How Food Insurance Plans Can Address Social Determinants of Health - PatientEngagementHIT.com

By Sara Heath

March 21, 2019 - New research highlights the cost efficiency of Medicare and Medicaid coverage for healthy food plans, demonstrating the effectiveness of programs that address the social determinants of health.

The researchers, hailing from the Friedman School of Nutrition Science and Policy at Tufts University, noted that food insecurity is a critical social determinant of health that can have a direct impact on a patient’s ability to be healthy.

A nutritious diet can prevent or help maintain certain chronic illnesses, while food security can positively impact other areas in life such as job performance or educational attainment.

But healthy food can be expensive, creating a cost barrier for patients from lower socioeconomic levels who are also at a greater risk of developing a chronic illness. These patients may benefit from community health and other medical programs that connect them to healthy food sources at a lower cost.

The researchers found that social supports through the Medicare and Medicaid insurance plans are financially feasible and are effective at reaching this target patient population.

“Our findings support implementation and evaluation of healthy food prescriptions within healthcare systems to improve the diet and health of Americans,” said co-senior author Renata Micha, RD, PhD, research associate professor at the Friedman School.

The team developed two programs that covered the costs for healthy and nutritious food through Medicare and Medicaid. Using an electronic debit card, beneficiaries received 30 percent subsidies in one of two plans. The first plan provided subsidies for fruits and vegetables only, while the second plan provided subsidies for fruits, vegetables, whole grains, nuts or seeds, and plant-based oils.

While both models proved successful, the second plan was more cost efficient and resulted in better patient outcomes.

For example, over the entire lifetime of current beneficiaries, the first model could prevent 1.93 million cardiovascular disease cases, while model two would prevent 3.28 million. Additionally, only model two was effective at preventing diabetes cases, likely because whole grains, nuts, and seeds are proven effective at preventing diabetes.

What’s more, the care model is exceptionally cost efficient, the researchers boasted. Although the models do not result in a net cost savings, they can be categorized as cost effective health interventions that deliver on a key patient need. These findings demonstrate that healthcare treatments can come in the form of social goods, and that those interventions can be cost effective.

“Medicare and Medicaid are the two largest healthcare programs in the U.S., together covering one in three Americans and accounting for 1 in every 4 dollars in the entire federal budget,” said co-first author Dariush Mozaffarian, MD, DrPH, dean of the Friedman School. “These new findings support the concept of Food is Medicine: That innovative programs to encourage and reimburse healthy eating can and should be integrated into the healthcare system.”

Model one cut $39.7 billion in healthcare costs while model two saved $100.2 billion over the course of current beneficiary lifetimes. Healthier diet result in lower healthcare utilization rates, the report authors explained.

The cost for subsidizing the food totaled at $122.6 billion for model one and $210.4 billion for model two. Again, while there are not cost savings from these programs, they are cost efficient and deliver on a public health need.

Model one cost $18,184 per quality adjusted life-year (QALY), an industry standard quality of life measure. For model two, that cost was $13,194. For less than $20,000 each year, Medicare and Medicaid programs could improve the quality of life for all of its beneficiaries, the researchers suggested.

These totals are remarkably less than what industry experts say are cost efficient programs. For a program to be considered cost efficient, it must cost less than $150,000 per QALY. Programs that cost less than $50,000 per QALY are considered extremely cost effective and a “medial best buy,” the researchers said.

“We found that encouraging people to eat healthy foods in Medicare and Medicaid – healthy food prescriptions – could be as or more cost effective as other common interventions, such as preventative drug treatments for hypertension or high cholesterol,” concluded co-first author Yujin Lee, PhD, postdoctoral fellow at the Friedman School of Nutrition Science and Policy at Tufts.

“Healthy food prescriptions are increasingly being considered in private health insurance programs, and the new 2018 Farm Bill includes a $25 million Produce Prescription Program to further evaluate this approach.”

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