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Each week, Health Affairs' Rob Lott brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.
A Health Podyssey goes beyond the pages of the health policy journal Health Affairs to tell stories behind the research and share policy implications. Learn how academics and economists frame their research questions and journey to the intersection of health, health care, and policy. Health policy nerds rejoice! This podcast is for you.
Hello, and welcome to A Health Podicy. I'm your host, Rob Lott. This April at Health Affairs, we're all about food, nutrition, and health. That's the subject of our new theme issue, a veritable smorgasbord of important research, examining the public investments and policies that really underpin some of the most innovative diet and lifestyle interventions aimed at things like improving access to healthy, safe and affordable food, eradicating hunger and reducing health disparities. One of those innovative interventions is medically tailored meals in which programs acting on a referral of a medical professional prepare and deliver nutritionist designed meals to people with complex health conditions and high acuity care.
Rob Lott:Such meals have been shown to improve patients' health in some cases, but we've also got a lot more to learn about their impact on healthcare use and spending. That's the subject of today's Health Odyssey. I'm here with Amy Dung, a PhD candidate at Tufts University's Friedman School of Nutrition Science and Policy. She's the lead author on a new paper from this month's issue that attempts to envision and quantify what the future might hold for this kind of intervention. Its title is, quote, Estimated Impact of Medically Tailored Meals on Healthcare Use and Expenditures in 50 US States.
Rob Lott:And so let's just dig in here. Amy Deng, welcome to A Health Podicy.
Shuyue Deng:Hi, thank you for having me.
Rob Lott:Awesome. So let's just start with some background. Can you describe a typical medically tailored meal program? Who runs something like this? What are the typical patients and what's their experience like?
Shuyue Deng:So medically tailored meal programmes typically are run by nonprofit organisations, hospitals or community based groups. They usually provide nutritionally tailored meal designed by registered dietitian and those meals are specially provided for the needs of individual with diet sensitive chronic disease like diabetes, heart disease, HIV cancer or kidney disease. Typically those patients are like severely ill and often experience food security and unable to consistently access the nutritious food themselves.
Rob Lott:And do you have a sense of how widespread this intervention is? Can most patients who need it find one in their neighbourhood?
Shuyue Deng:So I think currently medical illiterate meal program have expand considerably across The US especially in recent year. And I think they are most established in large urban centres like place in New York City, San Francisco, Boston and Los Angeles. But availability is lower in rural or less populous area.
Rob Lott:Do you have a sense of how effective medically tailored meals are as an intervention? How good are they at reducing healthcare utilisation or spending, improving people's health? What's the evidence base out there?
Shuyue Deng:Previously a lot of study have shown medically tailored meal programmes are highly effective. They consistently reduce hospital admission, emergency room visits, healthcare costs and for the coverage of high risk population. For example, medically telomere intervention have been associated with about sixteen percent fewer hospitalizations. And how common
Rob Lott:is it for something like medically tailored meals to be covered by someone's health insurance policy?
Shuyue Deng:So I think right now the health insurance are not that commonly cover medical illiterate meal but this starting to change. Coverage usually happens through special program like section eleven fifteen Medicaid waivers which allows states to test the innovative health approach like medical retailer meals. And for example, states like Massachusetts, California and others have already adopt those waivers. And additionally, some Medicare Advantage plans and private insurers are beginning to offer medically tailored meals because they recognise their potential to save money and improve patient health.
Rob Lott:Okay, so against this backdrop, you conducted a study with your co authors that basically asked, correct me if I'm wrong here, what if everyone who could benefit from or was eligible to receive medically tailored meals, what if they got them and what did your study find?
Shuyue Deng:So our research shown that if everyone who can benefit from medically tailored meals actually receive them, we find forty nine days have cost saving with Connecticut, Pennsylvania and Massachusetts seeing the highest saving per person. And only one state Alabama showing cost neutral. And we also find providing this meal across US nationally can save around 32,000,000,000 each year or to be processed in the first year. For hospitalisation, we find providing the medical entire meal in the first year can save around 3,500,000.0 hospitalisation each year nationally.
Rob Lott:Wow, that's a pretty big number. When you say savings, just to clarify, you're basically comparing the cost of implementing the program, paying for the food, paying the providers running the program, the less the savings from better health, less cost expenditures. Is that a fair interpretation?
Shuyue Deng:That's correct. That's the net cost saving, which already subtract the fees for like paying the meal and dietitian screening.
