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 something beyond the existing patchwork of programs. .
The “food is medicine” movement has gained momentum in recent years as insurance providers and government agencies have determined that they can do better for less money by improving people’s diets rather than giving them medical treatment as their conditions worsen. Can achieve health results.
The Colorado Department of Health Care Policy and Financing, which oversees the state’s Medicaid program, has made nutrition a priority and plans to seek federal funding to bring healthy foods to more members.
As things stand, the state’s Medicaid program can only pay for meals for some disabled people who have recently been released from the hospital, have left a nursing home, or are at risk of being placed in a facility because they Have lost a caregiver or are suffering from a major illness. Physical trauma, such as amputation.
Other health care providers and insurers have small-scale projects offering meals to people with specific conditions, and nonprofits rely on donations to reach people who need food distributed but cannot pilot Is not covered by any one of the programs.
If Colorado gets permission from the federal Centers for Medicare and Medicaid Services, the state could expand food assistance to broader groups, such as recipients who have chronic conditions or high-risk pregnancies, said Adela, Medicaid director at the Department of Health. Flores-Brennan said. Care policy and financing.
He said the state could also provide less intensive assistance such as production vouchers.
“It doesn’t have to be (ready-to-eat) food,” Flores-Brennan said.
Different groups have their own definitions of “food is medicine”, but in Colorado, most discussion focuses on produce prescriptions, food boxes for people with diet-related diseases, or medically formulated meals.
Product prescriptions may include either a debit card that can only be used for specific food items, or fruit and vegetable boxes. Food boxes probably contain most of the ingredients for healthy eating along with instructions, while medically prepared 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 expanding the number of people receiving food assistance dollars.
The department still needs to consult with communities and work out the details of its expansion plan, then submit it to federal Medicaid officials for approval. If it is successful, the state will get federal matching funds, but not for two years or more, Executive Director Kim Biemsteffer said during a summit on nutrition policy in November.
Seven other states also have waivers that allow them to offer some nutritional assistance through Medicaid, though they vary in exactly what they offer and for which populations.
“We’re already getting feedback from elected officials on how we can shorten that timeline,” he said.
Biemsteffer said that since April, the state has offered 30 days of food to some Medicaid members who have just been released from the hospital. He said the department is also working on a tool to help connect members with services, including food assistance.
“Even without that exemption, we can start,” she said.
Working to move the policy needle forward
Some organizations that administer Medicaid in different areas of the state have chosen to use discretionary dollars to improve health outcomes on food for patients who have chronic conditions and have difficulty purchasing what they need. . Colorado Access is paying to get medically prepared meals for some patients with congestive heart failure in Denver and food boxes for some people with diabetes or heart problems.
Insurance companies and programs like Medicare and Medicaid are still collecting data to determine whether food programs are producing cost savings and clinical outcomes, said Dr. Taman Osborn-Roberts, chief medical officer of Colorado Access. What they expect to see. Even if they benefit patients, the question will be how to finance it going forward, he said, because the system isn’t set up to cover food like drugs or procedures.
“We have created a health care system,” Osborn-Roberts said, “not a prevention system.” “It’s taken a while to move the policy needle forward.”
Colorado Access members who receive medically prepared meals get them through Project Angel Heart, a Denver-based nonprofit that produces about 13,000 meals per week. The group’s president and CEO, Owen Ryan, said that all the food they make is suitable for people with diabetes or heart problems, and they can make changes to recipes for customers who have food allergies, are vegetarians, Requires uncooked food or has kidney disease.
He said the federal money from the waiver will allow medically prepared meal providers to expand their operations.
“We are one of the very few providers that can say we can make heart-healthy, diabetes-friendly food that is gluten-free and does not contain pork,” Ryan said.
Project Angel Heart delivers food to Colorado Springs, Pueblo and the Denver area from Castle Rock to Longmont. Over the next two years, it plans to expand to Loveland and Fort Collins. While some health care providers have contracts, foundations and individuals finance most of the meals, said marketing director Christy Adams.
Most people don’t need an intensive service like medically prepared meals, but for the sickest parts of the population, they can make a difference. A study using Colorado’s all-payer claims database found that health care costs were reduced by nearly one-quarter when people with congestive heart failure, chronic obstructive pulmonary disease or diabetes received a prescription daily for six months. Got prepared food.
“They are little angels to me”
President and CEO Erin Pulling said Food Bank of the Rockies entered “food is medicine” territory by working on a pilot program with a handful of medical providers to provide nutritious options for the less seriously ill. Is.
About 70 people suffering from diabetes, pre-diabetes, heart disease or high blood pressure are now receiving the boxes. He said the program was nearing its end, but could be continued if they could get funding.
One of the partners is Denver Health. Dr. Meg Tomchow, a pediatrician at Denver Health who helped launch the partnership, said clinics are still working on assessing the overall outcomes of the meal boxes, but they expect to see benefits.
When doctors prescribe a pill, it may help a disease, he said, but healthy eating makes many conditions easier to manage.
“We’re really trying to take the barrier of access out of the equation,” Tomchow said.
By food bank standards, Medical Food Boxes are a high-cost program, Pulling said, because they have to purchase specific food items and hand-deliver them. Each box costs about $26 and contains about 11 meals, while the food bank can provide about three meals for $1 when using donated food and specific distribution channels. However, when compared to the cost of a hospital stay, the program is a bargain, she said.
Valerie Mays of Denver said her doctor referred her to the food bank program because she was having difficulty controlling her blood sugar. He said the boxes helped him find new breakfast and lunch options, which kept his diabetes under control.
A recent box included chicken, pinto beans, brown rice, oatmeal, canned fruits and vegetables, potatoes, carrots, mandarin oranges, and a large green fruit she couldn’t identify but thought was delicious.
Food bank staff not only dropped off boxes, Mays said, but also checked on her regularly and helped her sign up for nutrition assistance, which she didn’t think she would qualify for.
“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 you flip a switch”
Much remains unknown about how to best use nutrition to improve health, including the correct “dosage” of food for different populations.
Kaiser Permanente Colorado conducted a trial to compare outcomes when patients leaving the hospital received two or four weeks of meals, and found no significant differences, said Dr. Wendolin Gozanski, the health network’s chief quality officer.
If this is true, the best approach may be to feed more people for a shorter period of time. But depending on the group of people, the optimal length may be more or less, she said.
Kaiser Permanente Colorado asks every patient who comes for an appointment if they want help with food, transportation or other needs, and has a call center with trained staff to help connect people with resources, Gozanski said. Is. Health care providers are still evaluating how it’s going, he said, but realistically, if doctors need someone to help meet non-clinical needs, they have a way to do that. Don’t have the time or expertise.
The federal government is also studying how food can improve health. Luis Perez, a dietitian and researcher at the U.S. Department of Veterans Affairs in Aurora, said he found that patients who were receiving dialysis and had not been successful in reducing salt in their diets were able to make significant reductions when they went on dialysis. . Three medically prepared meals per day for four weeks. Reducing salt reduced blood pressure and fluid retention, he said.
Perez said he is still studying how to prolong the effects after stopping the diet. Hopefully recipients will have a better idea of what they need to eat to manage their condition, she said, though it may be a good idea to gradually reduce the number of meals while you adjust.
“We provide these meals and it’s like you flip a switch. It’s like night and day,” he said.
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