FOOD IS MEDICINE: FIELD STUDIES

Medically Tailored Meals

Food is Therapeutic.

Cathryn Couch
CEO
Ceres Community Project, member of FIMC

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MEDICALLY TAILORED MEALS ARE ONE EXAMPLE  of a food is medicine intervention. These are meals that are tailored to meet the unique nutritional needs of an individual based on their diagnos(e)s, as well as the additional complications that might come with that illness (i.e. treatment side effects, coexisting conditions , etc.). Research consistently shows that medically tailored meals improve health outcomes, lower the cost of care, and increase patient satisfaction. 
 
Most often, medically tailored meals are provided through a referral from a medical professional or healthcare plan. A medically tailored meal intervention includes three elements: a medical referral, a nutritional assessment by a registered dietitian nutritionist (RDN) who also oversees the meal plan design, and the preparation and home-delivery of these meals. Patients also benefit from the human connection provided by the home delivery of these meals, with research indicating that medically tailored meals reduce isolation and loneliness, which can negatively impact health outcomes.
 
Most providers of medically tailored meals are community based organizations who are members of the Food is Medicine Coalition (FIMC). This group’s Clinical Committee has issued a sophisticated set of Medically Tailored Meal Nutrition Standards, based on research and more than 30 years of experience developing the science of medically tailoring meals. The Clinical Committee is made up of Registered Dietitian Nutritionists, who are experts in treating serious illness with nutrition. 
photography by Douglas Gayeton - click to enlarge

MANNA is a non-profit organization that uses nutrition to improve health for people with serious illnesses who need nourishment to heal. By providing medically tailored meals and nutrition education, MANNA empowers people to improve their health and quality of life. With help from 7,000+ volunteers, MANNA delivers over 1.3 million nourishing meals per year to individuals across Pennsylvania and southern New Jersey.

A medically tailored meal intervention, as defined by the Food is Medicine Coalition , does not simply mean putting someone on a diet. FIMC clients’ medical lives are often complex – many are living with more than four serious illnesses at once – and they require an equally complex nutrition intervention. Medically tailored meals help the “sickest of the sick” in communities, often the 5% of patients that cost 50% of healthcare costs. 
 
As well as having to manage a complex medical diet, many of the patients FIMC serves are too sick to shop or cook, and the majority are living at or below the federal poverty guideline meaning that their access to healthy food is severely limited.

Health Partners Plans and Medically Tailored Meals

Catherine McCarron
VP, Clinical Programs, Medicaid
Health Partners Plans

FOUNDED MORE THAN 32 YEARS AGO, Health Partners Plans is a non-profit managed care organization in Greater Southeastern Pennsylvania that serves more than 250,000 members through its Medicaid, Medicare and Children’s Health Insurance Program (CHIP) plans. It is also one of the few MCOs in the nation that is hospital-owned.

 

In 2015, HPP and MANNA, a local community based organization, decided to explore a simple question: could they measure the positive health outcomes of members given therapeutic food as medicine to treat chronic health diseases? To find the answer, the HPP-MANNA Food is Medicine program began offering medically tailored meals and nutrition counseling to a small group of diabetic members. 

 

After the program improved health outcomes and lowered costs per member per month, HPP expanded the program. As of October 2019, more than 730,600 meals have been delivered to more than 3,000 HPP members suffering from various illnesses, including diabetes, heart disease, malnutrition and kidney failure. 

Charting Preliminary Outcomes

Findings for the population that ended services by January 1, 2019 show:

• Lowered blood-glucose levels for 23 percent of diabetic member
• Decreased utilization for inpatient admissions and emergency room visits
• Increased the use of preventive services such as visits with primary care practitioners
• Reduced overall medical costs per member per month by 18 percent

After the program improved health outcomes and lowered costs per member per month, HPP expanded the program. As of October 2019, more than 730,600 meals have been delivered to more than 3,000 HPP members suffering from various illnesses, including diabetes, heart disease, malnutrition and kidney failure.

HPP case managers assess their members for chronic conditions and social determinants of health needs, as well as their readiness to change their eating habits. Qualifying members are offered medically tailored meals prepared by MANNA, a Philadelphia based non-profit specialized in preparing meals that meet the nutritional needs of individuals with serious or chronic illnesses.

