Colorado’s Medicaid agency, health care providers and nonprofits want more people to get nutritious food as part of their overall health care, but no one is sure how to fund anything beyond existing programs.
The “food is medicine” movement has gained traction in recent years as insurance companies and government agencies decided they could achieve better health outcomes for less money by improving people’s diets than by giving them medical treatment after their condition worsened.
Colorado’s Department of Health Policy and Finance, which oversees the state’s Medicaid program, has made nutrition a priority and plans to apply for federal funding to bring healthy food to more members.
As it currently stands, the state’s Medicaid program can pay for meals only for people with certain disabilities who have recently been discharged from the hospital, left a nursing home, or are at risk of institutionalization because they lost a caregiver or developed a serious illness. physical setback such as amputation.
Other health care providers and insurers have small-scale projects to provide food to people with certain medical conditions, and nonprofits rely on donations to reach people who need food delivered but are not covered by any of the pilot programs.
If Colorado receives approval from the federal Centers for Medicare and Medicaid Services, the state could expand food assistance to broader groups, such as recipients with chronic illnesses or high-risk pregnancies, said Adela Flores-Brennan, director of Medicaid at the Department of Health. Treatment policy and funding.
The state could also offer less intensive support, such as production vouchers, he said.
“It doesn’t necessarily have to be (prepared) meals,” Flores-Brennan said.
Different groups have their own definitions of “food is medicine,” but in Colorado, most of the discussion has focused on prescriptions, prepackaged meals for people with diet-related illnesses, or medically tailored meals.
The product recipe can include either a bank card that can only be used for certain foods, or fruit and vegetable boxes. Lunch boxes contain most of the ingredients for healthy meals, possibly with instructions, while medically tailored meals arrive ready for the recipient to eat.
Critics of the approach argue that resources would be better spent on broader programs, such as improving the quality of school lunches and increasing the number of people receiving food assistance dollars.
The department still has to consult with communities and work out the details of its expansion plan, then submit it to federal Medicaid officials for approval. If successful, the state would receive matching federal funds, but that won’t happen for two years or more, Executive Director Kim Bimestefer said at the Nutrition Policy Summit in November.
Seven other states also have waivers that allow them to offer nutritional support through Medicaid, though they vary in exactly what they offer and to which populations.
“We’re already getting objections from elected officials about how we can shorten that timeline,” he said.
Since April, the state has provided meals for 30 days to some Medicaid members who just left the hospital, Bimestefer said. The department is also developing a tool to help connect members with services, including food assistance, he said.
“Even without this waiver yet, we can start,” he said.
We are working to move the policy needle
Some organizations that administer Medicaid in different regions of the state have chosen to use the discretionary dollars they receive to improve health outcomes for patients with chronic conditions who struggle to buy what they need. Colorado Access pays to get medically tailored meals for some patients with congestive heart failure and food packages for some people with diabetes or heart problems in Denver.
Insurance companies and programs like Medicare and Medicaid are still gathering data to determine whether food programs are producing the cost savings and clinical outcomes they hope to see, said Dr. Tamaan Osbourne-Roberts, chief medical officer of Colorado Access. If they do benefit patients, the question is how it will be funded going forward, because the system is not set up to cover food in the same way as drugs or procedures, he said.
“We’ve built a health care system,” not a prevention system, Osbourne-Roberts said. “It took a while to move the political needle.”
Colorado Access members who receive medically tailored meals receive them through Project Angel Heart, a Denver-based nonprofit that provides about 13,000 meals a week. Group chief executive Owen Ryan said all the meals they make are suitable for diabetics or those with heart problems, and can modify recipes for customers with food allergies, vegetarians, bland food or kidney disease.
Matching federal funds from the waiver would allow providers of medically tailored meals to expand, he said.
“We’re one of the few providers that can say we can make a heart-healthy, diabetic-friendly meal that’s gluten-free and doesn’t contain pork,” Ryan said.
Project Angel Heart delivers meals in Colorado Springs, Pueblo and the Denver area from Castle Rock to Longmont. In the next two years, it plans to expand to Loveland and Fort Collins. While some health care providers have contracts, foundations and individuals fund most of the meals, said Marketing Director Kristy Adams.
Most people don’t need as intensive a service as medically tailored meals, but for the sickest segments of the population, they can make a difference. A study using the Colorado All-Payer Claims Database found that health care costs dropped by nearly a quarter when people with heart failure, chronic obstructive pulmonary disease or diabetes received one medically tailored meal a day for six months.
“They are little angels to me”
Food Bank of the Rockies has also gotten into “food is medicine” mode by working on a pilot program with a handful of medical providers to offer nutritious options to less sick people, CEO Erin Pulling said.
About 70 people with diabetes, pre-diabetes, cardiovascular disease or high blood pressure now receive the boxes. The program is nearing its end, but it can be extended if they can find funding, he said.
One of the partners is Denver Health. Dr. Meg Tomcho, a Denver Health pediatrician who helped start the partnership, said clinics are still working to evaluate the overall results of the lunch boxes, but she expects to see a benefit.
When doctors prescribe a pill, it may help with one disease, but healthy food makes it easier to manage many diseases, he said.
“We’re really trying to remove the barrier to entry from the equation,” Tomcho said.
By food bank standards, medical food boxes are expensive programs because they have to purchase specific foods and deliver them by hand, Pulling said. The boxes cost about $26 each and contain about 11 meals, while a food bank can provide about three meals for $1 using donated food and typical distribution channels. Compared to the cost of hospital care, however, the program is affordable, he said.
Valerie Maes of Denver said her doctor referred her to the food bank program because she had trouble controlling her blood sugar. She said the boxes helped her come up with new breakfast and lunch options that keep her diabetes under control.
A recent box contained chicken, pinto beans, brown rice, oatmeal, canned fruits and vegetables, potatoes, carrots, mandarin oranges, and a large green fruit she didn’t recognize but thought was delicious.
Food bank staff not only dropped off boxes, but also checked in on her regularly and helped her sign up for nutrition assistance she didn’t think she was eligible for, Maes said.
“I always tell my friends, ‘They’re little angels to me,'” she said. “It helped me see that I can get better. I could feel better.”
“It’s like flipping a switch”
Much remains unknown about how best to use nutrition to improve health, including the right “dose” for different populations.
Kaiser Permanente Colorado conducted a trial that compared outcomes when patients leaving hospitals received two or four weeks of meals and found no significant difference, said Dr. Wendolyn Gozansky, the health network’s chief quality officer.
If this is correct, the best way is to give the meals to more people for a shorter period of time. But depending on the group of people, the optimal length may be shorter or longer, he said.
Kaiser Permanente Colorado asks every patient who comes in for an appointment if they want help with food, transportation or other needs and has a call center with staff trained to help connect people to resources, Gozansky said. The health care provider is still evaluating how that goes, but anecdotally, doctors seem to like having someone help address nonclinical needs they don’t have the time or expertise for, he said.
The federal government is also investigating how food can improve health. Luis Perez, a nutritionist and researcher at the U.S. Department of Veterans Affairs in Aurora, said he found that dialysis patients who had failed to reduce salt in their diet alone were able to significantly reduce salt when given three medically tailored meals a day for four weeks. The reduced salt led to lower blood pressure and fluid retention, he said.
Perez said he is still researching how best to prolong the effects after the meals are stopped. Hopefully, recipients will have a better idea of what they need to eat to manage their disease, although it may be a good idea to reduce the number of meals gradually as they adjust, he said.
“We serve these meals and it’s like flipping a switch. It’s like night and day,” he said.
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