Study: Home-de­liv­ered meals could save Medi­care mil­lions

Chicago Tribune (Sunday) - - NATION & WORLD - By Ri­cardo Alonso-Zaldivar

WASH­ING­TON — Medi­care could save $1.57 for every dol­lar spent de­liv­er­ing free healthy meals to frail se­niors af­ter a hos­pi­tal­iza­tion, ac­cord­ing to a new study that comes as lawmakers look to re­strain costs by pro­mot­ing pa­tients’ well-be­ing.

The re­port from the Bi­par­ti­san Pol­icy Cen­ter ad­dresses ways that Medi­care can do a bet­ter job co­or­di­nat­ing care for chron­i­cally ill pa­tients, who ac­count for most of the pro­gram’s $650 bil­lion an­nual cost. There’s a grow­ing recog­ni­tion that prac­ti­cal ser­vices like meal de­liv­ery can make a dif­fer­ence help­ing older peo­ple avoid health flare-ups that can send them to the hos­pi­tal.

“If you were go­ing to of­fer meals to every Medi­care ben­e­fi­ciary, it would be cost-prohibitiv­e,” said Kather­ine Hayes, health pol­icy direc­tor for the cen­ter. “By tar­get­ing it to a very, very sick group of peo­ple is how we were able to show there could be sav­ings.”

Sen. Ron Wy­den of Ore­gon, the rank­ing Demo­crat on the com­mit­tee that over­sees Medi­care, said lawmakers rec­og­nize the value of pro­vid­ing ad­di­tional sup­port ser­vices for pa­tients and he’d be in­ter­ested in ex­pand­ing such ben­e­fits for se­niors in tra­di­tional Medi­care.

The Bi­par­ti­san Pol­icy Cen­ter asked health pol­icy consultant Ananya Health In­no­va­tions to an­a­lyze the po­ten­tial im­pact of a nar­rowly tai­lored meal ben­e­fit for Medi­care.

Us­ing 2016 billing data that re­flected ac­tual cases, the consultant fo­cused on pa­tients with chronic con­di­tions such as di­a­betes, heart fail­ure, Alzheimer’s and os­teo­poro­sis. Pa­tients had to have two or more such con­di­tions, along with lim­i­ta­tions do­ing daily tasks such as bathing, cook­ing or get­ting dressed. Most were 75 or older. Some were liv­ing alone.

The study found more than 575,000 pa­tients with about 1 mil­lion hos­pi­tal stays. Us­ing other es­tab­lished re­search as a guide, the consultant es­ti­mated that pro­vid­ing seven days of healthy meals could avoid nearly 10,000 re­turn trips to the hos­pi­tal re­sult­ing in admission.

Medi­care would have had to spend about $101 mil­lion a year to pro­vide meals, but it would have avoided more than $158 mil­lion in bills from re­turn trips to the hos­pi­tal. The net sav­ings would be about $57 mil­lion.

In a real-world sit­u­a­tion, the sav­ings could be greater be­cause the study did not take into ac­count emer­gency room vis­its and nurs­ing home ad­mis­sions that could po­ten­tially be avoided.

Many fam­i­lies have had the wel­come ex­pe­ri­ence of neigh­bors and friends drop­ping off home-cooked food dur­ing a health cri­sis. For Medi­care pa­tients, who can be iso­lated from fam­ily and friends, meals can pro­vide health ben­e­fits as well. For ex­am­ple, healthy food can help a per­son with di­a­betes avoid too-high or too-low blood sug­ars. Or a pa­tient with heart fail­ure can avoid snack­ing on salty junk food that may lead to fluid build­ing up in the body.

“There is a grow­ing body of ev­i­dence that sug­gests that home-de­liv­ered meals can play a role in pre­vent­ing un­wanted emer­gency room vis­its and hos­pi­tal­iza­tions,” said Tri­cia Neu­man, a Medi­care ex­pert with the Kaiser Fam­ily Foun­da­tion. “Peo­ple who de­liver meals can check to be sure pa­tients are rel­a­tively sta­ble, tak­ing their med­i­ca­tions, and have ap­pro­pri­ate nu­tri­tion to sup­port their re­cov­ery.”

Medi­care Ad­van­tage plans sold by pri­vate in­sur­ers un­der Medi­care’s um­brella have al­ready started of­fer­ing such “sup­ple­men­tal” sup­port ser­vices to pa­tients who qual­ify. In ad­di­tion to meals, they can in­clude mi­nor home im­prove­ments like grab bars in the shower, or respite care. The pri­vate plans have lee­way to tai­lor some of their ben­e­fits. But it’s not hap­pen­ing yet for the 2 out of 3 ben­e­fi­cia­ries cov­ered by the tra­di­tional pro­gram.

The Bi­par­ti­san Pol­icy Cen­ter is rec­om­mend­ing that lawmakers grant Medi­care spe­cific au­thor­ity to of­fer ben­e­fits such as home-de­liv­ered meals, but only un­der cer­tain con­di­tions, in­clud­ing a de­ter­mi­na­tion by agency ex­perts that it would not in­crease over­all spend­ing.


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