NBTH: Healthy Food Is Health Care

The Next Big Thing in Health is a podcast where we explore the new big ideas that will help make health care more affordable, more available, and more effective.

AHIP President and CEO Matt Eyles and co-host Laura Evans sat down with Mom’s Meals’ Catherine Macpherson to discuss how to address food insecurity, as well as the value of food as medicine.

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Episode Transcript:

Eyles:

Hi everyone, and welcome to the Next Big Thing in Health, a podcast from AHIP. I'm one of your hosts, Matt Eyles.

Evans:

And I'm Laura Evans.

Eyles:

On today's episode, we welcome back one of our favorite guests, Catherine Macpherson. As the senior vice president of health care strategy and development and chief nutrition officer with Mom's Meals, she is responsible for ensuring Mom's Meals nutrition solutions meet the needs of its partners by designing clinical programs that meet their strategic objectives.

Eyles:

I'm really looking forward to the insights we'll bring to our conversation. Mom's Meals is also the sponsor of today's special episode. Mom's Meals recognizes the need of greater care and a more personalized way to access nutritious meals to many throughout their day. Mom's Meals brings specialized meal programs designed to support the many nuanced stages of life. Every individual has unique needs. Mom's Meals believe they deserve accessible nutrition that can improve health outcomes.

Spotlight: Mom's Meals

At Mom's Meals, our mission is to improve life through better nutrition at home. Using medically tailored meal benefits designed for members needs. We help health plans improve total cost of care through fewer readmissions, shorter in-patient stays, less emergency department visits and improved outcomes. Learn more at momsmeals.com.

Eyles:

Catherine, it's a pleasure to have you on the show again. Thanks for joining us today.

Macpherson

Thanks so much, Matt. It's great to be back together with you and with Laura,

Eyles:

Why don't we kick off the conversation and just catch folks up who may not be familiar with Mom's Meals? Can you just give us a little bit of background on the organization? How did it begin and what its mission and goals are?

Macpherson

Absolutely, happy to. First thing to know about Mom's Meals is we are a very mission-driven organization. So our mission is improving life through better nutrition at home. And we got our start from a mom who is a caregiver. So Barb Anderson is one of our co-founders. She was taking care of her mother who is aging in place and managing a chronic condition. And her mother-in-law was in the same set of circumstances. And she was a member of the sandwich generation, she had two sons who are college athletes, and everyone was losing weight in her family. So she you know, from a place of caregiving started to prepare family favorite meals and stock their refrigerators on the weekends. And kind of fast forward 24 years, we're still headquartered in Iowa where the company got started. But we are a national provider of medically tailored meals. We deliver to every address in the U.S. And you know, we really, that's that's how we got our start.

Evans:

I love that backstory. And it really speaks to such a special why and continuing the mission. And I, you know, as a mom, myself, you want this for your family, you want the very best. I want to talk about the basics here the importance of nutrition, because we all talk about this in our own homes, the importance of a healthy, balanced diet and food as medicine. That's a line that we're hearing more about. And I know that's really important to Mom's Meals. Can you talk about how your program works with specific menus that are meant to be healing with chronic conditions like diabetes, kidney disease, cardiovascular disease, and how you incorporate that food as medicine philosophy into what you do?

Macpherson

Absolutely. So if you think about food as medicine, it really means that we're just incorporating healthy food into health care. And that would be for the prevention and treatment of chronic diseases. So many of the diseases that you mentioned those leading diseases that are population faces: hypertension, heart disease, diabetes, kidney disease, they are driven by diet, they are nutrition-dependent.

Macpherson

If you think about how can we treat these diseases without integrating nutrition? You know, we really can't. what we do our philosophy for food as medicine is making it as easy as possible. I've been a dietitian for 25 years now proud to say that. And nutrition has always been part of the plan of care for patients, for members. But what we found is education isn't enough for some people, collaborating with them on a plan of change, when they just have barriers that are so difficult to overcome is just not enough.

