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Medicare's Food Delivery Dilemma


In the United States, around twelve percent of traditional Medicare beneficiaries are diagnosed with heart failure, while nearly twenty-five percent grapple with diabetes. Recent studies suggest that the effective management of these health issues, among others, could greatly benefit from the introduction of pre-made nutritious meal services.


Given the promising results, why hasn't Medicare explored the possibility of introducing food delivery services for elderly individuals dealing with health challenges?


Controversy Surrounding Medicare's "Food is Medicine" Program


The Biden administration is considering integrating "food is medicine" approaches into traditional healthcare, aligning with broader healthcare reform efforts. While some express skepticism due to limited clinical research, proponents argue that early indications suggest significant potential for improving healthcare outcomes and reducing overall costs. A study suggests that implementing medically-tailored meals in Medicare could save the program $3.4 billion annually.


Alissa Wassung, from the Food Is Medicine Coalition, highlights the cost-saving aspect of medically-tailored meals, emphasizing their value for both recipients and the healthcare system. In Washington, the focus has shifted towards determining the implementation process rather than debating the concept's viability. Some lawmakers advocate for immediate testing within Medicare, although the program remains cautious.


There is ongoing debate surrounding the commencement of the program, with differing perspectives on the most effective approach. While some argue that Medicare possesses the necessary capacity to launch the program independently, others advocate for Congress to pass legislation, granting Medicare additional authority and resources. Those in favor of congressional action contend that it would provide a more solid legal framework and ensure sustained support for the initiative.


Conversely, proponents of Medicare's independent initiation highlight the potential for quicker implementation and greater flexibility in adapting to evolving needs. Despite the varying viewpoints, the overarching goal remains the same: to enhance healthcare delivery and improve outcomes for Medicare beneficiaries.


Kim Corbin, a former aide to McGovern who now advocates for the "food is medicine" approach, believes that a congressionally directed pilot program is the best and quickest method. She highlights that when Congress is driven and allocates resources, it can lead to substantial transformations. Despite this, Corbin also supports the idea of Medicare conducting its own pilot program.


Navigating Food Integration in Healthcare Programs


The spokesperson for Medicare opted not to respond to inquiries regarding the program's authority to execute the idea through its Innovation Center. Instead, they emphasized that Medicare is actively engaged in partnerships with diverse government entities and stakeholders to address concerns related to food security and nutrition. This includes efforts to incorporate nutrition and health aspects into Innovation Center initiatives.


This conversation underscores the difficulties of incorporating food into conventional healthcare practices. Although medically-tailored meals have demonstrated potential in limited clinical studies and are currently being tested in pilot programs within certain states' Medicaid initiatives, expanding these efforts to a nationwide program as large as Medicare presents notable obstacles.


Medicare's operational arm conducts trials for program adjustments, with a primary focus on traditional modifications like restructuring physician payments. Despite possessing legal authorization, deploying this office to pilot food delivery poses significant challenges, as noted by Medicare experts.


Time limitations may impede Medicare's ability to initiate the food delivery concept before the forthcoming presidential election in November. Typically, Innovation Center trials necessitate months or even years to launch. For example, a plan to overhaul Medicaid's payment framework for cutting-edge cell therapies, announced in 2023, is not expected to commence testing until 2025.


Enacting legislation presents its own hurdles, as Representative McGovern and a bipartisan group have annually introduced a bill since 2020 aimed at this objective, yet it remains stalled in its introductory phase, lacking committee hearings, formal consideration, or a vote. Despite this, various sources directly engaged with Medicare offer differing perspectives on the agency's interest in piloting the food delivery initiative.


McGovern's chief of staff revealed that their office interacted twice with Medicare, discovering that the concept didn't align with their model due to insufficient clinical research. However, other experts maintain that the government is actively exploring the idea.


Dariush Mozaffarian, director of the Food is Medicine Institute at Tufts University, who also engaged with Medicare officials, emphasized the quest for the optimal approach. Mozaffarian believes Medicare plans to integrate a medically-tailored meals benefit into an existing Innovation Center experiment, rather than initiating a new pilot program.


The Bipartisan Policy Center, via its Food Is Medicine working group, advises Medicare to incorporate this benefit into ongoing experiments, such as initiatives to enhance care for individuals on dialysis. Anand Parekh, the center's chief medical advisor, highlighted this approach as more feasible given potential constraints.

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