Feeding the Sick

NOVEMBER 27, 2019

Photo by Ryan Levi

We know good nutrition is tied to good health. But is there evidence that food should be prescribed and paid for like medicine?

Listen to the full episode below, read the transcript or scroll down for more information.

What is 'Food is Medicine'?

There is a growing spectrum of interventions using nutrition as a medical treatment. They vary in intensity and are often referred to collectively as “Food is Medicine.”

Medically tailored meals: Designed for and delivered to people with conditions such as diabetes, cancer, HIV and kidney disease.

Food prescriptions and vouchers: Provides produce vouchers to farmers markets or grocery stores, or prescriptions to food pharmacies located in a hospital or clinic for patients who are food insecure.

Public benefits: Large government food and nutrition programs, like SNAP and WIC, that provide financial assistance to low-income individuals to purchase food.

 

Medically Tailored Meals

Evidence

  • Improves diet quality and reduces hypoglycemia for food-insecure diabetics 

Tradeoffs

Pros

  • Can lower medical costs and improve health outcomes
  • Treats the sickest and most expensive patients
  • Reduces food insecurity

Cons

  • Expensive intervention (~$20-$60 per patient, per day)
  • Only appropriate for a small number of patients
  • Difficult to scale

Examples

Patient Story: Bouba Dieme

Scroll through the images to learn about one patient receiving medically tailored meals.

Bouba Dieme is 33 years old. He lives with his wife, 5-year-old son and 16-month-old twins in Boston. He has a congenital heart defect and is on the list for a heart transplant.
Bouba Dieme is 33 years old. He lives with his wife, 5-year-old son and 16-month-old twins in Boston. He has a congenital heart defect and is on the list for a heart transplant.
Three years ago, he had open-heart surgery to install a pump to take pressure off his heart.
Three years ago, he had open-heart surgery to install a pump to take pressure off his heart.
Since the beginning of this year, Dieme (pictured with his wife Desirée Allen) has received weekly deliveries of medically tailored meals from a Boston-area nonprofit. They include lunch, dinner, salads, snacks and fresh fruit for five days.
Since the beginning of this year, Dieme (pictured with his wife Desirée Allen) has received weekly deliveries of medically tailored meals from a Boston-area nonprofit. They include lunch, dinner, salads, snacks and fresh fruit for five days.
The food is specifically tailored for Dieme's heart condition, which requires strict control of sodium. He says the meals have helped him lose weight, regain his energy, get back to working full time and keep him on the transplant list.
The food is specifically tailored for Dieme's heart condition, which requires strict control of sodium. He says the meals have helped him lose weight, regain his energy, get back to working full time and keep him on the transplant list.
"As a cardiac patient, when you're really sick, your margin is very small. So a small difference in the salt amount, for instance, can put you to bed or make you very sick," Dieme says.
"As a cardiac patient, when you're really sick, your margin is very small. So a small difference in the salt amount, for instance, can put you to bed or make you very sick," Dieme says.
"My biggest worry was that if I didn't get it together meal-wise, then it would impact him," Allen says of the time before Dieme started receiving the meals. "So now I know that no matter what, he's going to be OK. ... It's really his chance at getting the heart ultimately."
"My biggest worry was that if I didn't get it together meal-wise, then it would impact him," Allen says of the time before Dieme started receiving the meals. "So now I know that no matter what, he's going to be OK. ... It's really his chance at getting the heart ultimately."

Food Prescriptions & Vouchers

Evidence

The data on food prescriptions and vouchers are minimal, but some studies show these options can:

  • Reduce A1c levels for low-income patients with type 2 diabetes

Tradeoffs

Pros

  • Less expensive than medically tailored meals (~$20-$40 per patient, per month)
  • Potential for broader reach
  • Reduces food insecurity

Cons

  • Less tailored to patients’ specific medical needs
  • Limited evidence of impact on costs or health outcomes
  • May be logistically difficult for patients

Examples

  • Primary care providers at Boston Medical Center have written patients “prescriptions” for food at its Preventive Food Pantry since 2001.

  • Geisinger (PA) refers food insecure patients to its in-house Food Farmacy for food and nutritional education.

  • Vouchers 4 Veggies/EatSF provide monthly $20-$40 food vouchers to low-income residents in San Francisco and Los Angeles.

Public Benefits (SNAP/WIC)

NOTE: This section has been updated to clarify the tradeoffs of SNAP and WIC.

