Incentivizing Healthy Eating in Medicare, Medicaid Is Cost Effective, Study Finds

Eating a healthy diet can have enough of a health impact that it is cost effective to offset the cost of purchasing such food with health insurance coverage, according to new research published in PLoS Medicine.

Researchers found that a prescription for healthy food can improve health outcomes for beneficiaries in Medicare and Medicaid. The authors estimated the economic health benefits in 2 scenarios: if 30% of the cost of fruit and vegetables in supermarkets were covered (F&V incentive) and if 30% of the cost of fruits, vegetables, whole grains, nuts/seeds, seafood, and plant-based oils (healthy food incentive) were covered through Medicare and Medicaid.

The authors used a microsimulation model to estimate the number of cardiovascular disease and diabetes cases that would be prevented, quality-adjusted life years (QALYs), health-related costs, and incremental cost-effectiveness ratios for both scenarios. They estimated that under the F&V incentive, 1.93 million cardiovascular disease events would be prevented, 4.64 million QALYs gained, and $39.7 billion in formal healthcare costs saved. They estimated the saved costs: under the healthy food incentive, 3.28 million cardiovascular events and 0.12 million diabetes cases would be prevented, 8.40 million QALYs gained, and $100.2 billion in formal healthcare costs saved.

"We found that encouraging people to eat healthy foods in Medicare and Medicaid—healthy food prescriptions—could be as or more cost effective as other common interventions, such as preventative drug treatments for hypertension or high cholesterol," co-first author Yujin Lee, PhD, postdoctoral fellow at the Friedman School of Nutrition Science and Policy at Tufts University, said in a statement.

Given the savings of $39.7 billion for the F&V incentive and $100.2 million for the healthy food incentive and the fact that food subsidy and other policy costs were $122.6 billion and $210.4 billion, respectively, the authors considered the programs highly cost effective. Typically, medical interventions are considered cost effective if they cost less than $150,000 per QALY gained and are considered highly cost effective when less than $50,000 per QALY gained. The researchers calculated that the F&V incentive had incremental costs of $18,184 per QALY and the healthy food incentive had incremental costs of $13,194 per QALY.

Since Medicare has a larger population size, they estimated that the absolute health benefits were larger in the Medicare program compared with the Medicaid or dual-eligible populations. Both scenarios were cost effective at 5 and 10 years, and they were modestly more cost effective for Medicare and dual-eligibles. According to the authors, this is because Medicare and dual-eligible beneficiaries are older than Medicaid adult enrollees, “resulting in larger absolute reductions in cardiometabolic events and subsequent healthcare savings over a shorter timeframe.”

They noted that the findings of the study support pilot and demonstration programs testing the feasibility of incentivizing healthy foods through Medicare and Medicaid.

"These new findings support the concept of Food is Medicine: That innovative programs to encourage and reimburse healthy eating can and should be integrated into the healthcare system," said co-first author Dariush Mozaffarian, MD, DrPH, dean of the Friedman School of Nutrition Science and Policy at Tufts.

Reference

Lee Y, Mozaffarian D, Sy S, et al. Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study [published online March 19, 2019]. PLOS Medicine. doi: 10.1371/journal.pmed.1002761.