Why Medicare should try medically tailored meals

The federal government can make an investment in a service that could save nearly $14 billion in health care costs each year.

A groundbreaking cost-modeling 2022 study found that a national implementation of medically tailored meals for patients with diet-sensitive conditions and other factors — patients accounting for the highest costs in our health care system — could help avoid trips to the hospital and save $13.6 billion annually. This study was primarily based on two rigorous, peer-reviewed studies — one published in Health Affairs in 2018, the other in JAMA Internal Medicine in 2019, in which Community Servings, a Bostonbased nonprofit organization that provides medically tailored meals to people with chronic or critical illnesses, participated.

This represents a strong case that “food is medicine” — that eating the right foods, with a medical diet designed specifically for a patient by a dietitian, can make a major difference. The downside, however, is that Medicare still does not pay in most circumstances for medically tailored meals, which are delivered to patients who are too ill to shop for food or cook for themselves.

Medicare and Medicaid were designed as health care programs. Administrators who oversee the programs historically have not viewed their charge to be providing non-health supports of any kind. That is in spite of data that have long showed that social determinants of health — such as nutrition assistance and housing support — play an important role in one’s well-being.

Now there are strong signs that the government’s aversion to addressing social determinants of health is finally changing, backed in part by the abundance of data that show doing so is not only humanitarian, it makes fiscal sense.

For instance, Massachusetts’ Medicaid program — MassHealth — has transitioned many of its million-plus members into accountable care organizations. ACOs are groups of doctors, hospitals, and in some cases health insurance plans, that have elected to provide coordinated, highquality care for MassHealth members and be held accountable for the cost of providing services.

Beyond the fiscal incentive, these ACOs are being provided additional service dollars to collaborate with communitybased organizations and establish referral protocols. Nutrition is high on the list of targeted services, and we at Community Servings anticipate that by the end of 2023, at least 10 ACOs will be providing medically tailored meals for their chronically or critically ill members through Community Servings.

Massachusetts is not alone. Five other states — Arkansas, California, New Jersey, North Carolina, and Oregon — have received approval from Medicaid, through so-called Section 1115 waivers, to build “Food is Medicine” services into managed care contracts. Four states — Delaware, New Mexico, New York, and Washington — have pending waivers. And several states are taking their own legislative action to seek a Medicaid waiver application or create a state plan.

On the federal front, there are promising signs. Nutrition services took center stage at last year’s White House Conference on Hunger, Nutrition, and Health — the first national, government-led summit to set food policy agenda since 1969. Increasing access to medically tailored meals through a Medicare pilot program was a key recommendation from the White House.

In addition, the Centers for Medicare & Medicaid Services has announced a new opportunity — the Medicare Shared Savings Program Advance Investment Payments — to encourage health care providers in rural and underserved areas to join in forming Medicare ACOs. The program offers eligible ACOs financial incentives to build the infrastructure needed to promote equity by holistically addressing beneficiary needs, including social needs, through services that include medically tailored, home-delivered meals.

Congress is acting, too. Representative Jim McGovern of Massachusetts, along with other members of the Bipartisan Food Is Medicine Working Group, recently filed legislation that would require CMS to create a broad, multistate demonstration of medically tailored meals, which would track changes to health status and the subsequent impact on public spending for health care services.

This legislation should be enacted and, ultimately, a pilot should be launched. Such a broad test will finally provide the validation that policy makers need to invest in this important intervention.