Rob Lott:And it sounds like you described there's a fair amount of variation from state to state. So in one state there's a significant cost effectiveness in, I think you said it was Alabama, it's less so. What explains that discrepancy?
Shuyue Deng:I think there are several drivers for the variation. First, the eligible population size because states differ in demographic and the number of people who qualify for the programme. So that's one driver and the other is the baseline healthcare costs and the hospital hospitalization rate. In some states like where the healthcare is more expensive, like Connecticut, Pennsylvania and Massachusetts, there are more room to reduce costs and hospital use. And for states like Alabama, the baseline healthcare cost is not as high as like in the states in the Northeast Region.
Shuyue Deng:In addition to those two, another I think the key driver is the state specific healthcare system. Some states like for example, Maryland have a unique payer payment model. For example, Maryland's global hospital budget system already control costs in a different way. So in Maryland, we can find a different result.
Rob Lott:Gotcha. So essentially in states where cost is maybe a little more, you know, where prices are higher, where cost is not as under control, there's a greater potential savings from a program like
Shuyue Deng:this. Well,
Rob Lott:I have a lot more to ask about the model. It sounds really promising, but let's first take a quick break. And we're back. I'm here talking with Amy Deng, a PhD candidate at Tufts Friedman School of Nutrition Science, all about a paper in the April issue of Health Affairs in which she and her co authors estimated the impact of medically tailored meals. Can you talk a little bit about your timeframe as well in the study?
Rob Lott:I think you looked at outcomes after one year and then again at the five year mark. Why did you choose those points and what did you see in terms of a difference between those two points?
Shuyue Deng:That's a great question. We choose to model both one year and five year outcome to measure both the short term and long term impact of the intervention. The one year are mainly to show the immediate effect like reducing hospitalization and cost saving, which are important for decision maker who want to see like a quick result. But we also look at the five year outcome because many policies, especially at the states or federal level are planned and budgeted over multiple year cycles often around like five years. So that's why we choose this timeframe as well.
Shuyue Deng:And we are not extending the ear for like even longer because that may, I think compromise the accuracy of our result.
Rob Lott:Fair enough. Now this was a simulation which is sort of the whole point, right, to imagine what's possible and attempt to quantify it. But what if a policymaker came to you, for example, and said, this is all well and good. Now go ahead and generate some real world evidence. And let's also say they maybe give you a blank check to fund that research.
Rob Lott:Where would you start? What's next? What are the questions in this space that really haven't yet been answered?
Shuyue Deng:Yeah, thank you for this question. It's a great question, because it's showing the future potential research. And I think the next steps is like because I understand the simulation like ours help only paint the big picture of what possible and but I do acknowledge like further real world research can fill in the details and further guide the implementation policy. If I have like a blank check, I could start with a large multi stage random control trial of medically tailored meals. I will follow patients over several years and track healthcare use and spending and even include different populations like Medicaid, Advantage and eligible individual to see how med criteria meals perform in different insurance and healthcare system context.
Shuyue Deng:And in addition, I would also want to look at who could benefit the most and whether those effect differ by race, disability status, different disability status and geography and further more groups. So the next steps, there are a few key question I want to maybe ask here for future research potential. For example, I would like to see what is the optimal dose of medically tailored meals. Like how many meals over what period for what type of conditions? That's one question.
Shuyue Deng:And the answer is what happens when medically tailored meals are paired with other support like nutrition counseling, SNAP benefits or different care coordination? So that's the two questions I have in my mind but there is a lot of more to explore.
Rob Lott:Wow, so that's a great agenda. So what's your sort of final takeaway or your next big step?
Shuyue Deng:The final takeaway is medically meal can prevent hospitalisation and create cost saving for forty nine days. And although we know medically tailored meals work, but we want to make more efforts to make them more available, make this intervention or medically tailored meals become routine part of healthcare. And to do that we need more real world evidence studies like random control trials to show how to implement them well for people in need.
Rob Lott:Well, that's a great agenda for the road ahead and a great spot perhaps to wrap up. Amy Dung, thank you so much for taking the time to chat with us and to tell us all about your paper in the April issue of Health Affairs.
Shuyue Deng:Yeah. Thank you. Thank you for having me.
Rob Lott:It was it was great to talk to you. This was wonderful. To our listeners, If you enjoyed this episode, please tune in again next week. Tell a friend, smash that subscribe button. And until then, have a good week.
Rob Lott:Thanks for listening. If you enjoyed today's episode, I hope you'll tell a friend about a health policy.