Opinion | To Treat Chronic Ailments, Fix Diet First – The New York Times

As many of the issues that prompt heavy use of health care assistance are social and structural, like low health literacy, social isolation, and lack of access to healthy food options, the Medicare and Medicaid program often hit hospitals in poorer neighborhoods and rural hospitals the hardest. The decreased reimbursement leads to a downward spiral for hospitals and patients. Some provocative research on that subject, published last year, suggested that the federal centers’ program might actually have increased mortality from heart failure.

Another body of research, however, is showing that medically tailored meals can go a long way toward reversing that downward health spiral. A retrospective cohort study headed by Seth Berkowitz, M.D. at the University of North Carolina Chapel Hill School of Medicine, and published in April concluded: “Participation in a medically tailored meals program appears to be associated with fewer hospital and skilled nursing admissions and less overall medical spending.”

Tanvir Hussein, a clinical cardiologist and board member of Project Angel Food, said he is impressed by the preliminary results of the Medi-Cal study. If the numbers hold up and Medi-Cal chooses to add medically tailored meals in its coverage, he said, it could be a game changer for the lower-income populations he serves in southern Los Angeles.

“Maximal compliance with drug therapy doesn’t keep congestive heart failure patients out of the hospital without dietary adherence,” Dr. Hussain said. So providing medically tailored meals “is a potentially easy win all around,” he said. “Sick or elderly patients can stay home and remain independent, while reduced hospital admissions dramatically reduces health care costs and overall burden on the system.”

In Pennsylvania, Medicare payers are using medically tailored meals as part of treatment, based on a small 2013 study led by a Philadelphia nonprofit, Manna, that showed patients who received three medically tailored meals per day had shorter stays at hospital and far lower rates of hospitalization overall, compared to a control group. Now four companies that administer Medicaid in southeastern Pennsylvania have contracted with Manna to deliver specially tailored meals for selected patients with diabetes, cancer, renal disease, cancer and high-risk pregnancy, as well as congestive heart failure.

AmeriHealth Caritas’s southeastern Pennsylvania health plan began a medically tailored meals pilot in August 2016; starting with 472 members who went through the program, it had delivered 175,601 meals to a total of 553 members as of Sept. 30.

Care management has been at the center of that program. “Patients on the program must be simultaneously engaged in care management, so food is a small part of all pieces that fit together for members’ health,” said Joanne McFall, market president for AmeriHealth Caritas’s southeastern Pennsylvania health plan.

A study of 179 of the initial participants, from August 2016 to January 2018, showed a reduction of nearly 25 percent in overall medical costs, a 31 percent decrease in inpatient visits and a 20 percent decrease in emergency room visits.

Manna also serves patients with Aetna Better Health of Pennsylvania, a Medicare contractor. Their meals program began in October 2016 with 30 members, and has slowly grown over time. They too have seen a 30 percent reduction in patient hospitalization, according to Dr. Bernard Lewin, the organization’s chief medical officer.

While medical cost reductions are a significant benefit, Dr. Lewin said, he’s most concerned with the quality of people’s lives. “Someone who has congestive heart failure has a limited ability to do any work, and I mean walking up a flight of stairs. By addressing dietary elements to address that condition, they’re now able to get out of the house, but that improvement doesn’t show up on any spreadsheet.”

This content was originally published here.

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