Wednesday, May 15, 2019

Food Insecurity Becomes Focus for Population Health Programs

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.
https://healthitanalytics.com/news/food-insecurity-becomes-focus-for-population-health-programs?eid=CXTEL000000460294&elqCampaignId=9740&elqTrackId=479697992bb74754a4ad67f5047b7e95&elq=e8358b2e98cc4af1bb79de5b3b415338&elqaid=10222&elqat=1&elqCampaignId=9740

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