California Becomes The First State To Prescribe Food As Medicine
In one pilot program, doctor-approved meals lowered health care costs by 55 percent
By Anna Almendrala
Caren Latney was too weak to do simple household chores.
The 51-year-old had been diagnosed with lung cancer and, as she began treatment, struggled to stand over her stove long enough to prepare a meal. She didn’t really want to eat, anyway ― her intensive chemotherapy and radiation left her nauseated and exhausted. But high-calorie, protein-rich meals are essential for cancer patients, who face extreme weight loss, according to cancer experts.
The American Cancer Society recommends eating with other family members to make meals more enjoyable, and has suggestions for caregivers like fixing six to eight small meals, making smoothies and preparing bland foods to keep nausea at bay. But Latney, single with no family and on a fixed income, had no one available to help her prepare food. Insured by both Medicaid and Medicare for her cancer treatment, Latney couldn’t even afford to buy the amount of food required to survive her treatment, much less cook it.
Latney’s lack of social and financial support put her at risk of dying from her cancer treatment. Radiation and chemotherapy can cause patients to lose their appetite or suffer from nausea, causing extreme weight loss that can be life-threatening.
Her clinic was able to connect her with a local nonprofit organization that delivers a complete supply of food — three meals and one snack per day, every week — to low-income people who are in danger of malnutrition during a serious illness.
Eight years later, Latney, now 59, is still receiving the free meals from MANNA, or the Metropolitan Area Neighborhood Nutrition Alliance in Philadelphia, and the cancer has spread from the lung to the liver. But she credits the organization for helping her survive as long as she has.
“To be perfectly honest with you, I would not be here” without those delivered meals, Latney said.
Published research into MANNA’s work showed the meals had an impact on patient quality of life — and also major reductions in hospital costs, catching the attention of politicians in California. With high rates of food insecurity, chronic illness and Medicaid enrollment, California was looking for a way to bring down the overall costs of Medi-Cal, the state’s Medicaid program, with efforts that have a proven return on investment.
The new pilot program, which officially launched Friday with help from state senator Ben Allen (D) and California assembly members Blanca Rubio (D) and Richard Bloom (D), funds six nonprofit organizations throughout California that will deliver free meals to those who are insured by Medicaid and need a specific diet to help them manage their medical condition.
Nutritious, plentiful food plays an outsized role in helping people recover from major illness or live with a chronic condition. In addition to cancer treatment, which requires patients to eat high-calorie meals, people with cardiovascular illnesses may benefit from low-sodium food, while those with type 2 diabetes can better manage their disease with meals that are low in sugar and refined carbohydrates.
Across the country, an estimated one in eight Americans ― 42 million in total ― are food insecure. Not only does this mean that they may be experiencing hunger, but that the kinds of food they do eat are not nutritious enough to sustain an active, healthy life. At the same time, rates of chronic disease caused by poor nutrition are rising, and the more food insecure you are, the more likely you are to have chronic diseases like hypertension, coronary heart disease, hepatitis, stroke, cancer, asthma, diabetes and arthritis.
Despite its importance, food during an illness can often be an afterthought. Crucially, it is not covered by any medical insurance plan. Instead, people like Latney have to rely on nonprofits or charity to help them fill the nutrition gap, and not all cities have organizations that can help.
Organizations like MANNA are sorely needed throughout the U.S. About one in 10 adults on Medicaid has diagnosed diabetes and more than one in four have some kind of cardiovascular disease. What patients eat can have a major impact on their health outcomes.
But there are only 27 member organizations in 18 states and Washington, D.C., in the national Food Is Medicine Coalition, an association of nonprofit organizations that provide medically tailored food to people with serious or long-term illnesses.
Around the time that Latney began receiving her meals, researchers were also collecting data on how MANNA clients’ medical costs compared to other low-income patients with similar medical conditions who did not receive free meals.
They found that recipients of these free meals had average monthly medical costs that were 55 percent lower than Medicaid patients who didn’t get delivered meals. Hospital admission and duration rates were also significantly lower than the control group. Most strikingly, people who received meals from MANNA and were later hospitalized were 23 percent more likely to be discharged back to their homes as opposed to a long-term care or rehabilitation facility when compared to the control group.
Since this small study was published in 2013, all four companies that administer Medicaid locally throughout southeastern Pennsylvania have signed contracts with MANNA to deliver specially tailored meals for select patients with diabetes and cancer in an effort to lower state hospitalization costs.
California, where more than a third of its population is covered by Medicaid and one in eight people aren’t sure where their next meal is coming from, took notice.
Its new 12-week Medi-Cal pilot program will deliver specially formulated meals, as well as in-home visits from a registered dietitian, to 1,000 people with congestive heart failure — a patient group that has one of the highest rates of hospital readmissions within 30 days.
This three-year program will cost $6 million in total, and the money is spread out across six nonprofits throughout California, including Project Angel Food in Los Angeles County.
Richard Ayoub, CEO of the organization, notes that the extremely limiting diet that congestive heart failure patients have to follow would be challenging for people of any income level, let alone people who sometimes have to choose between paying for health care and paying for food.
People with congestive heart failure can have only two grams of sodium — less than one teaspoon ― a day. Any more will encourage the body to retain water, which increases the volume of blood and forces an already weakened heart to work harder. Processed food would be a cheap, convenient choice for these patients, but these products are usually high in sodium.
If the Food Is Medicine pilot program succeeds in demonstrating significant cost savings for Medicaid, known in California as Medi-Cal, the ripple effects could be enormous.
“We believe food is medicine and that this food will keep people out of the hospital, thus saving Medi-Cal hundred of thousands, if not millions, of dollars,” said Ayoub.
If Medi-Cal makes food a health benefit as Ayoub hopes, the federal government could assess the return on investment and conclude that food should be a nationwide Medicaid benefit.
John Baackes,CEO of LA Care Health Plan, one of the public agencies that administers Medicaid insurance in Los Angeles county, praised California’s pilot project as the investment the movement needed to mount a national case for food as a component of health care. He sees the state’s pilot program as one small step in the direction of re-imagining medical care to include social services that affect health, from housing to food security.
“We’re very anxious to see a program like this lead to policy changes,” he said.
As researchers and policymakers wait for the data from California’s pilot project to start rolling in, Latney pointed out that no matter what the return is for the state, the effect these meals will have on people struggling to survive will be immeasurable.
“They want to have not only a meal, but a meal that’s designed for them to survive,” she said. “I think it’s going to have a very, very big impact.”