Medicare Advantage (MA) beneficiaries given home-delivered meals in the four weeks after being discharged from a hospital were not only less likely to be readmitted within 30 days, they were also less likely to die, according to a study in JAMA Health Forum.
The 2018 Chronic Care Act gave MA plans greater leverage to address the social determinants of healthcare. In addition to giving insurers an impetus for launching dietary programs, the act also covers transportation for beneficiaries and other at-home services.
The study states that “nearly three-quarters of MA plans offered meals as a supplemental benefit in 2022, mostly driven by expectations of downstream cost savings based on findings from earlier observational studies of community-based nutrition programs, and desires to maintain market parity in an increasingly competitive MA space.”
Beginning in January 2021, Kaiser Permanente Southern California (KPSC) began offering home-delivered meals to eligible MA enrollees. The comparative cohort study in JAMA Health Forum examines data from 4,032 KPSC MA enrollees who’d been hospitalized for heart failure and 7,944 who’d been hospitalized for other reasons after they’d been discharged from Jan. 1, 2021, to Jan. 31, 2022. The data come from 15 hospitals in the KPSC network.
Patients received either two or three meals a day depending on whether they were enrolled in an individual or employer group plan, getting either 56 or 84 meals within four weeks of discharge. Individuals could enroll in either one of the plans, but not both.
“For instance, if a patient was hospitalized for [heart failure] and was covered under an employer group plan that had purchased the buy-up benefit, the patient would receive 3 meals per day, whereas another patient hospitalized for [heart failure] and covered under an individual plan would receive 2 meals per day,” the study states.
The most common diagnoses outside of heart failure included respiratory diseases, digestive problems and circulatory issues, the researchers found. Discharges related to heart failure were more likely to need acute care in the prior year compared to other discharges.
The study identified several reasons that eligible patients did not receive meals in the hospital. In some cases, the member could not be contacted, and in others they declined to use the meal benefit or said they already had an option for getting meals, either by cooking it themselves or having family and friends do so.
For people with heart failure, getting the meals significantly lowered the chances of being readmitted within 30 days and of dying compared to individuals who had not signed up for the meal delivery program in 2021 and 2022, but the results were not statistically significant compared to people who did not receive meals in 2019.
On the other hand, for people with other diagnoses, receiving meals significantly lowered the odds of death or rehospitalization within 30 days compared to the patients who did not receive meals in 2019, as well as the no-meals cohort in 2021 and 2022.
The researchers said their findings beg the question concerning how long such meals-at-home programs should last and the number of meals that should go to beneficiaries.
“While this home-delivered meals benefit was intended to be a short-term bridge for patients during a vulnerable period after discharge from the hospital, it was encouraging to see this association persisting into the 60-day period, especially for the non-HF cohort,” the study states. “It is unclear if the more robust outcomes observed in the non-HF vs the HF cohort were due to the larger number of meals (84 vs 56), a reflection of the clinical conditions that are more amenable to nutritional support, or some other factors.”