WASHINGTON – About 12 percent of traditional Medicare beneficiaries have heart failure. About a quarter have diabetes. There is early evidence to suggest that both conditions, and many others, may be better managed with pre-prepared, healthy meals.
So why isn’t Medicare delivering food to sick seniors?
The experiment would fit into the Biden administration’s larger push to integrate so-called “food is medicine” interventions into traditional medicine. Skeptics of this idea note that little clinical research has yet been done incorporating food into medicines. But proponents say early evidence shows the idea can improve health care outcomes and save costs for the entire health care system. One study By providing healthy prepared meals (commonly known as medically tailored meals) in Medicare, the program estimates it could save $3.4 billion in just one year.
“The benefit of medically tailored diets is that there are real cost savings,” says Alyssa Wasn, executive director of the Food Is Medicine Coalition. “The benefit is that it has value not only for the person receiving it, but also for our health care system.”
The debate in Washington right now is less about whether to test the idea and more about how to implement it. At least one outspoken Democrat in Congress believes a federal Medicare program can be implemented right away without help from Congress. This is unusual flexibility for a policy institution. Medicare is hesitant.
“We need to get creative, and we need to find a way to make it happen. And it needs to happen now,” said Rep. Jim McGovern (D-Mass.) on the issue. said at a recent summit on In an interview with STAT, he seemed visibly irritated.
“I just want them to get this damn thing over with,” McGovern said. “Do whatever you have to do. Move heaven and earth, I don’t care what it is. But just do it.”
But some warn that even if Medicare could do it, a bill in Congress that would give the program more power would be better.
“Congress directed [pilot] That’s the best and fastest route,” said Kim Corbin, a former McGovern staffer who now works on Food is Medicine. “If you have an ambitious Congress and get the money, you can really change things.” She said she also supports Medicare trying the idea on its own.
A Medicare spokesperson declined to answer STAT’s questions about whether the agency believes it has the authority to test the idea through its so-called innovation center. Instead, he said in a statement that Medicare is “actively collaborating with authorities around the world.” [the government] Work with stakeholders to address food security and nutrition, including efforts to integrate nutrition and health into the Innovation Center model. ”
This debate highlights how difficult it is to incorporate food into traditional medicine. Medically tailored diets have been successfully tested in small clinical trials and are being piloted in several state Medicaid programs that provide health care to poor Americans, but none as large as Medicare. It has never been integrated into a large-scale federal program.
Medicare has an office dedicated solely to testing changes to the program, but its experiments have primarily focused on more traditional adjustments, such as changes to how doctors are compensated. Several Medicare experts stressed to STAT that even if Medicare technically had the legal authority, it would be difficult to try the idea through the agency.
Medicare officials also may already be running out of time to test the idea before November’s presidential election. It often takes months, if not years, to launch an innovation center pilot. For example, plans to change the way Medicaid pays for high-tech cell therapies were announced in 2023, with trials not expected to begin until 2025.
But signing the bill is also not a simple step forward. Mr. McGovern and his bipartisan group of lawmakers have introduced legislation to do just that every year since 2020, but it has never received a committee hearing, let alone a formal debate or vote.
Several parties who spoke directly with Medicare about the idea gave varying accounts of the agency’s interest in piloting the program.
McGovern’s chief of staff told STAT that his office met twice with Medicare and was told the idea didn’t fit the model because there wasn’t enough clinical research to test the idea. .
But other experts insisted the government was still considering the idea.
“They’re looking for the best approach to make that happen,” said Dariush Mozaffarian, director of the Institute for Food is Medicine at Tufts University. He’s also talking with Medicare officials.
Rather than launching an entirely new pilot program, Medicare plans to integrate the medically tailored meal benefit into one of its existing experiments already being conducted through so-called innovation centers, Mozaffarian said. He added that he believed that.
“My sense is not that they don’t want to do it or don’t think they can do it, but that medicine is incredibly big and incredibly complex and they’re trying to figure out what’s right. “We think there is.’ That’s the best way to test that,” Mozaffarian added.
The Bipartisan Policy Center, a think tank that has launched its own “Food Is Medicine” task force, urges Medicare to add this to existing experiments, including continued attempts to improve care for people receiving dialysis. They are requesting that benefits be included.
“We ultimately chose this path rather than recommending it. [the Innovation Center] We tested the standalone model because we thought this model was more appealing to them given the potential limitations,” said Anand Parekh, the organization’s chief medical advisor.
