Providers,
payers, and other stakeholders are now making food insecurity a major component
of their population health efforts.
April 26, 2019 - Healthcare
providers, payers, and other industry partners are increasingly recognizing
that tackling food insecurity is a major component of a successful population
health management program.
In 2017,
approximately 40 million adult Americans lived in food insecure households,
while an additional 9.7 million hovered on the edge of being unable to afford
basic nutrition. More than half a million children live on the verge of
hunger every day, according to the USDA.
As the healthcare
industry starts to ramp up its data-driven capabilities to identify and address
the social determinants of health, stakeholders are increasingly developing
innovative strategies for ensuring that consumers have access to high-quality,
nutritionally sound meal options that can support better overall health.
Increasing food
security can reduce hospital utilization and control overall health system
costs, asserts a 2017 study from BMC
Geriatrics and Population Health Management. Access to
federal food assistance programs such as SNAP reduced the likelihood of
hospitalization for seniors by 14 percent and cut the likelihood of nursing
home admission by 23 percent, the study said.
Public and private
payers have been taking the lead in this area. Commercial insurance
companies such as Humana, Aetna, Blue Cross Blue Shield, and UnitedHealthcare, have invested hundreds
of millions in community-based initiatives targeting food security, among other
issues.
In February of 2019,
for example, Blue Cross Blue Shield (BCBS) Institute and Health Care Services
Corporation (HCSC) partnered to launch a food delivery
service for individuals living in “food deserts,” or areas without a
full-service grocery store and access to fresh produce.
“Food deserts are one
of the key social determinants of health impacting millions of Americans,” said
Manika Turnbull, vice president and community health and economic impact
officer at HCSC.
“With this program we
are meeting people where they live to provide access, affordable pricing and education
that can influence healthy behaviors, reduce health disparities and improve
their quality of life.”
Users can purchase
individual meals or sign up for a subscription package that allows them to
choose from pre-made options designed to provide quality nutrition. Meals
are then delivered directly to the home.
At Humana, food
security is a core component of the Bold Goal, a community-based
initiative to address socioeconomic issues that contribute directly to poor
health.
Food insecurity can
significantly increase the number of “unhealthy days” each month for Medicare
Advantage members, the payer says. Food insecure individuals often choose
between buying dinner and accessing medical care – since these members are also
more likely to have diabetes and heart disease, the choice compounds the
challenges of managing their chronic diseases.
Recent changes to the Medicare
Advantage and Part D payment rules have encouraged and reinforced these efforts
by payers to address a root cause of poor outcomes.
CMS will now allow
reimbursement for certain services specifically addressing social determinants
like food access.
“Today’s changes give
plans the ability to be innovative and offering benefits and services that
address social determinants of health for people with chronic disease,” said
CMS Administrator Seema Verma. “With Medicare Advantage enrollment at an
all-time high, plans need greater flexibility in offering benefits that they
focus on preventing disease and keeping people healthy.”
Care management plans
for Medicare Advantage patients can now incorporate diet “prescriptions” into
their care plans for patients with heart disease or diabetes, ensuring that
chronic disease patients can maintain a healthy lifestyle and overcome their socioeconomic
barriers.
Many patients facing
these challenges will have help directly from their providers, too. At
Geisinger Health System in Pennsylvania, diabetic patients can enroll in the “Fresh Food Farmacy”
program, which offers free access to healthy foods designed to support diabetes
control.
Geisinger serves many
areas where food insecurity is an above-average problem: in some of its
regions, about 14 percent of individuals are food
insecure, and nearly a quarter of children are at risk of hunger.
Since one in eight of
these food insecure individuals also has diabetes, aligning the care of both
these conditions can bring multiple benefits to patients, Geisinger believes.
The health system has
seen its diabetes care costs drop by two-thirds for participating individuals,
showcasing the intimate connections between diet and clinical care.
“Finding effective,
less expensive treatments for diabetes is critical because of its enormous
social and financial costs and its growing prevalence: One in 10 people
currently has diabetes, and it is estimated that by 2050 the figure will rise
to one in three,” said Andrea Feinberg, MD, Medical Director of Health and
Wellness.
“Our initiative has
had a greater impact on diabetes control (albeit in a small population) than
expensive medications that have significant side effects. We have also
seen significant improvements in patients’ cholesterol, blood sugars, and
triglycerides — improvements that can lower the chances of heart disease
and other vascular complications.”
But payers and
providers aren’t the only entities looking to make a dent in the widespread
problem of food insecurity.
Newer healthcare
stakeholders, such as Lyft, are also leveraging their community reach to
connect vulnerable individuals with healthy meals.
The rideshare
company is expanding its Grocery Access
Program to more than a dozen cities after piloting the program in Washington,
DC, in 2018.
Lyft will offer
discounted, flat-rate rides to selected grocery stores and farm stands that
offer a full range of fresh produce and other healthy food options.
The pilot program
charged residents just $2.50 for a ride to grocery stores in their area, and
included access to The Market at Martha’s Table, a community health
organization.
“The Lyft Grocery
Access Program is an innovative partnership that aligns with our mission to
support strong children, strong families, and strong communities,” said Tiffany
Williams, chief programs officer at Martha's Table.
“By offering
discounted flat-rate rides to three full-service grocery stores and to Martha’s
Table Market, the program has helped to reduce the time, transportation, and
financial barriers to healthy food access.”
Expanding the program
to densely populated areas such as Los Angeles, Chicago, Miami, Philadelphia,
Detroit, and Phoenix will allow more residents to overcome the challenges of
living in food deserts and gain more control over their health.
The concerted efforts
from across the care continuum may help to provide more stability for
individuals and facilities living on the edge of hunger. With food
security closely tied to overall healthcare spending and long-term outcomes for
affected individuals, addressing these problems as quickly as possible within
the community could have a major impact on the costs of care.
As healthcare
providers, payers, regulators, and other stakeholders continue to put more
focus on the social determinants of health, these innovative approaches to
tackling upstream health issues will continue to provide benefits for families
and individuals in need of assistance bridging the gaps between mealtimes.
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