November/December 2024 Issue
Medically Tailored Meals
By Alyssa Saltz, MS, RD, LDN
Today’s Dietitian
Vol. 26 No. 9 P. 24
Transforming Patient Care One Meal at a Time
Medically tailored meals have been available for more than 35 years. They started as a community response to the AIDS crisis as volunteers tried to develop strategies to help prevent malnutrition, manage side effects, and bring dignity to the lives of people with AIDS when there were no other proven treatments.1 Once the medical community developed treatments for this population, medically tailored meal programs evolved to help meet the nutritional needs of those living with other chronic health conditions.
The role of dietitians has been vital in the development and management of the medically tailored meals movement to ensure meal plans are evidence-based and meet high nutrition standards.
Individuals living with serious health conditions often are prescribed evidence-based nutrition therapy to help manage side effects, slow disease progression, and lower the risk of comorbidities. Much research has demonstrated improved health outcomes from following a medically prescribed meal plan for many health conditions. However, due to various barriers, such as socioeconomic status, education level, finances, lack of time, and limited cooking skills, patients may struggle to follow specified diet recommendations.
Using dietary interventions has been shown to not only improve medical outcomes but also lower financial burdens and raise patient satisfaction. Peer-reviewed research has demonstrated that for individuals with complex health conditions, medically tailored meals can lead to a 16% net reduction in health care costs, 72% fewer skilled nursing facility admissions, and a 70% decrease in emergency department visits.2 A focus on good nutrition also helps address malnutrition, frailty, independence, and more.
According to the Food Is Medicine Coalition, medically tailored meals are medically appropriate meals delivered to the homes of individuals living with severe, complex, and/or chronic illnesses who are too sick to shop or cook for themselves.1 Many medically tailored meal programs provide frozen or shelf-stable meals designed to meet the needs of specific health conditions. They often eliminate concerns around grocery shopping, label reading, food preparation, or determining what to eat. The meals are different from other prepared meal companies because they’re developed in accordance with high-quality ingredient standards, designed by dietitians, and tailored to meet postdischarge needs of individuals.
Medically tailored meal programs often accommodate multiple dietary restrictions rather than focusing on only calorie- or carbohydrate-controlled options, and they consider reductions in sodium and saturated fats, as well as increases in fiber and other nutrients. The programs also provide one-on-one nutrition counseling or MNT with a dietitian.
After patients are referred by medical professionals or health care plans, they may receive a limited number of meals per week or receive all three meals for the day, depending on their insurance coverage, ability to pay, and the service they choose. If a health care plan covers meals, patients may need to be assessed for eligibility. The length of time patients are enrolled in the program (generally a minimum of 12 weeks) will depend on their nutritional needs. Moreover, patients may need to be reassessed routinely to continue receiving meals beyond the initial period.
Research-Backed Benefits of Medically Tailored Meals
Studies have shown that 5% of patients generate 50% of health care costs.1 Medically tailored meals help to address the needs of this population with nutrition interventions to improve their overall health.1
Tufts University Friedman School of Nutrition Science and Policy conducted a study in 2022 looking at the amount of health care savings and reduction in hospital admissions if every eligible patient participated in medically tailored meals in the United States and found that there would be $14 billion in health care savings and 1.6 million fewer hospital visits in just one year’s time.3 With the current state of health care and a growing population of older adults needing medical care, medically tailored meals may be a solution to improve patient care, lower health care costs, and decrease the burden on our country’s stressed medical systems.
One study conducted by Metropolitan Area Neighborhood Nutrition Alliance found that client’s health care costs were reduced by $10,765 per month in the first three months after receiving medically tailored meals.4 Its pilot program on medically tailored meals found that receiving meals led to 37% shorter hospital stays, 50% fewer hospital admissions, 20% more likely to be discharged home, 28% cost savings, decreased hospital readmission rates, 50% fewer visits to the emergency department, 50% improved medication adherence, decreased social isolation, improved self-management of condition and satisfaction, and reduced malnutrition and improved health outcomes.
