Association Between Receipt of a Medically Tailored Meal Program and Health Care Use
Authors: Seth A. Berkowitz, Jean Terranova, Liisa Randall, Kevin Cranston, David B. Waters, John Hsu
Journal: JAMA Internal Medicine (2019)

<h3>Importance</h3> Whether interventions to improve food access can reduce health care use is unknown. <h3>Objective</h3> To determine whether participation in a medically tailored meal intervention is associated with fewer subsequent hospitalizations. <h3>Design, Setting, and Participants</h3> A retrospective cohort study was conducted using near/far matching instrumental variable analysis. Data from the 2011-2015 Massachusetts All-Payer Claims database and Community Servings, a not-for-profit organization delivering medically tailored meals (MTMs), were linked. The study was conducted from December 15, 2016, to January 16, 2019. Recipients of MTMs who had at least 360 days of preintervention claims data were matched to nonrecipients on the basis of demographic, clinical, and neighborhood characteristics. <h3>Interventions</h3> Weekly delivery of 10 ready-to-consume meals tailored to the specific medical needs of the individual under the supervision of a registered dietitian nutritionist. <h3>Main Outcomes and Measures</h3> Inpatient admissions were the primary outcome. Secondary outcomes were admission to a skilled nursing facility and health care costs (from medical and pharmaceutical claims). <h3>Results</h3> There were 807 eligible MTM recipients. After matching, there were 499 MTM recipients, matched to 521 nonrecipients for a total of 1020 study participants (mean [SD] age, 52.7 [14.5] years; 568 [55.7%] female). Prior to matching and compared with nonrecipients in the same area, health care use, health care cost, and comorbidity were all significantly higher in recipients. For example, preintervention mean (SD) inpatient admissions were 1.6 (6.5) in MTM recipients vs 0.2 (0.8) in nonrecipients (<i>P</i> &lt; .001), and mean health care costs were $80 617 ($312 337) vs $16 138 ($68 738) (<i>P</i> &lt; .001). Recipients compared with nonrecipients were also significantly more likely to have HIV (21.9% vs 0.7%,<i>P</i> &lt; .001), cancer (37.9% vs 11.3%,<i>P</i> &lt; .001), and diabetes (33.7% vs 7.0%,<i>P</i> &lt; .001). In instrumental variable analyses, MTM receipt was associated with significantly fewer inpatient admissions (incidence rate ratio [IRR], 0.51; 95% CI, 0.22-0.80; risk difference, −519; 95% CI, −360 to −678 per 1000 person-years). Similarly, MTM receipt was associated with fewer skilled nursing facility admissions (IRR, 0.28; 95% CI, 0.01-0.60; risk difference, −913; 95% CI, −689 to −1457 per 1000 person-years). The models estimated that, had everyone in the matched cohort received treatment owing to the instrument (and including the cost of program participation), mean monthly costs would have been $3838 vs $4591 if no one had received treatment owing to the instrument (difference, −$753; 95% CI, −$1225 to −$280). <h3>Conclusions and Relevance</h3> Participation in a medically tailored meals program appears to be associated with fewer hospital and skilled nursing admissions and less overall medical spending.