Center for Medicare & Medicaid Innovation
Presentation Abstract
Integrating Nutrition into Clinical Care Settings/Health Systems
Goals: (1) Identify existing pathways through which nutrition interventions are integrated into health care delivery and financing; and (2) Discuss key factors that influence access to these services by individuals at risk for and living with cancer.
Summary: Driven largely by an increase in health system screening for food insecurity coupled with a growing body of research showing that nutrition interventions can be effective at influencing health outcomes, health care utilization, and health care costs, an array of nutrition services are making inroads into health care delivery and financing. However, unless supported by philanthropy or research funds, these nutrition services are deployed largely outside of the cancer care continuum.
A few factors make it difficult for individuals with cancer to benefit from interventions like nutrition counseling, meals, groceries, and other food supports. Because, by and large, traditional Medicare and fee-for-service Medicaid do not cover nutrition services as discrete benefits, any instances of such coverage are due to the voluntary decisions of individual managed care plans that are participating in these programs. And in determining whether to cover nutrition services, plans are constrained by two factors: (1) regulatory parameters that dictate what they can and cannot do; and (2) the reality that the amount of discretionary funds that can be used flexibly to cover services that are not benefits within the traditional program is relatively small (e.g., the same bucket of funds must also finance any housing supports, utilities, extra disease management coaching, etc. that the plan wants to offer). Increasingly, providers that are engaged in alternative payment models also may have discretionary funds to spend on nutrition services–but again, these funds are limited and in high demand for a variety of services.
Plans and providers therefore are most likely to prioritize covering services that have a high likelihood of a rapid ROI. The cost impact of nutrition interventions on cancer treatment is not established in the literature. And there is also a large gap related to the longitudinal impact of health system nutrition interventions on cancer prevention. This makes it challenging for coverage of nutrition interventions for cancer to rise to the top for plans and providers.
This doesn’t mean there is no ROI–it just means we may not have asked the right questions yet. There are opportunities in research to look at, for example, the impact of nutrition in avoiding hospitalizations during treatment, or on reducing medications needed for side effects of treatment. The development of quality measures related to nutrition OR establishing that nutrition supports for cancer patients improve key quality measures are other levers that can motivate prioritizing coverage of cancer-related nutrition supports. Conceptualizing research with an eye toward translation into the health care system will speed progress for cancer-related nutrition interventions.
About Ms. Downer
Sarah Downer is a Health Insurance Specialist at the Center for Medicare & Medicaid Innovation, where she works to develop and implement innovations to improve health care and lower costs. Ms. Downer is also an attorney and was previously the Associate Director of the Center for Health Law & Policy Innovation at Harvard Law School, where she advocated for policy reforms that improve access and quality of health care for people living with chronic illness. She is a lead author of the Aspen Institute’s Food is Medicine Research Action Plan and has written and published on nutrition and health care policy. She received her B.A. from Harvard University and J.D. from Harvard Law School.