A Pivotal Moment for Medically Tailored Meal Policy

Ever since our founding in 1990, Community Servings has believed in the power of nutritious food to improve the lives of people impacted by critical and chronic illnesses. Once part of a small group of medically tailored meal (MTM) champions, we are now seeing rapid growth in government policies that support our efforts.

The Biden-Harris administration, as part of its 2022 White House Conference on Hunger, Nutrition, and Health—the first of its kind since 1969—called for the expansion of MTM as one of its top priorities to end hunger and advance health and wellness, launching a new federal policy push in support of the work that Community Servings has been undertaking for more than three decades.

On December 14, 2023, U.S. Congressman Jim McGovern, co-chair of the House Hunger Caucus and a longtime supporter of MTM and Community Servings, introduced a bipartisan bill, the Medically Tailored Home-Delivered Meals Demonstration Pilot Act (H.R. 6780), to create a four-year MTM pilot program within Medicare. A bipartisan group of U.S. Senators introduced a similar bill in the U.S. Senate just months before.

“I would say that we are at this real pivotal moment,” says Community Servings Senior Director of Policy and Research Jean Terranova. “We are seeing respect for the concept of medically tailored meals in a way that we never have before.”

“After 30-plus years in the field, it is exciting to see the momentum building around MTM in the healthcare space, as it directly addresses the need to improve health outcomes and reduce healthcare costs,” says Community Servings Chief Executive Officer David B. Waters.

Research Fuels Adoption

Galvanized by innovations in the 2010 Affordable Care Act, Community Servings began an in-house research and policy program a decade ago. In partnership with the Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School, the agency developed and proposed to health plans a framework for reimbursement, leading to Community Servings receiving reimbursement from healthcare organizations starting in 2014.

To build a body of evidence to support the effectiveness of MTM, we formed our first research partnership with Dr. Seth Berkowitz, now at the University of North Carolina School of Medicine, in 2017.

Research findings have helped turn skeptics into advocates. Community Servings has partnered with Dr. Berkowitz and other external clinical researchers to co-author four peer-reviewed journal articles demonstrating that our home-delivered MTMs improve health outcomes, reduce health care utilization and costs, and improve quality of life for individuals coping with complex illnesses. The White House cited one of those research studies—which found that study participants receiving meals from Community Servings had a 16 percent net reduction in healthcare costs—in its national strategy to end hunger and advance health and wellness.

Community Servings had 23 healthcare contracts last year, 10 of which are with MassHealth’s Accountable Care Organizations through the Flexible Services program. Previously, client meals were paid for almost entirely by philanthropic partners and through federal legislation like the Ryan White CARE Act. These new healthcare contracts have allowed the agency to serve significantly more clients. Community Servings now delivers about 1.1 million meals annually to more than 6,500 clients with critical and chronic diseases in New England, up from about 400,000 meals delivered to about 1,450 clients a decade ago.

“Research of and ROI for MTMs are data points extremely important to prospective healthcare partners, as they make the decisions about what nutrition programs will best impact their high-risk patients,” says Director of Strategic Growth and Business Development Erin DiBacco. “Our healthcare partners are impressed and reassured that Community Servings is at the forefront of research nationally, and [they] will often work with us to evaluate our individual partnerships as well.”

Community Servings is currently conducting three National Institutes of Health-funded studies examining the impact of MTM in partnership with researchers from Massachusetts General Hospital, University of North Carolina School of Medicine, the Friedman School of Nutrition Science and Policy at Tufts University, and University of Massachusetts Medical School.

Other organizations are also making the case. A recent Tufts study, which cited Community Servings research, found that MTM could save $13.6 billion annually on healthcare costs nationally.

Advocacy Leads to Policy

The establishment of the national Food is Medicine Coalition (FIMC) and the statewide Food Is Medicine Massachusetts Coalition in recent years has provided a structured opportunity to collaborate with other organizations to advocate for the health and economic benefits of MTM. In partnership with other MTM organizations, health plan payers and providers, policy leaders, academic institutions, and community-based organizations, we have worked to expand research, raise awareness, and make policy change.

Advocacy has contributed to several recent advancements in access to MTM:

  • Since early 2020, MassHealth’s Accountable Care Organizations have had funding opportunities to provide housing and nutrition support, including MTM, through the Flexible Services Program, as part of the Medicaid section 1115 demonstration initiatives.
  • In 2023, the Flexible Services Program was expanded to include nutrition support for all members of a household when the eligible member is a high-risk child or pregnant person.

Next Steps for MTM Policy

Congressman McGovern, who represents the second district of Massachusetts and has visited our Jamaica Plain headquarters multiple times, has noticed a sea change in MTM policy efforts. “Movement has been slow, painfully at times, but things are happening, and people are listening and wising up to the important role that medically tailored meals can play in our overall healthcare system,” he said at the Food is Medicine Coalition National Symposium last year. “I have found that those who are skeptical about medically tailored meals simply do not understand how they work.”

If the Medicare pilot program legislation moves forward in Congress it would be the first coordinated multi-state demonstration of MTM. “The prospect of having research and evaluation on a large-scale multi-state study within Medicare is huge,” Terranova says, “The other benefit is to show operationally that medically tailored meals can scale. It would be transformational if this leads to a permanent benefit within the Medicare program.”

In the meantime, Community Servings continues to advance MTM nationally. The FIMC Accelerator Program, for example, is an intensive one-year course that trains community-based food organizations from around the country to create MTM programs. The program’s intent is to create a national network of MTM providers uniquely attuned to the needs of local communities. The Accelerator program is co-led by FIMC, Community Servings, God’s Love We Deliver in New York, the Nonprofit Finance Fund, and CHLPI.

“It all comes together with the Accelerator program,” Terranova says. “There are nutrition programs across the country who want to provide medically tailored meals in their home communities, but don’t have the capacity to do so. If medically tailored meal reimbursement becomes part of Medicare, we will need a nationwide network of service providers to meet their needs.”

Since the Accelerator program started in 2020, three cohorts with a total of 13 organizations from around the country have graduated. The fourth cohort is currently underway. Eight of the organizations that have graduated from the program have launched MTM pilot programs so far.

At Community Servings, we are constantly thinking ahead to how we can help position the industry and our agency to advocate for policy changes—and be ready for them when they arrive—to help expand MTM to improve the health and wellbeing of individuals with chronic and critical diseases.

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