Macpherson

And so what we do with medically tailored meals as part of that food as medicine approach is, making it as easy as possible for people able to eat within the dietary guidelines to better manage a chronic condition like diabetes, like heart failure, like renal disease. You know, the fully prepared meal. You can't get much easier than that. It shows up at your front door, you heat it in the microwave for a minute and a half, and you are able to enjoy a delicious meal that helps you better manage your chronic condition and all without having to overcome barriers, like transportation, like access to a full-service grocery store, like being on your feet for long periods of time chopping, etc. Like really understanding the basic building blocks for eating for your condition or label reading, like limited English language skills. So so many of those barriers can be overcome with fully prepared meals. And when people have limitations.

Evans:

And Catherine, let me ask you, when you say education isn't enough, are you saying that most people, they can know all they want but it they just don't have necessarily the access or the wherewithal to be able to make these meals and that's where Mom's Meals comes in?

Macpherson

Exactly, exactly. And the medically tailored meals portion of somebody's sort of journey to adopting a healthier diet is a great jumpstart. So even if people don't have some of the barriers, they still may need the step that's going to make things easy for them to begin that change. Because change is hard. You know, we've all tried to change habits at one time or another and thinking about changing your diet when there are things you like and things you're familiar with and meals that you're used to preparing for yourselves or you know, places you're used to going. Changing that is really difficult. People don't know where to start. They don't know if they're going to like it. And so the fully prepared meals, even for people who don't have barriers, certainly for people who have barriers, it's very important. But even for people who don't have barriers, it just provides that structure and that ability to really change someone's food environment and make it as convenient as possible.

Eyles:

Yeah, I think Catherine, we focus a lot on those populations with chronic conditions. And we know how important nutrition is, especially for individuals who do have chronic conditions. But maybe we could turn for a moment to the importance of nutrition for maternal and child health, right? I mean, good nutrition during pregnancy is just vital for both the mother and the baby's health. We know important nutrients, whether it's iron, folic acid, calcium, or others can reduce the risk of complications and promote healthy development. And of course, making sure that new moms and babies have access to nutritious food from the very beginning. And once they're young children, as well, just creates a foundation for lifelong health. How do you think about using food as medicine to support say, expecting mothers and their children?

Macpherson

Yeah, that's a great question. And you bring up a lot of excellent points there. Nutrition is so fundamental to that healthy fetal development, to maternal health. You know, maternal mortality rates have been on the rise in the U.S. and disproportionately that's impacting women of color. And we know that social factors, including access to healthy food play a big role here. And we have seen really wonderful focus on the Medicaid side, Medicaid pays for about half of births in the U.S., we've seen a really nice focus on improving maternal health programs, including nutrition. So again, nutrition is so important for helping mom to get to full term, making sure that baby is at a healthy birth weight.

Macpherson

And even beyond kind of those basics for the treatment of conditions that are quite common during pregnancy. So think about high blood pressure or preeclampsia during pregnancy, or gestational diabetes, or if somebody has pre-existing diabetes. If somebody's on bed rest are expecting multiples or just any high risk perinatal condition. That's an area where nutrition can play an even more important role by treating that condition or helping someone to, again, just making it easier to eat healthfully during pregnancy is really important.

Macpherson

And we think about food as medicine in this circumstance, along with our health plan partners and helping them to advance their strategy for their members. So typically, the meals portion slots into a component of a maternal health program and it could be healthy moms, healthy babies, there typically is a maternal and child health strategy at the Medicaid program already. And what great thing that we've seen is that when medically tailored meals are introduced into that program, it can drive engagement. So the maternal health program is going to help with everything from diabetes testing strips, to access to nurses, to blood pressure checks, to ensuring that women are following up with their primary care provider after delivering. All kinds of really important aspects of care, but again, if people aren't engaging with that program, there are missed opportunities. And so meals because they provide an immediate impact to the mom, there is an immediate value there and potentially to family members, we do work with health plans that support not only their expectant member, but other dependent children or members in the household.

Macpherson

But this is again, an immediate value to the family, helping somebody to say this is going to make my life easier right away. Maybe I didn't have time before to pick up that phone when my nurse called, etc. But I'm gonna make time because this is something that's important to me. So we have seen, engagement rates go up. And certainly clinical improvement when medically tailored meals are introduced in the program. So it's kind of a win-win.

