Articles and Information from GA Foods

Meal Delivery Service for At-Risk Patients

Posted by John Siegel on Feb 10, 2016 10:03:20 AM

John Siegel is the VP of Business Development for GA Foods.  He has extensive experiencworking with health care organizations to optimize benefits provided to their members. Contact John at 954-732-6886 or jsiegel@gafoods.com to learn how your organization may benefit by providing these well-received services.

Food Insecurity in At-risk Populations

The U.S. Department of Agriculture reported that in 2014 a total of three million households with seniors (age 65 and older), and over one million seniors living alone, were food insecure. In other words, they don’t have reliable access to an adequate amount of food to meet their daily nutrition requirements.

food_or_medicine_LR.pngAt-risk patients (elderly and chronically ill) with food insecurity may have to choose between paying for their food or for their medication. Inadequate nutrition and/or medication non-compliance leads to increased health care utilization, such as more frequent hospitalizations and readmissions. Compounding the issue, after a hospitalization, patients experience symptoms such as decreased energy, pain, weakness, poor appetite and health-related dietary restrictions. These symptoms make preparing and eating nutritious meals difficult. Weight loss and poor nutrient intake can delay the healing and recovery process, resulting in longer, more challenging recoveries, creating a cycle of relapse and readmission.

The Role of Nutrition Care

Nutrition care, in the form of home-delivered meals (HDM) after a hospitalization or as part of chronic disease management, maximizes patient outcomes while reducing health care costs.

Nutrition care:

  • Promotes faster, more complete recoveries
  • Reduces risk of complications
  • Reduces hospital readmissions
  • Provides crucial support to patients with poor access to healthy foods
  • Improves overall health and quality of life
  • Decreases odds of further hospitalizations due to injury
  • Enhances management of chronic disease

Perhaps more important than these significant outcomes is that an overwhelming majority (92%) of HDM recipients reported these meals allowed them to remain independent and living in their own homes, improving their quality of life. By decreasing their need for shopping and cooking, a meal delivery service provides a regular source of nutritious food for those that need it for their recovery process.

Access to Food

Providing access to food for at-risk patients also reduces health care expenditures paid by Medicare and/or Medicaid and health plans. One study with significant results was from MANNA (Metropolitan Area Neighborhood Nutrition Alliance), a nonprofit organization in Philadelphia that cooks and delivers medically-appropriate meals and provides nutrition counseling to individuals that are chronically ill. Researchers evaluated health care costs of two sample groups, MANNA clients and a comparison group, matched for gender, age, race, and ethnicity, for a 12-month period. Here are the results from their study:

  • The total average monthly health care costs were $28,000 for MANNA clients and $41,000 for the comparison group.
  • The average cost of a hospitalization was $132,000 for MANNA clients and $220,000 for the comparison group.
  • MANNA clients had 50% less hospitalizations than the comparison group.
  • MANNA clients’ length of stay was 37% shorter than the comparison group.
  • MANNA clients were 20% more likely to be discharged from the hospital to their home rather than to long-term care.

Given the proven benefits for all involved, its no surprise that hundreds of U.S. hospitals, many large health systems and a growing number of health insurance plans are implementing and/or approving post-discharge home-delivered meals as part of their transition care services.

Is your transition care model missing a key component? Click here to download our newest white paper.

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Topics: Chronic Disease Management, MCO ROI, Healthcare Cost Reduction

Lower Healthcare Costs with Home-Delivered Meals

Posted by Maureen Garner, MS, RD, LD on Mar 17, 2015 3:30:00 PM


This is the final post of our 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we reviewed original research that shows the impact nutrition care has on patient outcomes.

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In the past few weeks, we have been reviewing research about the effect nutrition care has on patient outcomes. This week we will finish the series with a review of a pilot study that looked at the impact of home-delivered meals and nutrition counseling on the healthcare costs of chronically ill patients.

MANNA (Metropolitan Area Neighborhood Nutrition Alliance) is a nonprofit organization in Philadelphia that cooks and delivers medically-appropriate meals and provides nutrition counseling to individuals that are chronically ill.  Most of the recipients have cancer, renal disease or HIV/AIDS. Socioeconomic status is not a factor in determining who can receive their services, however, most of their clients are Medicaid-eligible.  Each week, MANNA delivers 21 frozen meals to recipients.  They also offer nutrition counseling by a Registered Dietitian.

Researchers evaluated healthcare costs of two sample groups, MANNA clients and a comparison group, matched for gender, age, race, and ethnicity, for a 12-month period.  The comparison group contained members of a local Medicaid managed care organization (MCO).  Because only aggregate data was provided by the MCO, some members of the comparison group may have been receiving food resources.  The authors do not believe any were receiving home-delivered meals.

While the MANNA research was a pilot study, the results1 were still significant:

  • The total average monthly healthcare costs were $28,000 for MANNA clients and $41,000 for the comparison group.
  • The average cost of a hospitalization was $132,000 for MANNA clients and $220,000 for the comparison group.
  • MANNA clients had 50% less hospitalizations than the comparison group.
  • MANNA clients’ length of stay was 37% shorter than the comparison group.
  • MANNA clients were 20% more likely to be discharged from the hospital to their home rather than to long-term care.

