would screen participants for food insecurity, assess acuity of need for medically tailored nutrition services, and direct participants to the appropriate level of service. Each participant who qualifies based on screening and assessment will receive one of the three medically tailored nutrition services for the duration of at least 16 weeks.
To leverage federal funds, MassHealth Accountable Care Organizations with active Flexible Services programs will be eligible to participate in the pilot by proposing enhancements to their current Flexible Services protocols.
At the conclusion of the pilot, the Commonwealth will use MassHealth data on the pilot participants to evaluate its impact, as compared to a matched-control group of similar MassHealth beneficiaries not receiving the nutrition service, on:
• Total health care costs
• Emergency Department utilization
• Hospital admissions and readmissions
• Pharmacy costs
• Clinical outcomes selected by the Medicaid director in consultation with the Pilot Commission, such as blood pressure, cholesterol, hemoglobin A1c, depression and other mental health indicators.
