Implementation of Medically Tailored Meal Programs Associated with Cost Savings

Kurt Hager, MS

The implementation of programs that provide medically tailored meals (MTMs) for individuals with diet-sensitive diseases may be linked to both improved health outcomes and significant savings in cost.

New research from investigators at the Friedman School of Nutrition Science and Policy at Tufts University suggests MTMs lead to fewer hospitalizations nationally, as well as a net cost savings of $13.6 billion annually.

“The goal of MTMs is first and foremost to improve health and well-being, and while the potential for cost savings is highly encouraging, it shouldn't be the sole rationale for investing in these and other programs that address nutrition-related needs,” said study author Kurt Hager, MS in an accompanying statement. “At the same time, the results are pretty extraordinary. It’s very rare to have cost savings in healthcare.”

Interest among health care systems, patients, and policymakers on the concept of food as “medicine” has been matched with rapid increase in the availability of nutrition programs for patients with chronic illnesses. Medically tailored meals are home-delivered meals customized and fully prepared for patients living with advanced illnesses, but limited coverage of MTMs exists nationwide, as neither Medicaid or Medicare provide it as a covered benefit.

The current study analyzed data on the 1- and 10-year associations of MTMs with hospitalizations, health care expenditures, and net costs among patients with ≥1 diet-related diseases and ≥1 limitations in instrumental activities of daily living (IADLs) who are covered by Medicaid, Medicare, and private insurance.

The study sample for the economic evaluation was drawn from the 2019 Medical Expenditure Panel Survey, with the study conducted from January 2021 - February 2022. Diet-sensitive conditions included diabetes, congestive heart failure, myocardial infarction, other heart disease, emphysema, and stroke, as well as non melanoma cancer, chronic kidney disease, and HIV infection.

Investigators estimated a total of 6,309,998 US adults with Medicare, Medicaid, and private insurance were eligible to receive MTMs. The mean age was 68.1 years, with most being female (63.4%), non-Hispanic White (66.7%), and had Medicare and/or Medicaid (76.5%).

The most common eligibility diagnoses were reported as cardiovascular disease (70.6%), diabetes (44.9%), and cancer (37.2%).

A meta-analysis of 5 previously completed studies revealed MTM implementation was associated with reductions of annual health care expenditures of 19.7% (95% confidence interval [CI], 6.9% - 32.4%) and annual hospitalizations of 47.0% (95% CI, 31.7% - 62.3%), compared with usual care.

If all eligible patients received MTMs, the current findings indicate the program costs would be $24.8 billion (95% uncertainty interval [UI], $23.1 billion to $26.8 billion). An estimated 1,594,000 hospitalizations (95% UI, 1,297,000 - 1,912,000) and $38.7 billion (95% UI, $24.9 billion to $53.9 billion) in health care expenditures could potentially be prevented within 1 year.

Across all health care payers, the policy was estimated to have an associated net cost savings of $13.6 billion (95% UI, $0.2 billion to $28.5 billion).

Over 10 years of the MTM intervention was anticipated to cost $298.7 billion (95% UI, $279.7 billion to $317.4 billion) and to potentially be associated with reductions in hospitalizations of 18,257,000 (95% UI, 14,690,000 - 22,109,000) and reductions in health care expenditures of $484.5 billion (95% UI, $310.2 billion to $678.4 billion).

The net cost savings would be $185.1 billion (95% UI, $12.9 billion to $377.8 billion) if the target population received MTMs for 8 months per year in each of the 10 years modeled.

“For people with chronic illness and physical limitations that make it difficult for them to shop and cook for themselves, these programs are a highly promising strategy for improving health and well-being,” Hager added. “The estimated reductions in hospitalizations and associated cost savings reflect that.”

The study, “Association of National Expansion of Insurance Coverage of Medically Tailored Meals with Estimated Hospitalizations and Health Care Expenditures in the US,” was published in JAMA Network Open.