Berkowitz and Tishler co-authored a study analyzing whether meal delivery programs could reduce healthcare costs among Medicare and Medicaid beneficiaries.
When you subtract the program costs from the estimated healthcare savings, participants in the tailored meal program saved $220 per month. The non-tailored program reaped savings of $10 per participant per month.
Tishler: In Massachusetts, between one in six and one in eight people are food insecure. That doesn’t necessarily mean they don’t have food, but they aren’t exactly sure where their next meal is coming from. And that will include people in the commercial market, there is no question on that. Particularly for large employers, their low-income workers may have real challenges. Look at people with children. I would be willing to bet a number of their workers’ children are getting subsidized meals at school or in the summer. Given that, it’s really easy to think about this area.
Tishler: About 80% of things we think about that affect people’s health and illness we can’t fix with a visit to the doctor or an antibiotic. It’s much more related to the neighborhood they are living in, what kind of food they are eating, how much education they have had, what language they speak and if they are socially isolated.
There is also data in other studies showing that hospital readmissions markedly decreased when people got meals delivered to them after a hospitalization. People who are much more likely for readmission and increased cost are exactly the people who aren’t going to have a community that is able to bring them food.
It is so compelling to see what seems like a pretty simple solution and see if it can move the metric on things that are causing us to spend so much money on healthcare.
Tishler: It surprised me that there was such a significant difference between the medically tailored meals and the non-medically tailored ones. I think that surprised all of us. We would like to say that food is food, but this article suggests that there may really be advantages to certain kinds of food. They both made a difference, but the medically tailored meals actually saved more money in monthly medical costs.
I think their average cost was $843 versus about $1,400 for their comparison group. We would all like to see more research that confirms this or begins to answer that not only that happened but why it happened.
Many of our members live on a fairly low income and in relative food deserts [areas with little or no access to healthy foods because of lack of farmers markets and grocery stores]. One of our medically tailored meals was broccoli and red peppers and salmon. And it would be harder for them to put that kind of meal together on a good day and even more if they’ve been ill or in the hospital.
Tishler: Barriers are really about seeing food (and other social determinants) as an important thing to improve health and reduce costs. Delivery of food might seem out of scope for a healthcare organization or health plan, but according to our data and others’, it might be a cost-effective way of preventing more expensive care—at least in certain settings.
It will require health plans and companies to think more broadly about what health is and what’s worth paying for. It would be a great benefit but would also benefit people’s health. Especially if the company made its choices wisely.
I was seeing patients at a homeless shelter for women, and it’s amazing. You can’t always tell who is homeless and who the staff are. Some of those women were putting themselves together and going to work. So that’s something to think about for companies.
Improving access to exercise is one thing, and that can be done relatively easily. They can subsidize gym memberships or make sure there are places to walk at work or start a walking program for the company at lunchtime. They can help people find community resources, which are there in all different kinds of communities. And some people like education about what healthy food is.
You don’t have to buy it for them, but you can do some demos at work and people can see a great way to use a zucchini.
Anything that helps decrease chronic stress—whether around social stressors or creating workplaces that are welcoming—all of those really do contribute to health. Helping people understand they are valued helps a lot.
Tishler: There are many different measures that people can use to look at social determinants of health. They can be tailored to specific populations or more general, but I definitely encourage organizations to find out more about their populations. I think there will be some obvious things they find, but they may also be surprised at the level of need.