National food prescriptions would save US lives & billions of dollars
It’s well known that good food is the foundation of good health. In the US, poor nutrition and food insecurity are major contributors to poor health outcomes and excess healthcare spending. A new report suggests that implementing medically tailored meals and produce prescriptions nationally in the US would not only improve health and be highly cost-effective but would also save healthcare costs by addressing diet-related chronic illness.
Recently, there’s been a focus on medically tailored meals (MTMs) and produce prescriptions designed to meet an individual’s specific health needs. The Food is Medicine (FIM) initiative is about incorporating targeted food and nutrition strategies into US healthcare nationally. A newly released report by researchers at the Food is Medicine Institute at Tufts University, supported by The Rockefeller Foundation, quantifies the potential health and economic benefits of FIM.
“The true costs of our food system – the environmental impact of how food is produced, the working conditions of the people who grow our food, and the impacts on our health, healthcare spending, and health equity are too often left off the price tag,” said Devon Klatell, Vice President of the Food Initiative at The Rockefeller Foundation. “This report can assist governments, companies and consumers in better evaluating the value of Food Is Medicine interventions by considering not just the price paid for food, but the return on investment in improved health outcomes they can deliver.”
MTMs are designed for people with severe, complex chronic conditions – such as poorly controlled diabetes, heart failure, HIV, or cancer – that limit their ability to perform the activities of daily living. The meals, tailored by a registered dietitian, would be delivered to individuals through a referral from a medical professional or healthcare plan.
Produce prescriptions are for people with at least one diet-related health risk or chronic condition, such as diabetes, pre-diabetes, high blood pressure, obesity or heart disease, as well as people with low incomes and/or food insecurity. Discounted or free fruits and vegetables (and sometimes other food items like nuts, whole grains, dairy and eggs) are provided by electronic benefit cards or paper vouchers redeemable at grocery stores or farmers markets.
The report describes two case studies. The first evaluated the true cost of expanding the implementation of MTMs nationally for adults 18 and over with at least one diet-related condition and a limited ability to perform activities of daily living. Simulation modeling was used to estimate one- and 10-year potential changes in annual hospitalizations, potential changes in annual healthcare expenditure, and overall policy cost-effectiveness associated with national MTM coverage, compared with no new MTM policy.
It was estimated that 6.3 million American adults with Medicare, Medicaid or private insurance would’ve been eligible to receive MTMs, leading to 1.6 million fewer hospitalizations annually. After accounting for all implementation costs, the policy was anticipated to lead to estimated net savings for the healthcare system of US$13.6 billion over one year and $185.1 billion over 10 years.
The second case study evaluated the cost of nationally implementing produce prescriptions for adults aged 40 to 79 with diabetes and food insecurity. The researchers used a microsimulation model to estimate the long-term health and economic impacts and cost-effectiveness. It was estimated that, based on national data, 6.5 million American adults met the eligibility criteria, that is, aged 40 to 79, with diabetes and food insecurity.
National coverage of produce prescriptions for these patients was estimated to prevent 292,000 cardiovascular disease events and add 260,000 quality-adjusted life years (QALYs) – a measure of how well a treatment lengthens or improves patient’s lives – over a lifetime, while being both cost-effective and cost-saving.
“Today’s report further demonstrates for FIM interventions like medically tailored meals and produce prescriptions, combined with nutrition education for doctors and insurance coverage of nutrition counseling provided by a registered dietitian, could make a real difference in the 10,000 weekly US deaths and $1.1 trillion in annual healthcare spending and lost productivity due to poor diets,” said Dariush Mozaffarian, the report’s senior author.
Momentum to add these strategies to healthcare is building, with nine US states approving waivers under section 1115 of the Social Security Act to deliver food-based nutritional interventions through Medicare to patients with eligible medical conditions. The current report comes in the wake of the September 2022 White House Conference on Hunger, Nutrition and Health and the accompanying National Strategy, both of which centered on the need to harness the potential of FIM.
But, presently, FIM is largely unavailable to individuals who might benefit from it. Neither Medicare nor Medicaid covers MTMs, and private healthcare entities must choose to cover them. Access to FIM programs is generally provided by community-based organizations.
The Food is Medicine report is available here.
Source: Tufts University