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.

Presenter

Presentation Notes

Our History God’s Love was started at the height of the AIDS pandemic in 1985. We went from delivering one meal to one man to over 2 million meals per year to 8,000 clients in FY19. Along the way we expanded our mission to serve those living with all illnesses. But we have remained a strong advocate and provider for PLWH. In 1991 we assisted in creating the first Ryan White Meal. We have been a proud recipient of Ryan White funding since 1991. Practice God’s Love is different than other meal providers because we truly believe food is medicine. We look at nutrition through the lens of illness and have 7 RDN’s on staff who are able to work with our kitchen to provide a restriction-based meal plan for our clients who are living with very complex illnesses. We don’t simply put someone on a diet, we take into account things like their comorbidities, medications, and to an extent their preferences. Implementation God’s Love leads the FIMC a national organization of organizations like God’s Love. The FIMC has a clinical committee who came together to develop nutrition standards. These are evidence-based and were developed from a team of RDN’s with over 50+years of combined experience in the MTM field. We are proud that these standards were adopted by the NYC Ryan White EMA for the entire Food AND Nutrition Services Category. The Research 42% of PWH who live in the NYC-metropolitan area are food insecure even with the receipt of food assistance. MTM are a low-cost, high impact intervention that has been a part of the Ryan White intervention for almost 30 years. Several studies have demonstrated the efficacy of MTM for PWH including one out of UCSF showing a 63% reduction in hospitalizations, 50% increase in medication adherence and 58% decrease in ER visits. HIV Treatment Cascade Research shows that access to food helps at each step of the Treatment Cascade. Access to food is often the reason that PWH get connected to care, because being active in care is a requirement of receipt of food and nutrition services through The Ryan White HIV/AIDS Program (RWHAP). Research (at left) also demonstrates that food secure PWH are more likely to maintain their care. Food insecurity in PWH is independently linked to non-adherence, and receipt of MTM increases adherence. Food insecure PLWHA are less likely than food secure PLWHA to have undetectable viral loads. Policy Despite all of the research, and our long history of serving PLWH, the only dedicated funding stream for MTM for PLWH is RWHAP. This funding does not cover all of those who come to us for services, forcing some agencies to institute waiting lists. There is also tremendous variation state to state on coverage for foot and nutrition. Our recommendations are listed here.

https://doi.org/10.1007/s11524-016-0129-7

medically tailored meals for pwh: research, policy, and practice · other clients living with...

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