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 Seniors in the Boston area who received meals at home through
programs like Meals on Wheels had fewer emergency department visits
and fewer hospital admissions than their peers who didn't get the
meals, leading to lower medical spending overall, researchers report
in Health Affairs.
"We've known for a while that lack of access to nutritious food has
important health consequences, but we haven't always had a good
sense that our interventions are actually effective," said lead
study author Dr. Seth Berkowitz, who was with Massachusetts General
Hospital and Harvard Medical School in Boston when the study was
conducted.
"It speaks to the potential for these kinds of interventions to
really make a difference in people's lives and let us know we should
study them more closely," said Berkowitz, now at the School of
Medicine of the University of North Carolina at Chapel Hill.
Berkowitz and his colleagues analyzed healthcare claims between 2014
and 2016 from the Commonwealth Care Alliance of Massachusetts, a
not-for-profit community-based health plan that manages care for
adults who are dually eligible for Medicare and Medicaid.
Medicare is the federal health insurance program for people over age
65 and also covers some younger disabled individuals. Medicaid is a
federal-state insurance program for low-income people of any age.
The study team focused on Commonwealth Care Alliance members with at
least six months of enrollment in one of two meal delivery programs,
and compared them to members who were similar but not participating
in a meal program.
Of the meal recipients, 133 got meals that were medically-tailored
for certain conditions, such as diabetes or a need for soft foods.
Another 624 got untailored meals from the non-profit Meals on Wheels
organization. More than 2,300 non-meal-recipients were in the
comparison group.
The research team looked at the number and costs of emergency room
visits, hospital admissions, use of emergency transportation,
inpatient visits, outpatient visits and pharmacy use.
They found that people in the medically-tailored meal program had
fewer emergency room visits and inpatient admissions and less
emergency transportation use than the comparison group. Those in the
nontailored meal program had fewer emergency visits and lower
transportation use but about the same rate of inpatient admissions.
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People in the medically tailored meal programs had lower medical
spending, by about $570 per month, than the comparison group and
those in the nontailored meal program had about $156 lower medical
spending per month.
The average monthly meal-program costs per participant were $350 for
the medically-tailored program and $146 for the nontailored program.
Subtracting the program costs, that could mean a savings of $220 for
the medically tailored meal program and $10 for the nontailored food
program, the study authors write.
"Addressing issues like food insecurity, though we still need to
learn more about the best way to do so, is a promising strategy for
improving health," Berkowitz said in an email.
Federal funding supports 35 percent of local food delivery programs.
Studies like these could play into conversations about federal
funding cuts to programs such as Meals on Wheels, Anthony Campbell
of the University of Alabama at Birmingham, who wasn't involved in
the research, said in an email. "This study is an excellent example
of the type of rigorous research needed."
The budget conversation will also become more prevalent as the U.S.
population grows older and requires more support, said Ellen
Barnidge of St. Louis University in Missouri, who wasn't involved in
the study.
"With the older adult population growing, we need to support
programs that keep vulnerable older adults who want to remain in
their homes able to do so," she said by email. "It appears from
other studies that home-delivered meal programs decrease nursing
home admissions, too."
"There's sometimes a stigma attached with accepting these services,
and some people don't access services they're eligible for," said
Dr. Julie Bynum of the University of Michigan School of Medicine in
Ann Arbor, who wasn't involved in the study. "This isn't just about
having food on your table but taking care of your overall health and
staying out of places like the emergency department," she said in a
telephone interview.
SOURCE: https://bit.ly/2JEIRI2 Health Affairs, online April 2, 2018.
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