Evans:

And I want to pivot quickly to mental health for just a second, because that's something that we're paying a lot closer attention to in this country right now. And historically, Catharine, mental and behavioral health conditions have been treated with counseling and medication and in some cases, hospitalization, of course, but we're learning more now and getting smarter. And the research shows us that our food choices really affect our gut, our brain functions and can have a serious impact on our mental health. Can you talk about how the lack of proper nutrition can have an impact on supporting one's mental well-being and what you all are doing to combat this?

Macpherson

Yeah, absolutely. Nutrition is extremely important for mental and behavioral health. If you think about it, part of what we're trying to do in the treatment of mental and behavioral health, as we again work with sort of the clinicians building the programs within the health plans we partner with, is certainly compliance with provider visits. And part of that is also medication management. So just kind of a foundational piece, you need adequate food to absorb and utilize medications like within your body.

Macpherson

But we also we also often see under and over nutrition in people with severe mental and behavioral health issues. There can be both under eating and overeating as someone struggles with different conditions, including depression, anxiety, etc. And then if you think about it, even at the cellular level, nutrients are are the building blocks for neurotransmitters. So you really can't have a healthy brain you mentioned, you know, healthy brain, healthy gut, etc, that food becomes part of our body. And having the basic building blocks for things like neurotransmitters is really critical.

Macpherson

And there's new research bringing to light all the time, sort of kind of new discoveries in this area, you know, maybe you're referring to kind of the ultra-processed foods study that grabbed a lot of headlines, and that there is a link between ultra-processed foods and, um, you know, mental health, mental health and well being that kind of the more ultra-processed foods, the lower the mental health and well-being. And we don't know all the mechanisms there, but that there are links, and it's just a very dynamic area of research. And certainly what we do know is that healthy food and nutrition is critical for for mental health and well-being.

Eyles:

Yeah, I think we all see how it gets connected food to our emotional well-being in different points in time, for sure. But the direct connection to the clinical outcomes are really important. I think food security is an area that we talk a lot about. And we know, especially with elderly disabled people who might have difficulty accessing food, or maybe they live in a food desert, that they have to rely on other resources. Maybe you could share just a little bit of perspective about how a balanced diet that meets the need of marginalized groups can really help those people and then also just how making sure people have access to healthy food can enable them to maybe age in place, rather than go into an institutionalized setting?

Macpherson

Yeah, those are great questions. And I'd like to start just for a minute and kind of talking about food insecurity. What has come out recently not only kind of the prevalence of food insecurity, I guess let's let's even start there. 34 million people in the U.S., about 10% of adults, but Black and Latino individuals experience food insecurity at a rate of 10 times that of white and non-Hispanic individuals. What we do know is that food insecure families are in trouble. So this was a recent study health health care spending among food insecure families is about 20% higher compared to food secure families. So there is that real food and health care link.

Macpherson

The mortality rate also goes up when people are food insecure. So mortality rate for food insecure people is about 46% higher than those with a sufficient diet. So a lot of disparity here. As we move toward health equity, we need a strategy around food security and I think that we are seeing seeing movement in this direction through things like the White House Conference on Hunger, Nutrition and Health.

Macpherson

You know, kind of back to your questions about specific groups and how food and nutrition can help them achieve health objectives. You gave the example about older adults aging in place, and people with disabilities, other vulnerable populations. So that is just so critical. And really, that's how Mom's Meals got our start, enrolling as a Medicaid provider to help enable older adults to age in place. So we became that long-term care provider of meals. And we do provide LTSS long-term services and supports and HCBS home and community-based service programs across the country today. And that, that is so important, we have a population that's aging, more and more people are turning 65 every year, and the majority of people want to age in their own homes in their communities. And you know, as we've learned during the pandemic, that can also be safer at certain times. And if we're going to be able to allow people to sort of have the agency to say, this is how I want to live out my years, I want to be at home, we can bring better health into the home through home delivery nutrition. So we can enable people who are aging in place, people with disabilities to be independent for as long as possible within their homes, within their communities.