Evidence

  • Some research shows SNAP does not improve dietary disparities

Tradeoffs

Pros

  • SNAP and WIC: Include nutrition education resources for participants
  • SNAP and WIC: Recently revised to encourage consumption of more fresh produce
  • SNAP: Available to tens of millions of people and does not require medical intervention to receive
  • WIC: Targets mothers and children in important early years

Cons

  • SNAP and WIC: Cannot fully alleviate food insecurity
  • SNAP: Doesn’t prevent purchase of unhealthy foods and assumes most meals will be made from scratch
  • WIC: Only available through a child’s fifth birthday

Examples

  • SNAP (Supplemental Nutrition Assistance Program) provides financial assistance to help people purchase food from grocery stores and certain farmers markets.
  • WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) aims to meet nutritional needs of low-income pregnant women, new mothers and children.

Landscape of Insurance Coverage of Food as Medicine

Payers are increasingly introducing programs to cover the cost of food for certain groups of patients. States have used Medicaid waivers to pilot food is medicine programs, some insurance companies have covered food for people eligible for both Medicare and Medicaid, and most recently, Medicare Advantage gained the option to offer it as a benefit. Here’s a snapshot of what is happening across the U.S.

Several states have been given waivers to cover food benefits for Medicaid beneficiaries: 

  • North Carolina received a waiver from the federal government to spend $650 million to experiment with new Medicaid benefits like food and housing over the next 5 years. Their plan includes piloting medically tailored meals. 
  • California is midway through a 3-year, $6 million pilot program to offer medically tailored meals to Medicaid recipients. 
  • Other states, including Arizona, New York and Maryland, also have Medicaid waivers allowing them to cover the cost of medically tailored meals, as well as non-tailored food and meal delivery.

Beginning in 2020, all Medicare Advantage plans will be able to offer members optional benefits for services including medically tailored meals and non-tailored meal delivery. Insurers in several states already offer meal delivery as a benefit for plans that cover members who are eligible for both Medicare and Medicaid:

  • Anthem plans in California, Georgia, Indiana, Kentucky, Missouri, Ohio, Virginia and Wisconsin offer a package of benefits called Essential Extras that includes meal delivery.
  • Amerigroup plans in Tennessee, Texas, and New Jersey will offer a similar plan, called Everyday Extras, which allows consumers to add benefits like meal delivery for no extra charge. 
  • Blue Cross is piloting efforts in several cities to provide home delivered meals to people living in food deserts.
  • In 2018, UCare in Minneapolis launched plans to help families purchase healthy foods.
  • In 2019, AmeriHealth Caritas DC took over the Produce Rx program, which provides weekly $20 produce vouchers to adult members with hypertension, pre-diabetes or diabetes.
  • Health Partners Plans in Pennsylvania provides medically tailored meals to patients with several different chronic conditions.

  • Kaiser Permanente recently launched Food for Life, a broad approach to addressing food insecurity among its California members. It includes medically tailored meals for certain patients with chronic illness and a texting campaign to connect more patients with SNAP.
     

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More Episode Resources

Latest Data on Food Insecurity in the U.S.

State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity (Berkowitz, Basu, Gundersen, & Seligman, Centers for Disease Control and Prevention, 2019)

Food Security Status of U.S. Households in 2018 (U.S. Department of Agriculture)

Additional Research on Food is Medicine

Massachusetts Food is Medicine State Plan: Collection of peer-reviewed research on food is medicine interventions. Part of an in-depth survey of Massachusetts food interventions with recommendations to expand access and coverage

Food is Medicine Coalition: Collection of research conducted in conjunction with members of national medically tailored meal coalition

Food and Nutrition Services Bundle: Pilot project offering food and nutrition resources to food insecure patients at two public hospitals in the Bronx

Episode Credits

Guests: Bouba Dieme, medically tailored meal recipient
Dr. Mandy Cohen, Secretary of Health and Human Services, North Carolina
David Waters, CEO, Community Servings

Original music composed by Ty Citerman; additional music by Blue Dot Sessions

This story was reported and produced by Ryan Levi and Victoria Stern. It was mixed by Ryan Levi.

Additional thanks to:
Dr. Rita Nguyen, Latchman Hirallal, Dr. Sheri Weiser, Cissie Bonini, Neal Curran, Dr. Sangeeta Hingorani, Kelly Fisher, Alyssa Auvinen, Andrea Talhami, Katie Garfield, Jean Terranova, Sarah Downer, Kristin Sukys, Dr. Seth Berkowitz, Catherine Drennan, the Tradeoffs Advisory Board

…and our stellar staff!