The participants were members of Commonwealth Care Alliance (CCA), a not-for-profit community-based health plan that manages and administers care for adults older than age twenty-one who are dually eligible for Medicaid and Medicare. All CCA members with at least six months of continuous enrollment in one of the two meal delivery programs in the period January 1, 2014–January 1, 2016 were eligible for this study.
The primary data source for this study was CCA health care claims.
The primary outcome was ED visits, including both those in which the patient was admitted as an inpatient and those in which the patient was discharged home. Secondary outcomes included inpatient admissions and use of emergency transportation. The authors also assessed medical spending (expressed as inflation-adjusted 2016 dollars). This included claims for five service categories that could be affected by nutrition programs: inpatient, outpatient, ED, pharmacy, and emergency transportation.
The study examined two meals programs. One was medically tailored by a registered dietician to participants’ needs, across seventeen dietary tracks, with combinations of up to three tracks permitted. The second, nontailored program delivered nutritious meals that were not tailored to the participants’ individual needs. The medically tailored program delivered a 5-day supply of lunches, dinners and snacks on a weekly basis, while the nontailored program delivered 5 days of lunch and dinner, usually on a daily basis.
The authors randomly selected CCA members who did not receive either meal program during that time frame. Using a technique called coarsened exact matching, the authors created matched controls group based on relevant sociodemographic, clinical, and pre-intervention health care characteristics. The authors conducted regression-adjusted analyses using generalized linear models.
Participants in the medically tailored meal program had significantly fewer emergency department visits (p<.001), inpatient admissions (p<.01) and lower emergency transportation use (p<.001) than the comparison group. Participants in the medically tailored program also had $570 lower medical spending per person than the comparison group (p<.001).
Participants in the nontailored meals program also had significantly fewer emergency department visits and emergency transportation use, but not fewer inpatient admissions. Participants in the nontailored program had $156 lower spending per person than the control group (p<.01).
Subtracting the program costs from the estimated savings yielded net savings of $220 for the medically tailored meals program and $10 for the nontailored meal program.
These findings suggest the potential for meal delivery programs to reduce the use of costly health care and decrease spending for vulnerable patients.