Pinpointing the need: Who can benefit from Home-Delivered Meals?

Posted on Thursday, March 21, 2019

Home-delivered meals are proven effective at helping senior citizens, the chronically ill, and recently discharged patients stay healthier. A recent Health Affairs study of Massachusetts Medicaid recipients showed that people who received customized meals for six months had fewer ER visits, reduced hospital admissions, and lower health care spending than those who did not receive the meals.

But how do health care companies, community groups, governmental agencies – even family members -- determine who could benefit from home-delivered meals? And how can they account for situational issues like lack of transportation or living near the poverty line that impact one’s ability access healthy food?

There are several approaches – from simple to high tech – that can help.

Just ask

Often the easiest and fastest approach is to talk with an individual to assess his or her needs. Almost half of health care organizations use an online assessment tool or a conversation to determine need. Key questions to ask include:

  • · Are you eating healthy meals each day?
  • · Are you homebound?
  • · Have you recently lost or gained a significant amount of weight?

There are online tools, too. The Centers for Medicare & Medicaid Services developed the Accountable Health Communities Health-Related Social needs screening tool to measure social determinants of health, the economic, social, and environmental issues that impact a person’s access to support, healthy food, stable employment, and housing.

Evaluate the situation

Certain situations are red flags for people needing nutritional support via home-delivered meals. Some common ones include:

  • Elderly people who can’t prepare nutritious meals for themselves due to physical limitations or social circumstances like living in a “food desert.”
  • Patients recently discharged from the hospital need good nutrition to help them heal. In fact, one study shows that access to good nutrition can cut readmission rates for people recently discharged from the hospital. But limitations of recovery – like not having the mobility or energy to cook – can reduce access to healthy meals.
  • People with chronic conditions may be preparing or buying their own meals, but those meals may not be nutritionally appropriate considering their medical condition. Many chronic conditions, particularly diabetes and hypertension, can be managed through improved nutrition. For example, a study in Health Affairs showed that access to nutritious meals through home delivery, resulted in up to 27 percent fewer cases of uncontrolled diabetes

Use data and analytics

With the rise of data and analytics, health care organizations have powerful metrics at hand to pinpoint patients and members who need nutritional support, or are at higher risk of needing it in the near future.

Using modeling and analytics, a company can combine data from various sources including claims, marketing metrics, and the census to create a snapshot of a person’s life. Using algorithms social determinants of health can be factored in. The result is a more complete picture of a person’s circumstance that can indicate whether he or she is at risk for needing non-medical support such as home-delivered meals that can help the individual stay healthy and out of the hospital.

For example, if an individual has a chronic medical condition, lives in a food desert, is near the poverty level, and doesn’t have a car, those combined factors could indicate that he would benefit from medically-tailored, home delivered meals to manage his chronic disease and support overall better health.

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