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Rx: Zucchini, brown rice, turkey soup. Medical plan - offers food as medicine.

Posted: Jun 28th, 2018 - 5:52 pm

PHILADELPHIA — Feliciano Pagan stood at his front door when the MANNA food truck pulled up to his two-story brick row home.

Pagan, 48, greeted the driver with a smile as he carried in two large bags filled with frozen dinners and fresh fruit that would last a week. Among the goods were chicken fajitas with brown rice and zucchini; chicken dumplings, carrots and beets; and sweet-and-sour pork chops with turkey noodle soup.

These medically tailored meals — all with limited salt and carbohydrates — are designed to keep Pagan, who has congestive heart failure, out of the hospital. Health Partners Plans, the nonprofit company that runs the Medicaid health plan Pagan belongs to, is betting on it.

Feliciano Pagan, a Medicaid recipient in Philadelphia, looks over his medically tailored meals made at the kitchens of the nonprofit MANNA and paid for by Health Partners Plans, his Medicaid health plan. (Phil Galewitz/Kaiser Health News)

Since 2015, Health Partners has joined a small group of insurers around the country to offer some members specially designed meals to improve their health. The company paid the full cost for 560,000 meals to be delivered to more than 2,100 of its members with various conditions such as diabetes, heart disease and kidney failure.

The Metropolitan Area Neighborhood Nutrition Alliance (MANNA), a Philadelphia-based nonprofit organization that provides medically appropriate food for people with serious illnesses, prepares and delivers the meals.

The service covers three meals a day and typically lasts six weeks, although members can renew for two additional six-week cycles. It also provides nutritional counseling. MANNA provides the meals to everyone in the household to help family members support patients who need to change bad diets. Health Partners, which serves Philadelphia and nearby counties, said its investment is paying off.

With the kick-start that comes from receiving these free meals and continued counseling to shop better and prepare healthy meals, the members are better able to control their diabetes, use the hospital less and reduce their medical costs, according to the health plan.

“We wanted to see how this would work out and we are quite pleased that with the cooperation of our members we did see a dramatic reduction in their costs … and improved outcomes,” said William George, CEO of Health Partners.

George would not disclose how much his health plan pays for meals, although one industry expert said it costs less than $15 a day per member.

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The growing number of “food as medicine” programs nationally are aimed at improving nutrition among adults with serious illnesses to help them heal, recover from medical procedures and control chronic diseases.

Aetna and two other insurers also have added the benefit for their Medicaid enrollees in the Philadelphia area.

California’s Medicaid program in May began a three-year pilot project to provide meals to several thousand adults with chronic diseases. In New York, the nonprofit group God’s Love We Deliver provides medically tailored meals to two dozen Medicaid managed long-term care plans.

An example of one of MANNA’s meals. (Phil Galewitz/Kaiser Health News)

Despite the success of these food programs, they are not standard benefits in Medicare — the federal health program for seniors and disabled people — or Medicaid — the state-federal health program for low-income people. Advocates say efforts to expand the programs are stymied by concerns about the cost and public resistance to a government health program providing free food.

But private Medicaid and Medicare plans have discretion to spend their government funding on services outside direct medical care. Proponents of these meal services are trying to persuade more of the private plans to adopt the programs.

Karen Pearl, CEO of God’s Love We Deliver, said while it may seem obvious that giving people healthy meals will help them get well, it’s still a huge change for plans focused on paying for doctor visits, hospital care and drug benefits.

“For plans trying to care for high-cost members, sometimes it’s hard to carve out money from the medical model, as nutrition has not always been front of mind,” she said.

A recent shift among government and private insurers to pay doctors and hospitals to keep people out of the hospital could give this approach a boost, according to experts.

A study published in Health Affairs in April found providing tailored meals for at least six months in a Massachusetts Medicaid health plan reduced ER visits, hospital admissions and health spending compared with adults who did not receive an intervention.

Another study, published this month in the American Journal of Managed Care, found that when the Maine Medical Center offered specially tailored meals to 622 high-risk Medicare patients, the hospital’s readmission rates dropped by 38 percent over two years, compared with patients without the intervention. The cost savings were more than $200,000, according to the research.

“Telling someone to go to the gym and eat healthy does not work anymore,” George said. People either don’t know how to eat nutritious meals, don’t have easy access to healthy food or can’t afford it, he said.

That was the case with Pagan, whose blue-collar neighborhood has fast-food restaurants but lacks a larger grocery store with a broad array of fruits and vegetables.

Pagan has had heart valve surgery and may soon need a heart transplant. His doctors have told him to cut back on greasy food, but he said he didn’t know how until Health Partners offered him the special meals.

“It’s hard not knowing what foods to eat,” Pagan said during an interview in May just after he received his latest meals from MANNA....


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