Association of National Expansion of Insurance Coverage of Medically Tailored Meals With Estimated Hospitalizations and Health Care Expenditures in the US

Abstract

ImportanceMedically tailored meals (MTMs) are associated with lower health care utilization among patients with complex diet-related diseases but are not a covered benefit in Medicare or Medicaid. The potential impact of extending insurance coverage for MTMs nationally remains unknown.ObjectiveTo estimate 1- and 10-year potential changes in annual hospitalizations, potential changes in annual health care expenditures, and overall policy cost-effectiveness associated with national MTM coverage for US patients with diet-related disease and limited instrumental activities of daily living who have Medicaid, Medicare, or private insurance.Design, Setting, and ParticipantsIn this economic evaluation, conducted from January 2021 to February 2022, a nationally representative sample from the 2019 Medical Expenditure Panel Survey was used to create a population-level cohort policy simulation model that estimated changes in annual hospitalizations and health care expenditures associated with coverage of MTMs. Participants were 6 309 998 US adults aged 18 years or older who had Medicare, Medicaid, or private payer insurance and at least 1 diet-sensitive condition and 1 limitation in instrumental activities of daily living.InterventionsTen nutritionally tailored MTMs per week for a mean of 8 months in each year of intervention.Main Outcomes and MeasuresThe main outcomes were total hospitalizations, program costs, health care expenditures, and net policy costs. One thousand Monte Carlo simulations for each of 10 years (2019-2028) jointly incorporated uncertainty in model inputs for effect sizes, hospitalizations, health care expenditures, and program costs.ResultsAt the 2019 baseline, an estimated 6 309 998 US adults were eligible to receive MTMs. Mean (SD) age was 68.1 (16.6) years; most were female (63.4%), were non-Hispanic White (66.7%), and had Medicare and/or Medicaid (76.5%). The most common eligibility diagnoses were cardiovascular diseases (70.6%), diabetes (44.9%), and cancer (37.2%). If all eligible individuals received MTMs, an estimated 1 594 000 hospitalizations (95% uncertainty interval [UI], 1 297 000-1 912 000) and $38.7 billion (95% UI, $24.9 billion to $53.9 billion) in health care expenditures could potentially be averted in 1 year. Program costs were $24.8 billion (95% UI, $23.1 billion to $26.8 billion), for an associated net savings of $13.6 billion (95% UI, $0.2 billion to $28.5 billion) from a health care perspective. In 2019 dollars, 10 years of the MTM intervention was anticipated to cost $298.7 billion (95% UI, $279.7 billion to $317.4 billion) and to potentially be associated with 18 257 000 averted hospitalizations (95% UI, 14 690 000-22 109 000) and reductions in health care expenditures of $484.5 billion (95% UI, $310.2 billion to $678.4 billion), for net savings of $185.1 billion (95% UI, $12.9 billion to $377.8 billion). Findings were robust in multiple sensitivity analyses.Conclusions and RelevanceThe findings suggest that national implementation of MTMs for patients with diet-sensitive conditions and activity limitations could potentially be associated with approximately 1.6 million averted hospitalizations and net cost savings of $13.6 billion annually. The results may inform US state, federal, and private-payer interest in expanding insurance coverage for MTMs among patients with diet-related chronic illness.

Liver Fibroblast Growth Factor 21 (FGF21) is Required for the Full Anorectic Effect of the Glucagon-Like Peptide-1 Receptor Agonist Liraglutide in Male Mice fed High Carbohydrate Diets

“…More in-depth preclinical and clinical studies into the role of the brain GLP-1R-liver FGF21 crosstalk may shed light on the well-documented variability in response to GLP-1RA and thereby enable precision medicine tailoring of GLP-1-based therapeutics to different individuals based on their genetics and environment such as diet. Given the benefits and growing call for wider implementation of “food is medicine” interventions such as medically tailored meals (MTMs) for diet-related diseases 70,71 , more indepth understanding of how dietary composition modifies GLP-1RA efficacy would inform refinement of current and future therapeutic protocols for the use of MTMs and GLP-1-based therapeutics for chronic weight management. Moreover, our results support the novel notion that the anorectic effect of GLP-1RA is comprised of discrete and differentially regulated actions of these compounds influenced by different dietary components.…”

Fibroblast growth factor-21 is required for weight loss induced by the glucagon-like peptide-1 receptor agonist liraglutide in male mice fed high carbohydrate diets

“…More in-depth preclinical and clinical studies into the role of the brain GLP-1R-liver FGF21 crosstalk may shed light on the well-documented variability in response to GLP-1RA and thereby enable precision medicine tailoring of GLP-1-based therapeutics to different individuals based on their genetics and environment such as diet. Given the benefits and growing call for wider implementation of “food is medicine” interventions such as medically tailored meals (MTMs) for diet-related diseases [ 85 , 86 ], more in-depth understanding of how dietary composition modifies GLP-1RA efficacy would inform refinement of current and future therapeutic protocols for the use of MTMs and GLP-1-based therapeutics for chronic weight management. Moreover, our results support the novel notion that the anorectic effect of GLP-1RA is comprised of discrete and differentially regulated actions of these compounds influenced by different dietary components.…”

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

“…140 For example, economic modeling suggests that 6.3 million eligible US adults may be eligible for medically tailored meals and that national implementation could save up to 1.6 million hospitalizations and $13.6 billion in net healthcare expenditures annually. 141 A growing number of public and private initiatives support healthcare reimbursement for such interventions, including Section 1115 waivers, 1915(b) waivers, and Managed Care Organization “in lieu of” services in Medicaid; and Special Supplemental Benefits for the Chronically Ill, Value-Based Insurance Design, Accountable Care Organization Shared Savings Programs, and Diabetes Prevention Program Expanded Model programs in Medicare. The USDA, Rockefeller Foundation and American Heart Association, and private healthcare are also supporting implementation and evaluation of these interventions.…”