Provision of medically-tailored meals linked with lower admissions and medical spending

1. In this retrospective analysis from Massachusetts, the provision of ten ready-to-consult medically-tailored meals (MTMs) to participants was linked to fewer inpatient and skilled nursing facility admissions.

2. Models estimating healthcare costs predicted significant reduction in monthly healthcare cost with MTMs.

Evidence Rating Level: 2 (Good)           

Study Rundown: Nutrition and diet are major contributors to maintaining health, and have an impact on clinical outcomes of chronic diseases such as diabetes, congestive heart failure, and renal disease. The development of medically-tailored meal (MTM) programs has sought to improve overall health for medically complex individuals by providing prepackaged meals developed by dieticians to optimize the impact of diet on health maintenance. The effectiveness of MTM programs on health outcomes and overall healthcare spending is not known. The current retrospective matched cohort study evaluated the effectiveness of MTM delivery in a population in Massachusetts. The study found that MTM with ten ready-to-consume meals was associated with a reduction in inpatient and skilled-nursing facility admissions, with modeled reduction in monthly healthcare costs.

The main strength of this study was the relatively complete data available on the study population with at least 360 days of pre-intervention data available for appropriate interpretation of the changes in cost and risk of admission. The main limitations of the study included the non-randomized design allowing for sources of bias, with those participating in the program more likely to be better connected to community health resources.

Click to read the study in JAMA Internal Medicine

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In-Depth [retrospective cohort]: This study was a retrospective matched cohort analysis of data available through the Massachusetts All-Payer Claims Database (MA-APCD) and Community Servings delivery records from 2011 to 2015. Participants were included if they were 18 years or older, had a home address within 100 km of Community Servings, and had data available in MA-APCD 360 days prior to MTM program enrollment. The MTM program consisted of 10 meals/week tailored by a dietician to a recipient’s medical needs. The comparison cohort consisted of individuals in the MA-APCD matched on demographic, clinical, and neighborhood variables. The main outcome was inpatient admissions, with secondary outcomes of admissions to skilled nursing facility, and healthcare costs.

The study included 499 MTM participants matched to 521 non-recipients. Recipients prior to intervention had greater mean healthcare costs and inpatient admissions compared to the control. Following the intervention, the MTM recipients had reduction in inpatient admissions (incidence rate ratio [IRR], 0.51; 95%CI, 0.22-0.80), skilled nursing facility admission (IRR, 0.28; 95%CI, 0.01-0.60), and estimated monthly healthcare cost (difference, −$753; 95%CI, −$1225 to −$280).

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