FOR YEARS, “MAUREEN” struggled to manage her diabetes while battling cardiac illness, asthma, and other chronic health issues. The 70-year-old Boston-area resident was not eating well and was severely overweight – until she found a recipe that helped her shed nearly 50 pounds and get her diabetes under control.
Maureen enrolled in a program that delivers medically tailored meals to her home. The meals, consisting of five days’ worth of lunches, dinners and snacks, are freshly prepared and approved by a registered dietitian nutritionist at Community Servings. The Boston-based nonprofit is a leading member of the Food is Medicine Coalition, a national group of medically tailored food and nutrition service providers, convened to advance research, public policy and best practices that support access to food and nutrition services for people with severe or chronic illnesses.
Maureen’s story shows how a simple intervention like regular, healthful meals can profoundly improve a person’s life. In addition to helping people like Maureen stay healthy, these meals also save money. A study published last April in the journal Health Affairs found a 16 percent net reduction in health care costs associated with the medically tailored meal service provided by Community Servings.
With this evidence that we can improve the lives of thousands of people while actually saving money, one might think this program is well on its way to national rollout. Our hospitals, doctors, and health insurers collectively spend 80 percent of our $1.3 trillion annual health care budget on managing chronic diseases.
Yet growing awareness in the health care field of the power of social interventions has not yet translated into large-scale partnerships between “food is medicine” services and health plans and public insurance programs such as Medicaid.
Understanding why, and what we can do about it, offers a useful guide to accelerate the uptake of medically tailored meals and many other promising but underfunded programs that could improve health while lowering cost. These programs will reach their potential only when we account for three fundamental dynamics of the community-based organizations that will need to deliver them:
Provide resources for innovation and scaling
Most community-based organizations get by on government contracts that do not cover the full cost of what it takes to offer their services as well as whatever they can raise in donations from community members. Nonprofit Finance Fund research shows that half of all U.S. nonprofits have operating reserves that cover three or fewer months of their costs. This leaves them unable, without outside support, to invest in scaling their programs. They will need government contracts that pay up front and on time, and private donors who provide flexible support they can use to build their organizational capacity.
Cover their risk
The leaders of many community-based organizations are deeply skeptical about new funding arrangements, corporate partnerships, or research into their costs. And they have every reason to be. Contracting reform by government or offers of partnership by powerful corporate interests have too often in the past left them with more work and less reliable revenues. To enlist them to scale up programs will require credible commitments of long-term, flexible and timely payments for new services and for preserving the services upon which the community already relies.
Generate a constituency for efficiency
Improving health outcomes while “saving 16 percent” sounds like something everyone can embrace. Community programs that deploy interventions that keep people healthier and save money are doing so by reducing doctor visits, hospital stays and ER visits. These outcomes-based programs create savings and efficiencies, but, depending on the intervention, these benefits can threaten silos of government program budgets or hospital and corporate medical company sales, which can create turf battles and resistance. Community-based organizations and the vulnerable people they serve are not going to be able to take these interests on by themselves. Sustaining commitment to these “win-win” programs will require strong political will from mayors, governors and medical industry leaders, and a mass movement to bolster them.
We can do well fiscally while doing good socially and medically. This will be a lot of work. Rewiring systems to work together in new ways always is. But the payoff is worth it – for the people who deserve access to programs that work and to the taxpayers funding them.
Antony Bugg-Levine is CEO of Nonprofit Finance Fund and co-editor of “What Matters: Investing in Results to Build Strong, Vibrant Communities.” David B. Waters is CEO of Community Servings in Boston. Both will be speaking at a public event on Nov. 27 titled “Invest in Results Because Outcomes Matter,” at the Federal Reserve Bank of Boston. Click here for more information