Evans:

As a follow up, Catherine, to Matt's question, I want to talk about how do we solve this? I mean, it just like seems like such a big mountain to climb the food insecurity piece of this? And it's something that will require an all hands on deck approach from government, private industry, community organizations, nonprofits, thinking about the role of some of the big health programs for just a moment, how do you think Medicaid and Medicare can provide better opportunities to integrate food as medicine into their programs? And what are some of the biggest obstacles that you see?

Macpherson

Sure, I love this question, because that's really what we're trying to do with food as medicine is integrate food and nutrition into health care at a larger scale. So I would say kind of the overarching umbrella where the momentum is really coming from is at the highest level. So the White House Conference on Hunger, Nutrition and Health that was held in September of 2022. Since then, we've had some follow-up meetings. Tufts University is taking the leadership role there. They've got a very strong nutrition policy and history. And they they did hold a food as medicine Summit in May of this year. And then they had a follow-up meeting on advancing food as medicine approaches from the White House conference in June. The White House came out again with a follow up challenge to end hunger and build healthy communities in May of this year, and asked for renewed commitments from public and private organizations to commit to ending hunger and advancing food as medicine.

Macpherson

So I think that's where we're seeing kind of a national movement, and what we're seeing in Medicare and Medicaid, let's start with Medicare. CMS, sort of in their pillars, looking at things like addressing social determinants of health and advancing health equity and coming out with new measures like the health equity index that we're going to see incorporated into stars measures. Those are all, I think, steps toward CMS's objectives. Kind of the biggest flexibility that we see in Medicare Advantage, our special supplemental benefits with the chronically ill. So on the supplemental benefit side, these really nice flexibilities to be able to address unmet social needs, like access to healthy food. So we have seen movement in that area, we continue to see that as a Medicare Advantage plans sort of look at part of the rebate dollars they have to spend in that area and payment from CMS and be able to decide what is going to be the most effective use of those dollars and look at things like food as medicine as providing not only sort of an important quality-based program, but also a strong return on investment for those dollars as well in health care.

Evans:

Beyond that, do you see any obstacles that you can identify that we can work to overcome or that we can identify to say, hey, let's work on chipping away at these?

Macpherson

Yeah, well, more money always helps, funding limitations. And I know that, you know, AHIP has done a lot of work in that area to to advocate for adequate reimbursement for Medicare Advantage plans to be able to provide the benefits and services that are going to meet the needs of their members. So on the Medicaid side, what we do see is a really nice, there was some great sub regulatory guidance that came out from CMS in January of 2023 around in lieu of services. So there are some existing flexibilities in Medicaid, value-added benefits, those can be paid for out of administrative dollars. Those programs tend to be a little bit limited. But in lieu of services, this is something that is available immediately. You don't need a statewide in lieu of services program as a managed Medicaid plan to kind of put that forward to this state. Even if your state does not have an ILOS program, and most don't, you can say we would like to pay for things like home delivered meals in lieu of emergency department visits, personal care hours that might be dedicated to meal preparation, or even hospital stays. And you know, it's not only home delivered meals, you could pay for other SDOH-related services.

Macpherson

So it's a really nice way to test new services for members to prevent that downstream high cost utilization. So in that sub regulatory guidance, it made it very clear that MCOs can take these ideas to the state, they need to be approved by the state, and then they need to be approved by CMS. But CMS has said, If it's less than one and a half percent of your capitation, it gets auto approved. There's a max of 5% of spend on in lieu of services. But you know, what we have seen is some movement in that area. And this is great, because these can be larger scale programs, because the standard is coming out of the medical spend. And that's where you know, food as medicine is really going to gain the momentum, it's making sure that we're spending the health care dollars that go toward care on the things that are care, you know, like food is part of the plan of care. Has been categorized as supplemental or as value add. But our argument is it should be prescribed along with medication to help somebody manage diabetes or kidney disease or hypertension or heart failure, for example.

