Happy National Nutrition Month! As celebrated by the Academy of Nutrition and Dietetics each March. Evidence supports the idea that Medical Nutrition Therapy (MNT) can be used as medicine to prevent and manage chronic diseases. The healthcare industry looks at diverse nutritional service offerings to optimize health, increase the quality of living, and mitigate the cost burden of chronic disease and illness.
In the following discussion, we will look at data supporting the food-as-medicine approach and the benefits and pitfalls that insurance companies and other third-party payors appraise as they face coverage decisions around nutritional services as a prevention and treatment option.
Food as Medicine: The Evidence
Food-as-medicine is a spectrum of services and health interventions that recognize and respond to the link between nutrition and illness. Research supports food as medicine across a range of conditions.
Plant-based diets have been shown to reduce the risk of chronic diseases, such as cardiovascular disease, diabetes, and type 2 diabetes. One study found that a plant-based diet was associated with a 16% to 24% lower risk of cardiovascular disease than non-plant-based diets.
Members with critical sensitivities to processed foods, like heart failure patients, may realize a decrease in risk or complications when nutrition therapy is offered as a benefit leading to less processed foods with less sodium. Similar improvement in complication-risk statistics may also be appreciated in individuals with kidney disease and many other conditions.
Certain foods and nutrients have been found to have anti-inflammatory properties such as omega-3 fatty acids found in fatty fish and certain nuts and seeds, which have been shown to reduce inflammation and improve health outcomes. This is important as chronic inflammation is a major cause of many chronic diseases, such as heart disease, diabetes, and cancer.
The Mediterranean diet has been found to have significant risk-lowering activity for cardiovascular disease compared to a control diet.
Food can be used as medicine to prevent and manage chronic diseases, and there is an ongoing debate on how health insurance companies and other third-party payors will support outcome-driven nutrition opportunities for their members via Nutrition Therapy.
Nutritional Interventions: The Third-Party Perspective & Cost Savings
Insurance companies can reduce costs by providing food as medicine and nutritional support services to their members, such as MNT, food prescription programs, and medically tailored meals.
The American Heart Association (2022) has highlighted the benefits of MNT services in the treatment of dyslipidemia, including improved quality of life, medication reduction, and savings of $818 per patient per year.
The American Heart Association reviewed the modelling of food prescription programs where direct pressing and food access stems from a patient-provider interaction. This intimate cross-section of food incorporation into outpatient medical planning demonstrated increased nutrition consumption and clinically significant reductions in body mass index and hemoglobin A1c. Additionally, published modelling for Federal Healthcare Programs' utilization of such services suggests that prescribing nutritious foods may yield savings of $100.2 billion in formal healthcare costs while preventing 3+ million cases of cardiovascular disease and diabetes.
The Journal of the American Medical Association (JAMA) published an economic evaluation that showed a national implementation of medically-tailored meals for patients with diet-sensitive conditions could decrease hospital stays and save $13.6 billion annually.
Insurance and other third-party payors must consider the potential for improved member satisfaction and retention, as well as cost savings and outcome improvement. A study published in the Journal of Health Economics found that insurance plans that offer nutrition and weight loss counselling have lower member churn rates than those that do not, resulting in significant cost savings over time.
The Opposition
Insurance companies can benefit from investing in nutrition support programs to help their members achieve better health and well-being. However, there are arguments against it, such as the high cost and lack of return on investment. Insurance companies must balance the cost of delivering services with the revenue they generate from premiums. Providing nutritional benefits to all members could be expensive, and insurance companies may not see a sufficient return on investment.
Insurance companies may argue that nutritional services should not be required to pay for services that are not effective or necessary for all members. Opposing opinions suggest that nutritional counselling can be effective for some people, but not for everyone.
Insurers and other third-party payors argue that members may be able to access nutritional services elsewhere, resulting in unnecessary costs. Depending on where members live, they may access dietary services through community resources, public health programs, or other providers. Insurance companies may argue that they should not be required to provide services already available to members through other channels.
