This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Diet can be deadly, especially for people with chronic health conditions like diabetes or heart disease. That's why some Michigan health care systems have begun providing free meals that are medically tailored to patients' diagnoses.

Beaumont Hospital, Troy and Spectrum Health's Butterworth and Blodgett campuses in Grand Rapids offer medically tailored meals to patients with diabetes and congestive heart failure, respectively. 
Caitlyn Melamed.
"If a patient is eating lots of salty foods, fast food, or frozen dinners like Marie Callender's, they get way too much salt," says Caitlyn Melamed, clinical program specialist - medically tailored meals at Spectrum Health's Grand Rapids hospitals. "It's very hard on their bodies and they'll be right back in the hospital."

Both Beaumont and Spectrum contract with Gordon Food Services (GFS) to provide the meals, which are prepared, packaged, and flash-frozen. GFS or UPS delivers the meals to participants' homes, seven dinners a week for 10 weeks. All meals have appropriate sodium content and carbohydrate content that make them good choices for people living with either diabetes or congestive heart failure. Near the end of the 10-week timeframe, both hospital programs have a registered dietitian schedule a phone or in-person consultation with patients to see how they are doing and answer any additional questions they might have about choosing foods that improve their health issues. The program also provides patients with a folder of information that includes suggested breakfast and lunch menus as well as local resources for healthy living.

"We know that chronic health issues, like diabetes, are very diet-dependent – especially type 2 diabetes, which is a chronic health issue that really can be helped with exercise and proper diet," says Sarah Berry, program manager for Beaumont Hospital, Troy. "By providing a meal, people do not have to worry about correct carbs, calories, sugar, or whatever might be needed for their diabetes at the time. The patient can count on this meal to be appropriate for their needs, without a lot of planning and thought going into it. It helps them plan all of their meals for the day more appropriately and control their blood sugars better."
Sarah Berry with a stack of medically tailored meals.
Proven results

Research confirms that medically tailored meals are a successful way to improve patients' health.

"When I first started researching medically tailored meals as an intervention, I found a lot of research showing that this approach improves patient outcomes — specifically for those who are food insecure and for those who lack access to health care," Berry says. "These study results got me interested."

For example, a study funded by the Robert Wood Johnson Foundation found that patients in a medically tailored meals program had fewer hospital and nursing home admissions and less medical spending. Using medical claims data from the Colorado All Payers Claims Database, a study by Project Angel Heart saw hospital readmissions drop by 13% and monthly medical costs decrease an average of 24% for patients with congestive heart failure, chronic obstructive pulmonary disease, and diabetes who received medically tailored meals. A University of California, San Francisco study of people with Type 2 diabetes, HIV, and other comorbid populations reported a 63% reduction in hospitalizations, 50% increase in medication adherence, and 58% decrease in emergency room visits.

"Medically tailored meals are not a new concept, but they are not used very widely," Melamed says.

Spectrum Health makes its medically tailored meals available to patients at its Grand Rapids hospitals, age 55 and older, who have been diagnosed with congestive heart failure.

"We wanted to focus on the elderly population that often has limited access to healthy food. Sometimes they are living alone and it's harder to cook for themselves," Melamed says. "They may have trouble standing long enough to prepare meals or driving to the grocery store and carrying groceries. In the case of congestive heart failure patients, we hope we can reduce their hospital readmissions and improve their overall quality of life by making it easier for them to eat healthy meals."

When a patient is identified as qualifying for the program, Melamed visits them in their hospital room to recruit them.

"It's a great program," she says. "I love to talk to patients. I tell them, 'I'm not here to take your blood or run tests. I'm selling you something that's free. It's free food.' Everyone loves free and everyone loves food."

Melamed credits Beaumont Hospital's program for inspiring her to bring medically tailored meals to Spectrum's patients. Both programs looked to the Michigan Health Endowment Fund for the funding that got them off the ground.  

"This was an idea I had gotten from a nursing conference I attended a couple years back, from a presentation from Johns Hopkins about providing medically tailored meals to the people of the community with chronic health issues," Berry says. "Our executives thought this was a great opportunity to improve care for those that we serve outside of the hospital."

Beaumont's program serves patients and community members with a diabetes diagnosis, aged 60 and older, and living within a 30-mile radius of the Troy hospital.
Sarah Berry explains the medically tailored meal program to a patient who is being released from Beaumont Hospital, Troy.
"We recently opened it up to the community. I've been advertising, giving flyers to providers, posting them around the hospital, and l sent them out to local community destinations," Berry says. "People in the community have been contacting me, asking, 'Can I qualify?' which has been really great."

Expanding efforts

While it's too early to evaluate how medically tailored meals are working for all Beaumont participants, Berry believes the data will reinforce the idea of continuing and expanding the program.

"I'm very excited to see the results for our patients and see what we can make of this program going forward," she says.
A medically tailored meal.
Melamed is hoping to see Spectrum's program expand to serve patients with diabetes, cancer, and renal disease. 

"We would love to see this grow," Melamed says.

Data collected from Beaumont and Spectrum in the future could help convince Medicare, Medicaid, and Michigan's private insurers to cover the costs of medically tailored meals.

"If our program is successful, the data will be provided to Michigan [public and private insurance] payors to encourage them to cover medically tailored meals as benefits," Melamed says. "Having insurance companies pay for a program like this would be great. Patients would have access to healthy foods, have a better quality of life, and not come into the hospital as often."

Medically tailored meals have also attracted attention at the federal level. The Medically Tailored Home-Delivered Meal Demonstration Pilot Act of 2020 was introduced by the members of Congress' bipartisan Food Is Medicine Working Group. The bill would establish a Medicare pilot program providing medically tailored meals to medically vulnerable older adults in their homes.

"We know that access to healthy food can be really difficult and this is a vulnerable population," Melamed says. "Medically tailored meals help the community and help this patient population to stay out of the hospital, live longer, and enjoy healthier lives."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos by Steve Koss except photo of Caitlyn Melamed courtesy of Caitlyn Melamed.