According to Catherine Macpherson, MS, RD, senior vice president and chief nutrition officer at Mom’s Meals, a leading nationwide provider of medically tailored, fully prepared home-delivered meals, “We’ve seen strong results with medically tailored meals for many groups of vulnerable people. When medically tailored meals are provided after discharge, we’ve seen rates of readmissions cut in half.4 For people with an uncontrolled chronic condition like diabetes or kidney disease, we’ve seen improvements in clinical status.”5,6
In a recent case study with a health plan in California for dually eligible (Medicare and Medicaid) members with heart failure, Mom’s Meals and the health plan provided six months of support: three medically tailored meals per day for the first three months, then two medically tailored meals per day for the next two months, then one meal per day for the last month. In the last three months, produce and pantry boxes also were delivered to the members’ homes, along with simple
recipes. Members also received up to seven calls from a dietitian and had access to a nurse and community health workers from their health plan. In this program, patients lost an average of 6 lbs and reported reduced heart failure symptoms. The number of visits to the emergency department was cut in half and the rate of inpatient hospitalization also was reduced by 50%. The cost savings of the program were 25%, which equals about $19,000 per patient per year. “Members reported very high satisfaction with the program, and many tried a new fruit or vegetable for the first time,” Macpherson says.
In California, they started the California Food Is Medicine Coalition, a nonprofit community-based organization that provides medically tailored meals and nutrition services to individuals living with serious medical conditions.1 They partner with different health plans and health care providers and have noticed improved health outcomes and reduced health care costs in their service areas that cover more than 65% of the state’s Medi-Cal population. Chronic physical or behavioral health conditions, in patient discharges, or high-risk pregnancies make Medi-Cal members eligible to receive a minimum of 12 weeks of medically tailored meals.
Medically Tailored Meals for Various Health Conditions
To be eligible for medically tailored meals, recipients with complex (often diet-related), severe, and chronic illnesses must be referred by a medical professional or health care plan. Often, individuals with high-need, high-cost conditions that have a higher risk of hospital or skilled nursing care admission are the best candidates for a medically tailored meals program. These chronic health conditions include cancer, CVD, chronic kidney disease, COPD, diabetes, end-stage renal disease, HIV, diabetes, and other diseases/conditions that may increase the need for hospitalization.7,8
Meals often can be tailored to meet the needs for the following dietary interventions:
• cancer support;
• diabetes friendly;
• general wellness;
• gluten-free;
• heart healthy;
• kosher;
• low fat;
• low fiber/high fiber;
• low sodium;
• pureed;
• renal friendly; and
• vegetarian/vegan.
Filling in the Gaps
Rene Ficek, RDN, CDCES, president and owner of Seattle Sutton’s Healthy Eating (SSHE), a medically tailored meals company that provides nationwide delivery, says, “We are one of those few companies helping to fill in the gaps for individuals who are between the start of chronic disease and a diagnosis that’s covered for medically tailored meals.” An RN founded SSHE in 1985 with the goal of helping individuals apply diet recommendations from doctors and dietitians to real life by providing freshly prepared meals that follow the recommendations of the American Heart Association, American Diabetes Association, and the 2020–2025 Dietary Guidelines for Americans. Today, the company employs three RDs, a certified diabetes care and education specialist, and an executive chef. “Our meals have been used for almost 40 years to help customers manage health conditions like diabetes, heart health, cancer care, kidney disease, liver disease, and more. We’ve seen lives transformed because of our meals, and what we take most pride in is helping individuals learn how to eat healthier by demonstrating what variety, freshness, and portion control should look like.”
While medically tailored meals must meet a set of stringent dietary guidelines for insurance coverage, there are alternatives accessible to those without insurance benefits or who don’t meet the disease criteria. Choosing freshly prepared meals that align with calorie consistency and dietary recommendations serves as an excellent starting point. This approach proves beneficial for individuals aiming to lower cholesterol, reduce blood pressure, improve blood sugar levels, and address various health concerns before they become more severe.
