Medically Tailored Meals for PWH: Research, Policy, and Practice · other clients living with...
Transcript of Medically Tailored Meals for PWH: Research, Policy, and Practice · other clients living with...
God’s Love runs The Food Is Medicine Coalition, a national volunteer association of medically tailored meal providers that focus on best practices in the provision of high-quality MTM, as well as advancing research and public policy that support access to MTM.
Success: Standard Adoption
At consumer request for higher quality nutrition, the NYC Ryan White
EMA adopted the FIMC Nutrition Standards for their entire Food and
Nutrition Services Category.
The Research Policy
References
Abstract
Contacts
Medically Tailored Meals for PWH: Research, Policy, and PracticeAccess to Nutrition as Key to Ending the Epidemic
Dorella WaltersSenior Director of External Program [email protected]
Alissa WassungDirector of Policy & [email protected]
Danielle ChristensonPolicy & Planning [email protected]
Research shows that food insecurity is associated with poor functional and clinical health outcomes, less engagement with HIV care and worse adherence to treatment for people living with HIV (PWH). Furthermore, when PWH become food secure it is associated with improvement across all aforementioned indicators. Pathways that link food insecurity and risk for HIV as well as affect course and consequence of infection include structural (economic, social, cultural), physiological, mental health, and behavioral pathways. Access to food for PWH has a profound effect on their health and wellbeing and plays a pivotal role in ultimately Ending the Epidemic.
MTM are a low-cost, high-impact intervention: one hospital night averted could provide medically tailored meals for half a year, and the health benefit is rapid. Research demonstrates that when PWH are nourished, health outcomes and well-being improve, adherence increases and reliance on emergency rooms and hospitals decreases.
Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health1
• 63% reduction in hospitalizations• 50% increase in medication adherence• 58% decrease in client emergency room visits
Examining Healthcare Costs Among MANNA Clients and a Comparison Group2
• Average monthly healthcare costs dropped more than 28% for PWH who received MTM
• Participants who receive MTM also had 50% fewer hospital admissions and were 23% more likely to be discharged to their homes rather than another facility.
Unfortunately, even with research demonstrating the effectiveness of MTM, too many PWH remain food insecure. 42% of PWH who live in the NYC-metropolitan area are food insecure, even with receipt of food assistance.3
The only dedicated funding stream for medically tailored meals for PLWH is the Ryan White HIV/AIDS Program (RWHAP), and it doesn’t cover all those who come to MTM agencies for services, forcing some MTM agencies to institute waiting lists or reduce services. Even within some localities, funding may be inadequate to provide as much MTM as is needed by the most food insecure clients. There remains tremendous variation by state in coverage of food and nutrition outside of RWHAP. In states where RWHAP continues to pay for the majority of medical expenses for PWH due to lack of Medicaid expansion, comprehensive coverage of access to MTM remains lacking. Medicaid and other public insurance do not provide MTM in a comprehensive manner.RECOMMENDATIONS:• Federal: The most comprehensive way to increase access is to make MTM a
reimbursable benefit in both Medicaid and Medicare for people who are too sick to shop or cook for themselves
• State: Many states have funded MTM for people with HIV and other critical illnesses through Medicaid waivers and various other demonstration projects with great result
• Local/EMA/TGA: Local RWHAP planning councils can choose to fund MTM in a more robust way, either as a support service or a core medical service
1. Palar, K., Napoles, T., Hufstedler, L.L. et al. J Urban Health (2017) 94: 87. https://doi.org/10.1007/s11524-016-0129-72. Jill Gurvey et al., Examining Healthcare Costs Among MANNA Clients And A Comparison Group, 4 J. OF PRIMARY CARE &
COMMUNITY HEALTH, 311-312 (2013).3. Aidala A., Yomogida M., and the HIV Food & Nutrition Study Team (2011). HIV/AIDS, Food & Nutrition Service Needs:
Community Health Advisory Fact Sheet. New York: Mailman School of Public Health, Columbia University: 1.
Practice: The Medically Tailored Meal Intervention (MTM)
God’s Love is founded in 1985 when one woman delivered a meal to a man dying of AIDSGod’s Love assists in creating the first Ryan White Meal and receives funding from the Ryan White Care Act in 1991
Our History
God’s Love establishes our Nutrition Department to help PWH and their caregivers
2001 - God’s Love expands its mission to include other clients living with serious illnesses
From one meal to one person
To 2 million meals per year to 8,000 clients
1985
2019
Figure 1. God’s Love We Deliver Medically Tailored Entrees (photo: J. Choi)
Research shows access to food helps: Connect PLWH to care Maintain PLWH in care
Increases medication adherence Helps PLWH achieve viral suppression by
maintaining food security and reducing side effects
Therefore, access to appropriate food is key to Ending the Epidemic.
The HIV Treatment CascadeUsing Nutrition to Help End the Epidemic
Implementation: The Medically Tailored Meal Nutrition Standards
Chart 1. The Medically Tailored Meal Intervention at God’s Love We Deliver
Development of the Nutrition Standards• Collaborative FIMC Agency RDN
Effort• Experts in HIV nutrition, having
served the population over time• Evidence -Based Practice
Guidelines• Ensure Standardization and Quality• Ability for Agency Individualization
Chart 3. HIV Care Continuum. CDC. https://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-carecontinuum.pdf.