Evans:

And I'm sorry, I've one more question just along those lines. It astounds me that you can deliver to every single zip code in the country.

Macpherson

We can, yeah, including Alaska, Hawaii, Puerto Rico. So anywhere, one of our health plans has members we're able to deliver.

Evans:

Are you mailing them? I mean, how are you getting these? How are you doing that?

Macpherson

Yeah, so about two-thirds, more than two-thirds of our meals are delivered by our own employee drivers. So we have refrigerated vehicles, we have drivers, and that tends to be for our longer term programs and long term services and supports, chronic care program, some of our post-discharge programs even. So you know that that's been great to see and where we have a concentration of members that we're serving, we're going to look to add a driver. That's part of our model. It's something we've learned over 24 years in business, and we're vertically integrated, we make our own meals, we pack them formembers, we deliver our meals, and we're proud to do that. But in cases where we have a short-term program, where in most programs, people start out on third-party carrier just because that speed to start is so important. Imagine discharged from the hospital, we want to get there as quickly as possible. So we can very often be there the next day in that case. So we do utilize third-party carriers, we have long-standing decade plus relationships with these carriers, and they know that someone's not going to eat if the food is not there on time. Yeah. And so you know, our meals are all refrigerated. And so those coolers are packed in a refrigerated temperature, they get there safe, and then they're just stacked in the fridge. So that's all part of our model. And yeah, something that we've got a big operations and logistics team that focuses on all those details.

Eyles:

Amazing, literally soup to nuts as long as there's not a food allergy in there.

Macpherson

I like the food reference.

Eyles:

Well, you covered a number of important developments on the administration side with the White House Conference on Hunger and Hutrition, also touched on some important regulatory policy areas. Are there areas that you're paying attention to from a legislative perspective that you think would help advance the goals of bringing healthy food options to all? I know that's an important advocacy component too is whether or not we need some new federal legislative approaches to help advance the cause.

Macpherson

Sure, absolutely. So I would say the biggest opportunity that we see or the most progresses, just making meals a covered benefit. And we talked about that a little bit previously. So you know, meals getting paid for out of the medical spend. And so there is a movement both in Medicare and Medicaid to that end.

Macpherson

So on the Medicare side, federally, we have seen a bill introduced in July 2023 in the Senate. It's the medically tailored meals pilot, and it would be a pilot is fee-for-service Medicare. And that would test the efficacy and the cost per providing post-discharge meals to help prevent a readmission. And we know that from a return on investment standpoint, there's nothing stronger than a post-discharge meals program. And that's why it is so common in Medicare Advantage, for example. So about 70% of MA plans have a post-discharge meals benefit today. And if you think about It's a 30 day return, you're preventing a 30 day readmission and that can be a very expensive proposition and meals themselves are again sort of low cost, low risk and big satisfaction driver.

Macpherson

So what we do see is bipartisan legislation introduced by Senator Stabenow, with Marshall, and Booker and Cassidy. And there will soon be a companion bill in the House. It's not the first time this bill has been introduced, but it was reintroduced in this Congress, this was great. And if it does save money in Medicare, that means it could become a standard benefit. And would be standard in MA then as well. So that's one to watch.

Macpherson

And then what we see on the Medicaid side, which is similar is, but this is more at the state level, five states this year introduced a state legislation that would cover medically tailored meals as a Medicaid benefit. So that was California, New York, Florida, Pennsylvania, Texas. So you can see some very large Medicaid states here. So California and New York, the two largest, and looking for ways, again, to drive cost savings in these programs while addressing social needs, like food access, healthy food access for the beneficiaries. So we're continuing to watch those and we think this is just the start. So what we do hope to see in the future is in Medicaid and Medicare, that medically tailored meals become a covered benefit.

Evans:

So we are obviously big fans of Mom's Meals and your your approach with this. How can listeners who may also be very excited about this work, how can they support you? And how can the organization maybe help them develop a program in their own community?

