Objective Healthcare leaders seek guidance on prudent investment in programs that improve patient outcomes and reduce costs, which includes the value of nutrition therapy. The purpose of this project was to conduct an evidence review and evaluate claims analyses to understand the financial and quality impact of nutrition support therapy on high‐priority therapeutic conditions. Methods Task 1 included a review of existing literature from 2013 to 2018 to identify evidence that demonstrated the clinical and economic impact of nutrition intervention on patient outcomes across 13 therapeutic areas (TAs). In Task 2, analytic claims modeling was performed using the Medicare Parts A and B claims 5% sample dataset. Beneficiaries diagnosed in 5 selected TAs (sepsis, gastrointestinal [GI] cancer, hospital‐acquired infections, surgical complications, and pancreatitis) were identified in the studies from Task 1, and their care costs were modeled based on nutrition intervention. Results Beginning with 1099 identified articles, 43 articles met the criteria, with a final 8 articles used for the Medicare claims modeling. As examples of the modeling demonstrated, the use of advanced enteral nutrition formula could save at least $52 million annually in a sepsis population. The total projected annual cost savings from the 5 TAs was $580 million. Conclusion Overall, optimization of nutrition support therapy for specific patient populations is estimated to reduce Medicare spending by millions of dollars per year across key TAs. These findings demonstrate the evidence‐based value proposition of timely nutrition support to improve clinical outcomes and yield substantial cost savings.

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Malnutrition, particularly under-nutrition, is highly prevalent among adult patients with a diagnosis of gastrointestinal (GI) cancer and negatively affects patient outcomes. Malnutrition is associated with clinical and surgical complications for patients undergoing therapy for GI cancers and the costs associated with those complications is a high burden for the US health system. Our objective was to identify high-quality evidence for nutrition support interventions associated with cost savings for patient care, followed by a complex economic value analysis to project cost savings for the US health system. A narrative literature search was conducted in which combined keywords in the areas of therapeutic nutrition (nutrition, malnutrition), a specific therapeutic area [GI cancer (esophageal, gastric, gallbladder, pancreatic, liver/hepatic, small and large intestine, colorectal)], and clinical outcomes and healthcare cost, to look for nutrition interventions that could significantly improve clinical outcomes. Medicare claims data were then analyzed using the findings of these identified studies and this modeling exercise supported identifying the cost and healthcare resource utilization implications of specific populations to determine the impact of nutrition support on reducing these costs as reflected in the summary of the evidence. Eight studies were found that provided clinical outcomes and health cost savings data, 2 of those had the strongest level of evidence and were used for Value Analysis calculations. Nutrition interventions such as oral diet modifications, enteral nutrition (EN) supplementation, and parenteral nutrition (PN) have been studied especially in the peri-operative setting. Specifically, peri-operative immunonutrition administration and utilization of enhanced recovery pathways after surgery have been associated with significant improvement in postoperative complications and decreased length of hospital stay (LOS). Utilizing economic modeling of Medicare claims data from GI cancer patients, potential annual cost savings of $242 million were projected by the widespread adoption of these interventions. Clinical outcomes can be improved with the use of nutrition interventions in patients with GI cancers. Healthcare costs can be reduced as a result of fewer in-hospital complications and shorter lengths of hospital stay. The application of nutrition intervention provides a positive clinical and economic value proposition to the healthcare system for patients with GI cancers

Background: Malnutrition continues to be associated with outcomes in hospitalized patients. Methods: An updated review of national data in patients with a coded diagnosis of malnutrition (CDM) and the use of nutrition support (enteral nutrition [EN] and parenteral nutrition [PN]) was conducted using the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project and Medicare Claims data. Results: Results demonstrated a growing trend in CDM accompanied by continued low utilization of PN and EN. Conclusion: Underutilization of nutrition support may be due to product shortages, reluctance of clinicians to use these therapies, undercoding of nutrition support, strict adherence to published guidelines, and other factors.

Background: Hospital-acquired conditions (HACs) have a direct impact on value, as they decrease quality and increase costs. Numerous interventions have been tried, including nutrition support therapy, with unknown effect on value.Therefore, a value analysis of nutrition support therapy on HACs was performed. Methods: An extensive literature search was performed. Using the Medicare Parts A and B Claims 5% Sample data set, analytic claims modeling was conducted. Results: The search identified 1099 studies, with eight meeting the inclusion criteria. All studies were performed on adult critically ill patients and focused on HA infections (HAIs) as the HAC. One study underwent Medicare claims modeling and revealed nutrition therapy has the potential of saving at least $104 million annually in Medicare patients with HAIs. Conclusion:Nutrition support therapy has the potential to reduce costs of Medicare spending in respect to HAIs.

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Healthcare leaders have been looking for guidance on investment in programs and resources that reduce hospitalacquired conditions, length of stay, and readmissions. In 2017, ASPEN realized the need to expand from an organization that promotes utilization of nutrition support therapy to one that also articulates the value proposition for nutrition support across the continuum of care. From that premise, the Value Project was developed. The overall goal of the project was to describe the impact of nutrition care, particularly related to specific conditions, on healthcare outcomes, costs, and resource utilization. Specifically, the synthesizing of economic evidence to demonstrate the impact nutrition has on patient outcomes in specific therapeutic areas (TAs) will provide ASPEN members and stakeholders more effective messaging to communicate with key healthcare decision makers, such as administrators, providers, payers, and regulators.The methodology used was a nutrition care outcomestargeted literature review in selected high-impact TAs, using a graded methodology to select studies for which their results could be modeled using the Medicare claims database. This modeling produced outcome differences that were translated into cost savings to demonstrate the economic value of nutrition.The results of the literature search found a high variability in the quality of evidence, with most study end points focused on clinical outcomes and not cost. The evidence was of, on average, only moderate quality. Most studies investigated oral nutritional supplements rather than enteral or parenteral nutrition, and most were done at a single site rather than multicenter trials. Also, most of the highlevel quality studies were conducted outside of the United States. The initial search started with 1099 nutrition studies. In the 13 originally selected TAs, 114 papers had clinical and/or cost outcomes measured. In the 8 selected TAs with literature that was evaluated to be strong, 81 studies were available, with only 43 studies in the 5 chosen TAs, and 8 studies modeled in the Medicare claims database.

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