In recent months we’ve written about the importance of good nutrition for improving consumer outcomes and lowering the cost of care. For example, adults who are food insecure have health insurance costs $1,863 higher than adults who have access to adequate nutrition and are 15.3 percentage points more likely to have a chronic illness (see What Does The Farm Bill Have To Do With Health Care?). And my colleague Sarah Threnhauser recently reported on President Trump’s proposed budget for fiscal year 2019, in which the spending for supplemental nutrition assistance program (SNAP, or as the program is commonly referred to, “food stamps”) could be cut (see The Collision Of Food Policy & Health Care Costs).
Then, there are the effects of malnutrition. Among consumers with chronic diseases, malnutrition costs $15.5 billion annually in additional health care spending per year (see Economic Burden of Disease-Associated Malnutrition at the State Level). Addressing this malnutrition has proven results. The cost-effectiveness of nutrition interventions using oral nutritional supplements (ONS) has been documented in both the hospital and community settings—consumption of a high-protein ONS both during hospitalization and 90 days post discharge amounted to cost savings of 12.2%, and a cost-effectiveness ratio of $33,818 (see Health Care Costs Matter: A Review Of Nutrition Economics – Is There A Role For Nutritional Support To Reduce The Cost Of Medical Health Care?). About 7.1% of all inpatient hospital stays during 2013 involved malnutrition as a primary or secondary diagnosis, or in about 1.95 million of the total 27.6 million non-maternal and non-neonatal inpatient hospital stays (see 7.1% Of Inpatient Hospital Stays For Adults & Children Involved Malnutrition). Malnutrition accounted for nearly $42 billion, over 12% of the $346.1 billion aggregate hospital cost for non-maternal and non-neonatal stays that year.
On the other end of the nutrition equation are the high number of individuals who are overweight and obese, which can lead to chronic diseases and also add to the cost of health care. In 2008, medical costs due to obesity were $147 billion, and in 2012, the cost of diagnosed diabetes was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity (see Chronic Diseases: The Leading Causes of Death and Disability in the United States). A study by the Urban Institute, The New York Academy of Medicine and Trust for America’s Health found that investing $10 per consumer in community-based programs to increase physical activity and improve nutrition could save $16 billion annually, with a return-on-investment of $5.60 for every $1 spent (see Investments in Disease Prevention Yield Significant Savings, Stronger Communities).
What are we seeing in the market response to this social need? Last month I saw one interesting example of meeting this need with the announcement of “The Ford Mobile Farm,” located on the campus of Cass Community Social Services on Detroit’s west side – “an indoor farming and educational program to provide Detroit-area residents and restaurants with fresh produce year-round” (see Ford Mobile Farm Turns Innovation Employee Idea Into Source Of Healthy Food And Nutritional Education For Detroit). The farm is funded using $250,000 from the Bill Ford Better World Challenge, a grant program funded by Ford Motor Company and Bill Ford.
If you take a look around the market, this approach to community nutrition isn’t common, but it exists. The AspenPointe Community Garden in Colorado Springs has been in operation since 2012 (see AspenPointe Garden and AspenPointe: A Therapeutic Community Garden); the Mental Health Center of Denver’s Farmers Market includes a 40,000 square foot urban farm, a therapeutic garden, an aquaponics greenhouse, and community gardening space (see Dahlia Campus Farms and Gardens); and Services for the UnderServed Urban Farms—which includes 40 growing spaces and eight community farms in four New York City boroughs—provides therapeutic horticulture, nutritional programming, and employment opportunities (see SUS Urban Farms).
Which raises the question: where are nutrition programs in the planning (and budgets) of payers and health plans?
Last fall, the California Department of Health Care Services (DHCS) announced its three-year Medicaid Medically Tailored Meals Pilot Program after January 1, 2018. The pilot will involve Medi-Cal (California Medicaid) beneficiaries with selected chronic health conditions, in a test on the effect of an evidence-based, specialized nutrition program on the participants’ hospital readmissions related to their chronic health condition, admissions to long-term care facilities, and emergency room utilization related to complications of their chronic health condition (see California To Launch $6 Million Medicaid ‘Medically Tailored Meals” Pilot Program In 8 Counties).
And in Pennsylvania, the Philadelphia-based Health Partners Plan (HPP) implemented a healthy meal program—Food-as-Medicine—to address food-related social determinants of health for Medicaid and Medicare consumers, in tandem with the Metropolitan Area Neighborhood Nutrition Alliance (MANNA) (see Payer Meal Program Addresses Social Determinants of Health). HPP contracted MANNA to provide members 21 meals per week over six months in 2015, and as a result, reported a 27% reduction in hospital admissions, a 6.9% reduction in emergency department visits, a 15.9% reduction in provider organization visits, and a 7.9% reduction in specialist visits.
In 2016, Geisinger, another Pennsylvania-based health plan and health system, launched the Fresh Food Farmacy. The Farmacy provides adults with diabetes and their families with food, recipes and menus to prepare two healthy meals per day, five days a week. Additionally, adults participate in group classes for diabetes self-management for at least 15 hours. The program costs about $2,200 per consumer per year and has resulted in the cost of care dropping two-thirds and HbA1c levels have dropped more than two points among participants (see How Geisinger Treats Diabetes by Giving Away Free, Healthy Food).
In March, the Blue Cross Blue Shield Association (BCBSA) announced it had launched a new subsidiary to address social determinants of health, which includes plans to address nutrition “deserts,” or areas that have limited access to affordable and nutritious food (see Blue Cross Blue Shield Association Launches Institute To Address Social Determinants). And Humana’s Bold Goal initiative is a long-term strategy to address community-level social determinants of health, including nutrition; it is a population health strategy to help the communities it serves be 20% healthier by 2020 (see Humana Bold Goal Targets Members’ Social Determinants Of Health).
As we see more research on the costs of bad nutrition and more demonstration of the ROI of investing in nutrition programs, we’ll likely see more investments by provider organizations, public agencies, and health plans in nutrition. What will these models look like? It’s too early to tell, but the answer to that question will be determined by what strategies work. For more on the social services, be sure to check out: The Social Services Market: Over $331 Billion In Spending In FY2016, U.S. Spending On Housing Assistance Programs: $44.7 Billion In 2016, U.S. Spending On Income Assistance: $185.5 Billion In FY2016, and U.S. Spending On Nutrition Assistance Programs: $101 Billion In FY2016.