Massachusetts is among the more aggressive innovators when it comes to healthcare, and is one of just a dozen states implementing a Medicaid ACO model. We’ll be curious to see how providers integrate social determinants of health into their value-based plans — especially for the complex Medicaid population.
Yes, Massachusetts is one of the wealthiest states in America, but still there are more than 800,000 people enrolled in MassHealth ACOs. That’s a lot of people with a lot of social and healthcare needs.
About 10 percent of households statewide are food insecure, which is estimated to drive $1.9 billion in avoidable healthcare costs each year. On top of that, few providers ask patients about food insecurity, and even fewer have the information, time, or funding to follow up with practical interventions. (Mass. Food Is Medicine Coalition)
Roadmap for the Bay State
After two years of studying the issue, Massachusetts has released its Food is Medicine State Plan, a strategy that outlines 15 recommendations and an all-stakeholder roadmap for change. The efforts are supported by a $1.8 billion Section 1115 waiver and some pretty solid commitments from community-based organizations (CBOs), payers, and providers.[Related reading: Better Health Could be a Meal Delivery Away]
First, ACOs will be required to address social determinants of health — including food insecurity — and starting next year reimbursement will be available for those services. The roadmap also calls for a number of funding streams to pay the CBOs that ultimately provide the meals, deliveries, and transportation.
That’s critical considering only about 18 percent of CBOs currently receive funding from health organizations for food programs. Rather than acting exclusively as charitable centers, CBOs in the state plan will become part of the larger healthcare ecosystem.
The idea is to build a continuum in which patients with needs are identified, handed off to local resources, and tracked through an IT backbone that closes the loop. Interventions will include medically tailored meals for individuals (treatment) as well as population-level healthy food programs (prevention).
The Massachusetts food-as-medicine strategy is the largest and most ambitious we’ve seen. Implementation will no doubt be a painstaking process, but we believe it will be worth the investment. Research cited in the state plan document shows solving the issues surrounding food insecurity reduces total healthcare costs including primary care, inpatient, emergency, and pharmacy spend.
For example, a meal delivery program targeting dual-eligibles demonstrated that plan members who received medically tailored meals for six months had 50 percent fewer inpatient admissions and 70 percent fewer emergency department visits compared to those not enrolled. Researchers found an average net savings of $220 per member per month.
At the population level, a study of Supplemental Nutrition Assistance Program (SNAP) participants in one county found those who received a 30 percent rebate on the fresh produce they purchased with SNAP benefits consumed 26 percent more fruits and vegetables. Their overall healthy-eating scores also increased.
Our Take: Food-as-medicine programs are proven to achieve positive outcomes and reduce healthcare costs, so the most important part of any plan will be establishing payment for providers and community organizations to allow them to build capacity for the long term.