“In my previous role as a clinical dietitian, I frequently encountered patients grappling with overwhelming dietary recommendations from their physicians,” Ficek says. “Balancing heart-healthy eating with newly diagnosed diabetes, many felt lost in the complexity of dual dietary requirements. I often emphasized that these dietary guidelines share similarities, and adopting a calorie-controlled, healthful diet featuring lean proteins, vegetables, fruits, whole grains, and low-fat dairy could effectively manage these conditions. Importantly, such a diet not only addresses specific health concerns but also serves as a preventative measure against other chronic diseases. Now, in my current capacity, I take pride in contributing to the creation of meals designed to alleviate stress and confusion surrounding dietary choices. These meals not only address health concerns but also serve as valuable tools for educating individuals on what constitutes a healthful diet.”
How Dietitians Are Getting Involved
Like Ficek, dietitians as a whole are a critical aspect of the medically tailored meals movement. RDs can manage, plan, and provide expertise to meal programs. They can help perform research on how the Food as Medicine movement improves patient care, connect individuals with medically tailored meal programs, and help them manage their conditions to feel their best and maintain independence.
Erin Pellegrin, RD, LDN, director of culinary nutrition and education with Unite For HER, a nonprofit organization focusing on the health and wellness of individuals diagnosed with breast and ovarian cancers, based in West Chester, Pennsylvania, says, “RDs’ involvement in medically tailored meals enables us to drive home the education we provide to the patients we serve. Whether it’s involvement in recipe development or assisting patients with selecting the foods/meals that best support their health, the impact is great and goes far.” In tangible ways, RDs can do the following for patients:
1. Reduce the stress and confusion patients experience when they must make adjustments to their current way of eating to better support their health goals.
2. Introduce patients to new recipes, flavor profiles, and methods of cooking that promote their health.
3. Preserve their energy. Food preparation and cooking may feel like an arduous task for patients dealing with fatigue, neuropathy, and other types of chronic pain. Medically tailored meals enable them to enjoy foods that support their health and lighten their load.
Macpherson primarily works with health care partners, including health plans, health systems, and hospitals that want to establish medically tailored meal programs for one or more of their populations. “I ensure the program design will optimize outcomes for those receiving meals and be cost-effective for the partner. And there’s a way to measure the impact of the program,” Macpherson says.
At Mom’s Meals, dietitians work in a variety of roles. The director of research and development collaborates with the team of chefs to ensure that medically tailored meals meet dietary guidelines and that menus are updated to offer seasonal selections. RDs provide support and education to individuals in the program, and other dietitians work directly with health plan customers to ensure their meal programs are running smoothly.
Working With Patients
When RDs sit with patients, Macpherson says they should ask them if they know whether medically tailored meals are covered by their insurance plan. Most patients won’t know, so RDs can encourage them to call the number on the back of their insurance card to find out.
“Most people with Medicare Advantage have medically tailored meal benefits for two to four weeks after discharge from an inpatient stay. Some have benefits for longer periods of time—12 weeks or longer to help them better manage a chronic condition.
“In addition, many Medicare Advantage members have a monthly allowance on a card they can use to pay for Mom’s Meals or other medically tailored meals,” Macpherson says. Patients on Medicaid also may have medically tailored meal benefits following a recent hospital admission or during pregnancy.
According to Pellegrin, patients with chronic conditions should have more insurance coverage and nutrition support, as well as additional programs and education to reduce the risk of disease and improve overall health. When medically tailored meals aren’t available to patients, RDs can fill that gap by connecting them with companies that provide home-delivered meals that meet high nutrition standards and offer RD support. Unite For HER partners with Sunbasket Meals, a meal delivery service that provides meal kits and freshly prepared meals for a variety of dietary patterns, to offer members the choice of three dinners (six servings total) preselected by its team of dietitians to be delivered to their homes.