Macpherson

Yeah, I love that question. So I think if you're completely unfamiliar with Mom's Meals, you can go to momsmeals.com, we have our refrigerated meals are right there online. You can see all of our conditions, specific menus, which there are nine. You can look at our array of of meals, there are about 60 to 70, across our different menus. And you can just self-order. So if you want to try them, you're caring for a loved one who might benefit from these meals, you can try them yourselveds.

Macpherson

If you want to do more reading about food as medicine, we have a great white paper on our website. It's a food as medicine, white paper. And that covers topics from policy to benefit pads in Medicare and Medicaid to food insecurity. And you know, some really nice stats and studies. So if you are trying to get a program off the ground within your organization, that's a great resource to kind of take that information and incorporate that into your internal discussions and to advocate for food as medicine program.

Macpherson

I think that you know, we're also happy, our team at Mom's Meals, we love to work one-on-one with organizations. That's part of what I do talking to health care groups kind of all day, every day, from health plans to providers to consulting groups, to state and local organizations to research institutions. And it's just wonderful to see the momentum in the space. But we're happy to kind of provide insights into what we've learned over 24 years in this space, and help you develop your program plan and get it off the ground.

Eyles:

So Catherine, I know you recall this from last time we were together on the podcast, our famous, maybe infamous question at this point about what the next big thing in health is. And I know last year, you talked about coordination between Medicaid, Medicare, helping to make food as easy to prescribe as medicine. What's the next big thing in health? I'll come back to that question one more time?

Macpherson

Yeah, no, I think that those two mentioned last year are still crucial and critical. And we do see some progress there. I think that there is more interest from providers, particularly value-based providers in food as medicine. And that's wonderful. I think the prescribing piece and making food as easy to prescribe as medicine has a ways to go. But if anyone listening is working in that area, I think that's a great opportunity.

Macpherson

But what's next, so in thinking about our corner of health care around food as medicine, I think what we're starting to see is more of a food as medicine strategy for health plans. So you know, we've seen a social determinants of health strategy, health equity strategy, I think what we're starting to see as a food as medicine strategy, and this is really coming out, again, from the momentum from the White House Conference and, you know, some of the research that has recently come out. So I just want to mention a great study as well. There was a recent study in JAMA with Medicare Advantage members who had heart failure and had chronic conditions and this was Kaiser Permanente study. Mom's Meals happen to be the meals provider within that research and were mentioned there in the paper. But what we did see in that research was that post-discharge meals prevented readmissions and lower mortality. So again, a lot of efficacy. There's a lot of evidence out there for food as medicine. So I think number one, we are going to see health plans develop this food as medicine strategy, and medically tailored meals being a piece of that and you know, what else is going into that overall robust strategy to meet the needs of all members?

Macpherson

Number two, what I think we could start to see would be quality measures for food as medicine. And that would just follow on. There are quality measures, for HEDIS, and Stars about all kinds of care, preventive care, for medication, compliance, etc, adherence. So all kinds of measures, what we don't see yet are specific measures around food and nutrition. So I think that next big thing could be those kinds of quality measures, because we know when the rubber hits the road, right, you're going to kind of make sure you're focused on areas where there are quality measures that you need to hit. And those quality measures around food and nutrition could be very important to advancing the food as medicine strategy. That's another area that I think would be a next big thing.

Macpherson

And one more note on that as well around this idea of quality and proof around food as medicine because again, you know, we need evidence to continue to advance the food as medicine agenda is Mom's Meals is a founding partner in the Validation Institute's new food med certification program. So this is a program for providers of food as medicine solutions, who can get their programs certified by an organization with expertise in digging into the details around methodology, calculation, on how the evidence is evaluated. So Mom's Meals along with Uber Health Avesis, and Albertsons are the founding partners there. And there's a great swath of advisors, and then a whole team of mathematicians who are doing the evaluation. But this again, is just another piece of this movement toward evidence and proof and quality around food as medicine programs. So this move toward a larger strategy and quality I think are the next big thing.

Evans:

Amazing what a service you're providing.

Macpherson

Thank you.

Eyles:

Yeah. Thank you so much for being with us, Catherine, great to work with you.

Macpherson

Great to work with you as well. Always a pleasure.