Home-Delivered Meals Keep Medicare, Medicaid Population Out of ED, Lower Costs

Meal delivery programs reduce the use of costly healthcare services, such as emergency department (ED) visits, and help cut costs for dually eligible Medicare and Medicaid beneficiaries, according to a study published in Health Affairs.

“Approximately 13% of US households report food insecurity, meaning that they lack ‘consistent, dependable access to enough food for active, health living,’” wrote the authors of the study. “Food insecurity is associated with poor health and increased use of ‘big ticket’ health services, such as ED visits and inpatient admissions.”

According to the authors, this results in $77 billion in excess healthcare expenditures annually. The issue may be particularly pertinent among those dually eligible for Medicare and Medicaid, which has led to support for services such as meal programs.

The researchers used a study sample of members of the Commonwealth Care Alliance who were dually eligible for Medicare and Medicaid and had at least 6 months of continual enrollment in 1 of 2 meal delivery programs from January 1, 2014, to January 1, 2016. Members who did not participate in either meal program were used as controls. The study included 133 individuals participating in a medically tailored meals program with 1002 matched controls. It also included 624 participants in a Meals on Wheels—type nontailored meal program with 1318 matched controls.

Results of the analysis showed that participation in the medically tailored meals program was associated with approximately 1.5 fewer ED visits (adjusted incidence rate ratio [aIRR]: 0.30; 95% CI, 0.20-0.45), 0.3 fewer inpatient admissions (aIRR, 0.48; 95% CI, 0.26-0.90), and 1.14 fewer uses of emergency transportation (aIRRL, 0.28; 95% CI, 0.16-0.51).

Participation in the nontailored meal program was also associated with fewer ED visits (0.69 [aIRR, 0.56; 95% CI, 0.47-0.68]) and uses of emergency transportation (0.64 [aIRR, 0.62; 95% CI, 0.49-0.78]) but not with fewer inpatient admissions (aIRR, 0.88; 95% CI, 0.69-1.11).

Both meal programs also led to lower medical spending. For the medically tailored meals program, participants spent $843 monthly on medical expenses, compared to $1413 for those in the matched control group. After subtracting the cost of the program, participants saved $220 per month. Participants in the nontailored meals program spent $1007 monthly on medical expenses, while those in the matched control group spent $1163. Accounting for the cost for the program, participants saved $10.

The authors noted that while they did not conduct a formal cost-effectiveness analysis, the lower estimates of cost suggest that the programs can offer savings for payers, or at least be cost-neutral, while reducing ED visits and emergency transportation.

“Home-delivered meals—in particular, those tailored to recipients’ medical needs—show promise for helping curtail the use of selected costly health services in adults dually eligible for Medicare and Medicaid, a medically and socially complex population for whom effective interventions can be hard to come by,” the authors concluded.

In February, a survey revealed that addressing food instability and other social determinants of health is becoming more popular among executives. The survey found that the majority of executives—which include payers, third-party administrators, hospitals, government, consultants and analysts, and vendors—are increasingly adopting social determinants of health into their programs.

Reference

Berkowitz S, Terranova J, Hill C, et al. Meal delivery programs reduce the use of costly healthcare in dually eligible Medicare and Medicaid beneficiaries [published online April 2018]. Health Aff. doi: 10.1377/hlthaff.2017.0999.