Home-delivered meals might reduce ER visits

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Delivering meals to vulnerable sick people might be a simple way to cut back on emergency room visits and hospitalizations, reining in some of the costliest kinds of medical care, according to a new Health Affairs study.

Low-income seniors or disabled younger people who received home-delivered meals — particularly meals designed by a dietitian for that person's specific medical needs — had fewer emergency visits and lower medical spending than a similar group of people who did not receive meal deliveries.

"This is an excellent study that really points out, again, how important it is to get food to people," said Craig Gundersen, a professor of agricultural strategy at the University of Illinois, who was not involved in the study. "Some people's response is that will drive up the federal budget, which on one hand it does. But on the other hand, we have to look at the cost savings associated with this ... [through] non-trivial reductions in health care costs in our country."

There's growing evidence that the forces that shape health aren't just access to medicines, doctor's visits or surgeries, but factors such as the neighborhoods people live in, economic security and access to housing or transportation. These social factors that contribute powerfully to people's health have not traditionally been seen as part of the medical system, but they are a growing area of interest for health insurance companies interested in containing costs. People who lack reliable access to food are responsible for $77.5 billion per year in excess health care expenditures, according to one analysis.

The study drew its participants from the Commonwealth Care Alliance, a nonprofit community-based health plan in Massachusetts that provides coverage to people who are eligible for both Medicaid and Medicare. People that qualify for both programs tend to be poor with complicated health problems, and the health plan offered enrollment in either a regular home-delivery meal program or one that was tailored to the patient's specific dietary needs.

People who received medically tailored meals had about 1.5 fewer emergency room visits, on average, over a 19-month period, compared to a similar group that did not receive meals. They were hospitalized about half as often. People who received home-delivered meals saw a smaller reduction in emergency room visits.

"We do know that people, when they face food insecurity, often make a lot of trade-offs: Do I pay for my food? Do I pay for my medicine?" said Seth Berkowitz, an assistant professor of medicine at the University of North Carolina at Chapel Hill who led the work. "Not knowing where your next meal is coming from is stressful. It may be difficult to manage your chronic condition when you're worrying about that."

Unlike a gold-standard medical trial, in which people would have been randomly assigned into groups that either received the meals or did not, the researchers created comparison groups that closely matched the demographic and health conditions of the people who received meals. That's a major limitation of the study, since it's possible that those who received meals had other characteristics that accounted for their lower use of emergency and hospital services.

While it doesn't prove that the meals were the cause of the decreased dependence on the emergency room, the study provides a tantalizing hint that providing meals could help people avoid costly medical care. The people who received a medically tailored diet spent $220 less per month than the comparison group. Those who received meals at home saved $10 per month.

"It's an exciting time to be doing this kind of work, because I do think people are realizing this is a frontier we should be examining," Berkowitz said. "I don't want to oversell this or say it's going to solve our problems, but this has been underappreciated for a long time."


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