Information Artwork by Douglas Gayeton - Click to Enlarge

Today, the HPP-MANNA Food Is Medicine program has expanded to include members with other chronic illnesses, such as heart disease, malnutrition and kidney failure. Health Partners Plans views the Food Is Medicine (FIM) program as another tool to assist members with certain chronic conditions to self-manage their conditions. The FIM program also educates the member about how diet affects condition – something that is tangible instead of just words on paper or verbal communication from the healthcare providers. 

 

By partnering with HPP, MANNA aims to demonstrate the value of medically tailored meals by providing members with therapeutic nutrition services that improve health and quality of life. The success of the MANNA-HPP partnership can spark changes in the healthcare landscape that ensure access to medically tailored meals for every individual with a health condition that could

Neighbors Nourishing Neighbors... with food.

Sue Daugherty
CEO
Metropolitan Area Neighbourhood Nutrition Alliance (MANNA)
Philadelphia, PA

MANNA was founded in 1990 by seven members of Philadelphia’s First Presbyterian Church in response to the HIV/AIDS epidemic. Initially, they provided care and comfort to those who were dying, but as HIV/AIDS treatments became available, they evolved to provide medically tailored meals for people with nutrition-impacted diseases and nutrition counseling to help people improve their health outcomes and quality of life. 

Information Artwork by Douglas Gayeton - Click to Enlarge

MANNA VOLUNTEERS 

They donate their time for various reasons including employee involvement, community service requirements for school, connection to MANNA’s mission, and simply for the feeling of giving back. Sometimes volunteers are even former clients.

 

During their three hour shifts volunteers chop vegetables, pack meals, fill meal trays, make sandwiches, bake and perform other tasks with the guidance of MANNA’s professional chefs. Each morning, the meals are sorted and packed into MANNA’s fleet of trucks. Staff drivers make weekly deliveries to each of our clients. They receive 21 meals in each delivery, ensuring that 100% of their nutritional needs are met for the week. 

Today, MANNA’s staff of licensed registered dietitians ensures that each medically tailored meal meets the unique and often complex nutritional needs of its clients. The nutrient levels of these meals vary depending on each individual’s disease state and are based on research compiled by organizations such as the Academy of Nutrition and Dietetics, American Diabetes Association, National Kidney Foundation, and the American Cancer Society. 

MANNA utilizes five (5)
climate-controlled trucks and paid delivery drivers to ensure each of its 1,200 clients receive their weekly meal deliveries on their scheduled day.

 

MANNA drivers are sure to greet each client with a smile as they make their weekly deliveries. Depending on the needs of the client, drivers often assist with unpacking the meals and ensuring they are stored properly. 

Information Artwork by Douglas Gayeton - Click to Enlarge
Photos by Douglas Gayeton - Click to Enlarge

One area that is part of HPP and MANNA’s pilot project is Fairhill, a heavily Hispanic Philadelphia community, frequently ranked as the poorest neighborhood in the poorest major us city.  More people are obese, more people smoke, and fewer are insured. 67.1% of children are in poverty and the drug trade is rampant.

MANNA serves 1.3 million medically tailored meals each year in a delivery zone encompasses most of the nine (9) county Philadelphia and southern New Jersey region. While most clients reside in the metropolitan area, MANNA delivery drivers cover over 1,000 square miles in the surrounding region. For those residing outside the delivery zone, MANNA recently expanded a shipping program via an insurance partner that allows the organization to reach members residing across the state of Pennsylvania. 

Delivering meals to their clients’ doorsteps ensures they have access to 100% of their nutritional needs, and eliminates barriers such as cost, mobility, and nutrition literacy that prevent individuals from obtaining the food they need to manage serious illnesses. All meals arrive frozen and may simply be reheated in an oven or microwave, which enables clients to focus on healing rather than preparing a medically appropriate meal.

Information Artwork by Douglas Gayeton - Click to Enlarge

What do you expect as an outcome?

Sharing the successful outcomes of the HPP-MANNA Food Is Medicine partnership may convince healthcare insurers that investing in medically tailored meals for chronically ill people may save money in the long run, as people may become healthier, and their utilization of services (ER visits and inpatient admissions) decreases while their use of preventive services, such as PCP visits, continues. 

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