Recently, a few of us at Community Catalyst had the pleasure of breaking bread with the holistic health innovators at Community Servings, a non-profit that delivers high-quality food to individuals and families living with critical or chronic illness.
Each year, Community Servings delivers 395,000 free, home-style meals to 1,300 people throughout eastern Massachusetts who are not well enough to cook. Ninety-five percent of the beneficiary families live at or below the poverty line. The service provides customized, nutritionally calibrated lunches, dinners, and snacks, five days a week. Consumers choose from an array of culturally sensitive menu options.
Over a wonderful lunch from their kitchen in Jamaica Plain, Boston, we discussed how Community Servings can contribute to managed care organizations (MCOs) by promoting the under-appreciated idea that "food is medicine."
The first course: a warm, toasted flatbread topped with crumbled feta and fresh herbs.
"Malnutrition is one of the greatest contributors to admission and readmission to hospitals and to admissions into nursing homes," Community Servings CEO David Waters wrote in an oped for The Huffington Post in November. "Chronically and critically ill individuals who can remain in their homes while battling whatever health challenge they face can be part of the solution to reduced medical costs.
"But if you are a young mother facing breast cancer or a man struggling with kidney dialysis, it is impossible to stay out of the hospital if you can't eat."
The chef returned with a fragrant soup of cauliflower, lentil, and cumin.
A 2010 article from the New England Journal of Medicine explains the stressful cycle that links food insecurity and chronic illness (see page eight). Food insecurity leads to constrained dietary options, which causes poor diet, which is followed by sudden fluctuations in weight and blood sugar. These changes in the body increase risk of chronic disease, which creates new financial pressures and impairs a person's ability to manage their diet and earn an income. In turn, this increases risk of further weight gain and of poor management of the underlying condition, which leads to increased health care spending, which further increases food insecurity, starting the cycle over again.
Research has long shown that poor diet is associated with chronic disease. A solid base of evidence, explicated in a white paper developed by Community Servings, shows that carefully-planned meals can help protect against adverse outcomes:
- • A study performed in Philadelphia found that medically tailored, home-delivered meals significantly reduced health care costs for people living with HIV/AIDS. Health care expenditures for the study cohort averaged $50,000 per person per month in the six months prior to the home-delivered meals program. In the six months after the start of the meals program, health care costs for the same population averaged just $17,000 per person per month (see reference 58).
- • Wasting—rapid body mass loss—is observed in many cancer patients because of poor diet. A study found that a mere 5 percent weight loss in cancer patients is associated with decreased survival rates and quality of life and increased risk of complications—making hearty, healthy, and appetizing food all the more important (see reference 77).
And then, to round out the meal: butternut squash ravioli topped with tomatoes, wilted kale, and a garlicky carrot pesto sauce.
The dual eligible demonstration projects are coming down the pipe in a slew of states, and health programs are placing newfound emphasis on branching out into services that were not typically considered "medicine." Organizations like Community Servings will be looking for ways to shine as health plans ask questions like "What will our enrollees eat, and how will that affect their health?"
The delivery of high-quality meals is just one type of service that could prove valuable as MCOs provide services for enrollees with chronic and critical illness. Non-emergency transportation services can help patients get to appointments they otherwise would miss. Home assistant personnel can be trained to spot hazards that can cause falls and can perform de facto well-being checks. Social workers can coordinate the efforts of family members who provide home care and supports.
“I truly believe [the meals program] keeps them from rehospitalization," a social worker wrote in a survey conducted by Community Servings. "With nutrition you have a lower risk of things like dehydration, malnutrition and negative side effects of medication."
As MCOs and policymakers test what works, the breadth and sophistication of these ancillary services could grow by leaps and bounds. Advocates should stay informed about these new innovations that can improve outcomes for enrollees with critical or chronic illness.
Learn more about Community Servings at their website.
– Christophe Stuck-Girard, Legal Intern, Voices for Better Health