Mom's Meals®, Inland Empire Health Pilot Program Reduces Hospital Visits for Patients With Congestive Heart Failure

Posted on Wednesday, June 15, 2022 in News

When people with congestive heart failure ate medically tailored meals and had easy access to other health-related tools for a period of six months, their condition improved, according to the findings of a pilot initiative jointly run by Inland Empire Health Plan (IEHP) in California and Mom’s Meals, it was announced today.

The pilot program, which offered participants fully prepared lower-sodium meals, fresh produce and dry goods; nutrition education; a digital scale; and home visits, also saw a decrease in medical costs. “The initiative clearly demonstrated that when individuals with this serious cardiac condition eat healthy foods over a period of time, it results in fewer hospitalizations and reduces the overall cost of care,” said Catherine Macpherson, M.S, R.D.N., Senior Vice President of Healthcare Strategy and Chief Nutrition Officer for Mom’s Meals, a leading provider of medically tailored, home-delivered meals. “We hope to replicate these outstanding results in other similar populations, including Medi-Cal beneficiaries eligible for medically tailored meals under California’s CalAIM Community Supports program.”

Launched in June 2021, the pilot program provided more than 28,000 meals to select IEHP members from Riverside and San Bernardino counties in California. A total of 93 people, each with congestive heart failure and a minimum of two hospital stays within the previous year, took part. Community Health workers from IEHP also completed an in-person visit and assessment with each participant prior to the start of meal delivery.

“Patients with congestive heart failure tend to have a high rate of emergency room visits and hospitalizations,” said Dr. Gabriel Uribe, DSW, IEHP director of community health. “Upon discharge, they often lack social supports to effectuate successful lifestyle changes needed to improve chronic care. Our initiative showed that a holistic approach to managing the condition led to better patient outcomes, including fewer trips to the hospital.”

The program resulted in a 50% reduction in both trips to the emergency room and hospitalizations. Other positive outcomes included weight loss and a boost in medication adherence.

In addition, the initiative showed significant medical cost savings. Cost to care for those in the pilot program fell from $7.2 million to $5.4 million annually, or a savings of about $19,355 per member annually or $1,613 per member monthly.

During the first half of the program, Mom’s Meals provided three lower-sodium fully prepared meals per day. As the second half of the program approached, Mom’s Meals tapered fully prepared meals to two per day, then to one while also offering healthy produce and pantry boxes, delivered to the homes of pilot participants. Along with nutrition education by Mom’s Meals’ registered dietitians and healthy recipes, members were supported in learning food preparation aligned with dietary guidelines for heart failure. Of food options received, 81% of participants preferred the fully prepared meals, 16% the produce boxes and 3% the boxes of pantry staples. 

Members also received digital weight scales, delivered by IEHP’s “Health Navigators.” This allowed individuals to track weight changes that might be due to fluid build-up in the body, a risk for hospitalization. During home visits, Health Navigators assisted participants in connecting to care management nurses, shared heart failure management plans and conducted health risk assessments.

“One of our goals is to empower our members to be their healthiest selves,” Dr. Uribe said.

Lavinia Williams, an IEHP member who participated in the pilot program, credited it with helping her to stabilize her health. “IEHP helped me be a better person,” she said. “If I wasn’t part of the program, I don’t think I would be here. They saved my life.”

The lower-sodium meal options from Mom’s Meals all contain 600 mg or less of sodium and are developed based on nutritional guidelines from the American Heart Association.

IEHP is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the nation. It supports more than 1.4 million residents in California’s Riverside and San Bernardino counties who are enrolled in MediCal or Cal MediConnect Plans.


About Mom’s Meals

Mom’s Meals provides refrigerated, ready-to-heat-and-eat meals through Medicaid and Medicare Advantage health plan benefits as well as for direct purchase. By offering many nutritionally tailored options and delivering to homes nationwide, Mom’s Meals fuels better health outcomes for all. Its long-term care, chronic care and post-discharge care programs also allow clients to lead healthier lives while remaining independent at home. For more information, visit

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