Photo: Bryan Goodchild
Nutritious food provided to people who have complex health problems and are experiencing food insecurity can provide significant health benefits, including reduced hospitalization and use of emergency room services as well as lower health care costs, according to a study led by UMass Chan Medical School researchers.
The study, published April 8 in Health Affairs, is the first peer-reviewed study of Medicaid-funded "food is medicine" programs that looked at health care utilization and costs. It is also the largest such nutrition study to date, with more than 20,000 participants receiving care from 17 accountable care organizations (ACOs) and 16 community-based organizations.
MassHealth ACOs are health systems or groups of providers, sometimes working in partnership with a health plan, that accept responsibility for the quality and cost of care for a defined population of MassHealth members.
The nutrition initiative, part of the Flexible Services Program offered by MassHealth, the Massachusetts Medicaid and Children’s Health Insurance Program, was introduced in 2020 through ACOs that partnered with community-based organizations to deliver the services. The program was part of the state’s Medicaid Section 1115 demonstration, which allows the Medicaid program to pilot innovative programs likely to improve health among its members.
In addition to nutritional guidance, the program eliminated barriers to eating healthier by providing a range of medically tailored meals, home-delivered meals, food boxes or groceries, produce prescriptions, food vouchers or gift cards, kitchen supplies, and connection to community food pantries or federal nutrition program assistance.
Researchers analyzed data for MassHealth members ages 1 to 64 who were enrolled in an ACO, had at least one health-based criterion such as behavioral health, complex medical needs such as diabetes, need for assistance with activities of daily living, or high-risk pregnancy, and experienced food insecurity. The study ran from January 2020 to March 2023.
Nutrition program participants were compared with ACO members who were eligible for it but did not receive services.
Participation was associated with a 23 percent reduction in hospitalizations and 13 percent reduction in emergency department visits compared with eligible non-participants.
During the period following the height of the COVID-19 pandemic (2022-2023), health care costs were on average $1,721 lower among participants while they were receiving services. Throughout the study period, health care costs were on average $2,502 lower among adults with more than 90 days of enrollment in the program, compared with non-participants, which resulted in net cost savings to the Medicaid program after paying for program services for these adults.
“The effect sizes we saw are impressive and encouraging, but they do align with some prior research that has looked at similar programs,” said first author Kurt Hager, PhD, assistant professor of population & quantitative health sciences.
Dr. Hager said the nutrition program reduced barriers to healthy diets for participants so patients who were very sick didn’t have to make challenging trade-offs, such as between paying for food or paying for medication.
“The intensity of these services can offer a stabilizing effect and may improve health directly through better nutrition while also making other routine medical care more effective, for example by improving medication adherence,” he said.
The program allowed ACOs and their community partners to tailor flexible services through a set pool of funds.
“They targeted the services to where they thought they would be most impactful for the people who had the greatest need,” said Matthew J. Alcusky, PhD, PharmD, MS, associate professor of population & quantitative health sciences and principal investigator and senior author of the study.
Hager said he was also excited by findings that compared utilization and costs in the period after the worst of the COVID-19 pandemic, when health care was returning to more typical use.
"The nutrition services can be highly cost-effective when you look at how much health care costs were reduced and compare it to the costs of operating the Flexible Services Program," said Hager. “For example, among adults receiving nutrition services for at least three months, health care cost reductions were greater than the costs of providing food to participants, resulting in net cost savings to the Medicaid program for these members.”
