As we finish the May 2023 celebration of Older American's Month with its theme of "aging unbound," it is important to consider how the concept of "food is medicine" can help address health equity challenges and give all people more opportunities to age well. The current focus on food as medicine emphasizes the use of nutrition to promote health and prevent disease.

This focus has led to programs that provide medically tailored meals (MTM) to patients facing serious health challenges, which improves their access to nutritious food and helps address any issues with nutrition security. These programs have gained popularity because of their significant impact on improving health outcomes while reducing healthcare costs, particularly for older adults at risk of malnutrition.

Opportunities to increase MTM access

The historic 2022 White House Conference on Hunger, Health, and Nutrition offered a unique opportunity to increase access to MTMs with the White House pledging to reduce hunger and diet-related disease for all. The Food Is Medicine Coalition, comprising over 100 nonprofit organizations across the United States, is at the forefront of the movement. The coalition operates a Food Is Medicine Accelerator initiative to provide funding and resources to nonprofits and social enterprises working to expand access to these MTM programs. The accelerator offers training and technical assistance to help organizations build capacity and sustainability, while the coalition advocates for policy changes that would allow greater access to the programs.

One such policy change is the Medicaid section 1115 demonstration waiver, which provides states with federal funds to test new approaches to improve the health of Medicaid beneficiaries who suffer from certain chronic conditions, including heart disease, diabetes, and cancer. Four states have received approval for the waiver for a food is medicine program, with more expected to follow. Success in these states could allow waivers to be extended to Medicare as well.

Private companies are also seeing the value of viewing food as medicine. After a recent Community Assessment Survey noted that half of older adults in Indiana reported lack of access to affordable quality food, Blue Cross Blue Shield provided $4.4 million to provide fresh produce to senior meal sites or as part of home-delivered meals.

Promoting health equity

Studies have shown that providing MTMs to patients can help improve their health status while reducing healthcare costs. A Kaiser Permanente study found that high-risk patients diagnosed with heart failure were half as likely to be readmitted to the hospital after 90 days if they had received MTM. And the cost for six months of meals roughly equals one night's stay in a hospital, making the program a prudent fiscal choice. Racial and ethnic minorities have the highest incidence, prevalence, and hospitalization rates from heart failure as well as the worst outcomes, so expanding MTMs should benefit these groups. A number of organizations have pledged to collect more data with the Food Is Medicine Research Initiative to help garner support to start and expand programs into areas that most need it.

Screening for food insecurity and malnutrition is an essential part of targeting food is medicine and MTM programs, especially for older adults who are at higher risk of malnutrition. By identifying individuals who are at risk, healthcare providers can intervene early and help prevent health complications. However, screening alone is not enough. We must take action to address the root causes of food insecurity and malnutrition, including poverty, lack of access to healthy food and social isolation. MTMs can play a crucial role in addressing these problems.

Collaboration is key

The Aspen Institute's Food Is Medicine Action Plan calls for greater collaboration between healthcare providers, insurance companies and community organizations. The federal government could include funding for such programs in the upcoming Farm Bill, a critical piece of legislation that shapes our nation's food and agricultural policy. Other changes, like incentivizing the use of SNAP for purchasing fruits and vegetables and creating a program providing boxes of locally sourced produce to Medicaid beneficiaries, could also help.

By implementing additional MTM programs across the country, we could help prevent 1.6 million hospitalizations and save insurers a net amount of $13.6 billion per year. Food is medicine programs have the potential to improve the health and well-being of millions. By providing access to nutritious food and MTMs, we can address food insecurity and malnutrition, improve health outcomes and reduce healthcare costs. Through collaborative work, we can expand access to these programs, advocate for policy changes that support their implementation and address the root causes of food insecurity and malnutrition, which would make a meaningful impact on health equity challenges.

Lisa Zullig, MS, RDN, CSG, CDN is the director of nutrition services at God's Love We Deliver in New York City.

Jean Terranova, JD, is the senior director of policy and research at Community Servings in Boston.