Medicare could save $1.57 for every dollar spent delivering free healthy meals to frail seniors after a hospitalization, according to a new study that comes as lawmakers look to restrain costs by promoting patients' well-being.
The report Thursday from the Bipartisan Policy Center addresses ways that Medicare can do a better job coordinating care for chronically ill patients, who account for most of the program's $650 billion annual cost. There's a growing recognition that practical services like meal delivery can make a difference helping older people avoid health flare-ups that can send them to the hospital .
"If you were going to offer meals to every Medicare beneficiary, it would be cost-prohibitive," said Katherine Hayes, health policy director for the center. "By targeting it to a very, very sick group of people is how we were able to show there could be savings."
Sen. Ron Wyden of Oregon, the ranking Democrat on the committee that oversees Medicare, said lawmakers recognize the value of providing additional support services for patients and he'd be interested in expanding such benefits for seniors in traditional Medicare.
The Bipartisan Policy Center asked health policy consultant Ananya Health Innovations to analyze the potential impact of a narrowly tailored meal benefit for Medicare.
Using 2016 billing data that reflected actual cases, the consultant focused on patients with chronic conditions such as diabetes, heart failure, Alzheimer's and osteoporosis. Patients had to have two or more such conditions, along with limitations doing daily tasks such as bathing, cooking or getting dressed. Most were 75 or older. Some were living alone.
The study found more than 575,000 patients with about 1 million hospital stays. Using other established research as a guide, the consultant estimated that providing seven days of healthy meals could avoid nearly 10,000 return trips to the hospital resulting in admission.
Medicare would have had to spend about $101 million a year to provide meals, but it would have avoided more than $158 million in bills from return trips to the hospital. The net savings would be about $57 million.
In a real-world situation, the savings could be greater because the study did not take into account emergency department visits and nursing home admissions that could potentially be avoided.
Many families have had the welcome experience of neighbors and friends dropping off home-cooked food during a health crisis. For Medicare patients, who can be isolated from family and friends, meals can provide health benefits as well. For example, healthy food can help a person with diabetes avoid too-high or too-low blood sugars. Or a patient with heart failure can avoid snacking on salty junk food that may lead to fluid building up in the body.
"There is a growing body of evidence that suggests that home-delivered meals can play a role in preventing unwanted emergency room visits and hospitalizations," said Tricia Neuman, a Medicare expert with the Kaiser Family Foundation. "People who deliver meals can check to be sure patients are relatively stable, taking their medications, and ... have appropriate nutrition to support their recovery."
Medicare Advantage plans sold by private insurers under Medicare's umbrella have already started offering such "supplemental" support services to patients who qualify. In addition to meals, they can include minor home improvements like grab bars in the shower, or respite care. The private plans have leeway to tailor some of their benefits. But it's not happening yet for the 2 out of 3 beneficiaries covered by the traditional program.
The Bipartisan Policy Center is recommending that lawmakers grant Medicare specific authority to offer benefits such as home-delivered meals, but only under certain conditions, including a determination by agency experts that it would not increase overall spending.