In addition, several types of medically tailored meals programs exist that offer patients fully prepared meals or partially prepared meals, requiring little meal planning and preparation. Ficek says a program that offers fully prepared meals helps patients with limited cooking skills or who want more convenience due to limitations or a hectic schedule. It’s important to consider the patients’ constraints and abilities when choosing a program that’s best for them. “Programs like SSHE do the shopping, planning, prep work, and cooking for patients, so they can focus on taking care of themselves and doing the things they love.”
Patients’ lives are being transformed through the nutrition provided by medically tailored meals. Mary Anderson, a patient with stage 3 kidney disease, who’s been enrolled in a heart-healthy, diabetes-friendly meals program for more than four years, says that the meals she receives have kept her kidney values steady. The nutrition and sodium reduction in the meals “have helped me so much. The meals also are convenient. I don’t have to plan, prepare, or shop for meals. I eat so much more healthfully than I would if I were preparing meals at home on my own, especially since I’m over 80 years old and living alone.”
— Alyssa Saltz, MS, RD, LDN, is a registered dietitian nutritionist in Northern Illinois, serving as the lead dietitian at Seattle Sutton’s Healthy Eating. In her role, she oversees nutritional standards, manages the Nutrition Ambassador Program, and provides personalized counseling to customers, drawing from her extensive experience in various areas of dietetics.
Recommendations for RDs
• Review nutrient analyses of medically tailored meals. Review nutrition content to ensure the meals and overall program are suited for your patient’s needs. Find programs that follow high nutrition standards and work with a variety of health conditions rather than just one condition or a single diet.
• Connect with RDs working with medically tailored meal programs. Making personal connections with fellow dietitians increases confidence in the program and helps determine whether it will work for your patients. Many programs have resources to connect patients with their services. RDs also can help patients choose the correct menu type, consider food allergies, discuss food aversions, and include taste and cultural preferences.
• Contact insurance plans to determine whether they cover medically tailored meals. Since many patients have this benefit, and some unknowingly, contact their insurance carrier to refer them to a medically tailored meal program and determine how they can take advantage of this service affordably.
• Search for programs with sustainable practices and environmentally friendly products. Look for plans that minimize food waste, use recyclable materials, and focus on economical food sourcing.
References
1. California Food as Medicine Coalition website. https://www.calfimc.org. Accessed September 9, 2024.
2. Hager K, Cudhea FP, Wong JB, et al. Association of national expansion of insurance coverage of medically tailored meals with estimated hospitalizations and health care expenditures in the US. JAMA Netw Open. 2022;5(10):e2236898.
3. Medically tailored meals could save U.S. nearly $13.6B per year. Tufts University website. https://nutrition.tufts.edu/news/medically-tailored-meals-could-save-us-nearly-136b-year. Updated October 17, 2022. Accessed September 9, 2024
4. Gurvey J, Rand K, Daugherty S, Dinger C, Schmeling J, Laverty N. Examining health care costs among MANNA clients and a comparison group. J Prim Care Community Health. 2013;4:311-317.
5. Nguyen HQ, Duan L, Lee JS, et al. Association of a medicare advantage posthospitalization home meal delivery benefit with rehospitalization and death. JAMA Health Forum. 2023;4(6): e231678.
6. Callahan CN, Hart BB, McNeil CK, Duerr JM, Weller GB. Improved time in range during 28 days of meal delivery for people with type 2 diabetes. Diabetes Spectr. 2022;35(3):358-366.
7. Perez LM, Fang HY, Ashrafi SA, et al. Pilot study to reduce interdialytic weight gain by provision of low-sodium, home-delivered meals in hemodialysis patients. Hemodial Int. 2021;25(2):265-274.
8. Berkowitz SA, Terranova J, Randall L, Cranston K, Waters DB, Hsu J. Association between receipt of medically tailored meal program and health care use. JAMA Intern Med. 2019;179(6):786-793.