As a result, it can be challenging to measure the impact of nutrition services on health outcomes, and insurance companies may argue that they should not be required to pay for services that cannot be adequately evaluated.
It is important to consider the evidence in support of outcomes and cost-savings in order to make informed decisions.
Ultimately, insurance companies will need to balance the costs and benefits of providing nutritional services to their members, considering their members' specific needs and preferences and the larger healthcare landscape.
Insurance companies' coverage of nutritional services will depend on a variety of factors, such as changes in healthcare policies and regulations, the evidence bases for effectiveness, and the financial and operational considerations of insurance companies.
However, some indications covering nutritional services may become more common. For example, several large insurance companies, such as UnitedHealthcare and Cigna, already offer coverage for nutritional counselling and support services for specific conditions such as diabetes and heart disease. Additionally, there is growing recognition among healthcare providers, policymakers, and the public about the importance of nutrition in promoting health and preventing chronic diseases, which may lead to increased demand for nutritional services and more significant pressure on insurance companies to cover them.
Nutrition services are expected to become increasingly common among insurance companies and other third-party payors due to increasing demand from patients and healthcare providers. It will be important to spotlight nutrition as a healthcare service and benefit year-to-year and its role in care planning.
References
American Heart Association (2022). Strategies to address socioeconomic and racial and ethnic disparities in chronic diseases by incorporating food and nutrition programs into the primary healthcare setting. Retrieved on March 12, 2023 from https://www.heart.org/-/media/Files/About-Us/Policy-Research/Policy-Positions/Access-to-Healthy-Food/Medical-Nutrition-Therapy-Policy-Statement-2022.pdf
Cavanagh, M., Jurkowski, J., Bozlak, C., Hastings, J., and Klein, A. (2017). Veggie Rx: an outcome evaluation of a healthy food incentive programme. Public Health Nutr, 20. doi: 10.1017/S1368980016002081
Hager, K., Cudhea, F.P., Wong, .B., Berkowitz, A., Downer, S., Lauren, B.N. & Mozaffarian, D. (2022). Association of national expansion of insurance coverage of medically tailored meal with estimated hospitalizations and health care expenditures in the US. JAMA Network Open, 5(10). doi:10.1001/jamanetworkopen.2022.36898
Kim, H., Caldfield, L.E., Garcia-Larsen, V., Steffern, L.M., Coresh, J. & Rebholz, C. (2019). Plant-base diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality in a general population of middle-aged adults. The Journal of the American Heart Association, 8(16). https://doi.org/10.1161/JAHA.119.012865
Lee, Y., Mozaffarian, D., Sy, S., Huang, Y., Liu, J., Wilde, P.E., Abrahams-Gessel, S., Jardim, Gaziano, T.A., & Micha R. (2019). Costeffectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLoS Med, 16. doi: 10.1371/journal.pmed.1002761.
McMacken, M. & Shah, S. (2017). A plant-based diet for the prevention and treatment of the 2 diabetes. Journal of Geriatric Cardiology, 14(5). 10.11909/j.issn.1671-5411.2017.05.009
Minelli, P. & Montinari, M.R. (2019). The Mediterranean diet and cardioprotection: Historical overview and current research. Journal of Multidisciplinary Healthcare, 12. doi: 10.2147/JMDH.S219875
Sikand, G., Cole, R.E., Handu, D., Johnson, E.Q., Arpino, L.M., & Ekvall S.M. (2018). Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: A systematic review and meta-analysis. Journal of Clinical Lipidology, 12. doi: 10.1016/j.jacl.2018.06.016.
Stromsnes, K., Correas, A.G., Lehman, J., Gambini, J, & Olaso-Gonzales, G. (2021). Anti-inflammatory properties of a diet: Role in healthy aging. Biomedicines, 9(8). doi: 10.3390/biomedicines9080922
