By Emma Glassman-Hughes
Boston University News Service
BOSTON — State lawmakers heard enthusiastic support earlier this month for a “food is medicine” program that would provide foods tailored to help those with chronic diseases while addressing hunger in the state.
A bill sponsored by state Rep. Denise Garlick, D-Needham, and Sen. Julian Cyr, D-Truro, would create a pilot program within an existing statewide Medicaid initiative and would “effectively and equitably address the link between food insecurity, chronic disease, and healthcare costs,” according to Cyr.
The bill being considered by the Legislature’s Joint Committee on Public Health would expand the existing Flexible Services Program, a statewide Medicaid initiative that facilitates partnerships between healthcare providers like Mass Health’s Accountable Care Organizations (ACOs) and community-based partners that provide nutrition and housing services.
While it was officially approved several years earlier, the Flexible Services Program was delayed until April 2020 and took effect just as the COVID-19 pandemic swept in to ravage healthcare and nutrition systems around the country.
Kristin Sukys, a policy analyst at Harvard Law School’s Center for Health Law and Policy Innovation, said the Flexible Services Program is “fantastic” because it allows the state to put healthcare dollars toward critical “nutrition interventions,” providing nutrition and housing services to “thousands of MassHealth enrollees across the state.”
Sukys, who works with the nutrition advocacy group Food is Medicine Massachusetts, said the proposed food and health pilot program would build on that progress, filling gaps within the Flexible Services Program and amassing evidence in support of a variety of state-sponsored nutrition interventions.
Though other states, including California and New York, have adopted food is medicine (FIM) programs in recent years, the impact has been comparatively narrow.
California’s plan only provides medically tailored meals or made-from-scratch meals that are hand-delivered to the sickest patients who are unable to shop or cook for themselves. These recipients often have complex and specific dietary needs in order to absorb their medications.
Sukys said the pilot program proposed in this bill would be the first in the nation to provide a spectrum of tailored nutrition services for patients with varying degrees of health concerns, chronic diseases, and access to nutritious foods, including medically tailored meals, medically tailored food packages with fresh or lightly prepped ingredients that patients can cook themselves, and nutritious food referrals that allow low-income patients and families to shop for fruits and vegetables on their own.
In March 2020, Food is Medicine Massachusetts released a case study about the efficacy of food is medicine programming. It found that “comprehensive and medically appropriate food support” is associated with improved health for patients with chronic illnesses like HIV, cancer, heart disease, and diabetes and that “diabetes distress,” or worries about one’s ability to consistently manage their blood sugar levels, “improved for patients with type 2 diabetes after six months of medically tailored meals.”
Among those who testified at the Oct. 7 meeting was Kurt Hager, a Ph.D. candidate studying food is medicine programs at the Tufts Friedman School of Nutrition Science and Policy.
“This bill is so well-timed,” Hager said. “A lot of organizations have partnered with healthcare in the last year-and-a-half and have gone through a really big learning curve.”
He added that 300,000 annual deaths in the U.S. resulting from cardiovascular disease and diabetes are attributable to diet. He emphasized that low-income households, racial and ethnic minorities and the elderly are disproportionately vulnerable.
Hager said that “COVID-19 has further exposed the horrific burden of diet-related chronic disease,” noting that Tufts researchers concluded 63% of 1,000,000 COVID hospitalizations were linked to high rates of obesity, hypertension, cardiovascular disease and diabetes.
Hager also cited Tufts research that found medically tailored meals yield “dramatic improvements in health outcomes and overall cost savings when administered in a very sick population.”
A Tufts analysis found that if a similar program were implemented at the federal level, an estimated 9 million people in the U.S. would be eligible to receive medically tailored meals, resulting in a net annual savings of $23 billion.
“These cost savings are almost unheard of in healthcare,” Hager said. “Food is medicine is smart health policy.”
A long stream of supporters testified in favor of the bill, including representatives from hospitals and advocacy groups such as Community Servings, a Jamaica Plain–based medically tailored meals provider currently working with MassHealth’s Flexible Services Program.
Vanessa Georges, a healthcare professional from Worcester, told the committee that the meals provided to her by Community Servings since her head and neck cancer diagnosis in 2018 have “saved my life,” nursing her from 90 pounds to her current 130 pounds.
Sukys said there was wide support for the proposal.
“We’ve talked to a variety of agencies and legislators and everyone understands it, [they agree] it’s really needed to address the intersection between food insecurity, chronic disease, and healthcare costs,” Sukys said in a phone interview.
Sukys also spoke at the meeting in favor of the bill, which she said provides an opportunity to envision “the ideal food is medicine system” wherein “all healthcare centers […] can provide a spectrum of nutrition services for low-income individuals with chronic conditions, […] and all members of the household are nourished, so indexed patients won’t need to share their food with hungry children or caregivers.”
This pilot, she said, which would be the first of its scope in the nation, would truly recognize “the connection between food insecurity and chronic disease” and create a framework for the rest of the country to follow.