Per the CDC, chronic diseases are among the most common, costly, and preventable of all health problems. Providing home-delivered meals to those with chronic conditions is an economical solution.  GA Foods’ home-delivered meals program allows members to have medically-appropriate, easy-to-prepare meals and remain independent in their homes.  Health plans that add post-discharge meals and chronic disease management meals to their supplemental benefits, see a return on investment of 3 to 1.

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1Gurvey, J, et al. J Prim Care & Comm Health 2013;4(4):311-317.

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Topics: Home Delivered Meals, Chronic Disease Management, MCO ROI

Hospital Malnutrition and Discharge Planning

Posted by Maureen Garner, MS, RD, LD on Mar 4, 2015 1:10:00 PM

This is the fourth of a 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we will review original research that shows the impact nutrition care has on patient outcomes.

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Malnutrition is a common health issue

Hospital malnutrition in developed countries is more prevalent than most realize. Here are some statistics1:

- It is estimated that one-third of patients are malnourished upon admission to the hospital.

- If left untreated, approximately two-thirds of these patients will become even more compromised during their hospitalization.

- Roughly one-third of patients not malnourished at admission will become malnourished during their hospital stay.

Malnutrition in the frail and elderly is an important area of concern, because it has been correlated with many poor outcomes2:

- Increased risk of pressure ulcers
- Impaired wound healing
- Increased infection rate
- Muscle wasting
- Functional loss, resulting in more falls
- Longer hospital stays
- Higher readmission rates
- Higher treatment costs
- Increased mortality

Nutrition care improves clinical outcomes

Most of these adverse outcomes are preventable or can be improved with nutrition intervention. The Alliance to Advance Patient Nutrition has developed a model for interdisciplinary nutrition care. (Figure 1) 

static_abbottnutrition_com_cms-prod_malnutrition_com_img_Alliance_Care_Model_2014_v1_pdf Figure 1:  Source:  www.malnutrition.com

The Steering Committee of the Alliance published a call to action that outlines the comprehensive model from hospital admission through discharge.  Their sixth principle, Develop a Comprehensive Discharge Nutrition Care and Education Plan, ensures that nutrition goals achieved in the inpatient setting are not compromised once a patient is discharged1. 

Access to food is an important part of discharge planning

One area the Steering Committee suggests be addressed in the discharge plan is access to food.  This is one area that is frequently neglected in care transition planning and of particular concern for the frail and elderly.  Providing access to food through home-delivered, post-discharge meals allows the frail and elderly to regain their strength and energy sooner.  It also helps reduce unplanned hospital readmissions.  Proactive hospitals and health plans are providing post-discharge meals as part of transition care planning.  The GA Food’s home-delivered meals program allows the frail and elderly to have nutritious, easy-to-prepare meals and remain independent in their homes.

For more information on the benefits of post-discharge meals, see this blog post.

Contact John Siegel at GA Foods

Download free ebook on questions to ask when choosing a home-delivered meals provider.

1Barker, LA. Et al. Int J Environ Res Public Health. 2013; 8(2):514-527.

 2Tappenden, KA, et al. J Parenter Enteral Nutr 2013;37:482-497.

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Topics: Malnutrition in Elderly, Home Delivered Meals, MCO ROI

Do Home-Delivered Meals Affect Surgical Outcomes?

Posted by Maureen Garner, MS, RD, LD on Feb 18, 2015 2:46:00 PM

This is the third of a 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we will review original research that shows the impact nutrition care has on patient outcomes.

Surgical diagnoses added to CMS readmission penalties

The first post of this series discussed the readmission rates of Medicare patients and the impact readmissions have on healthcare costs.  As part of the Hospital Readmissions Reductions Program (HRRP), CMS is reducing payments to hospitals with excess readmissions rates for certain diagnoses. Readmission is defined as an admission within 30 days of a discharge.  In FY 2015, chronic obstructive pulmonary disease (COPD) and total hip or knee replacement surgeries are being added to the list of diagnoses.  This is the first year that surgical procedures are included.Surgical_pt_LR

Malnutrition is a common reason for readmission after surgery

In anticipation of surgical procedures being measured, researchers at Emory Hospital examined factors associated with a hospital readmission within 30 days of discharge for general surgical inpatients.  Since most of these surgeries are planned, the suggestion is there is an opportunity to intervene preoperatively to decrease the risk of readmission after surgery. 

 According to their study1, the most common reasons for readmission were:

  • Gastrointestinal problems/complications (27.6%)
  • Surgical infections (22.1%)
  • Failure to thrive/malnutrition (10.4%)

It is estimated that one-third of patients admitted to hospitals are malnourished.2 While in the hospital, all patients are screened for nutrition risk. If a patient is found to be malnourished, nutrition intervention is provided while hospitalized.  However, nutrition intervention needs to begin earlier for those undergoing planned surgery and needs to continue after discharge.

Proper nutrition improves patient outcomes

Providing home-delivered meals is a great way to ensure adequate nutrition prior to and following surgery, particularly for older adults.  Many live on a fixed income and their food intake decreases with age. Per the Academy of Nutrition and Dietetics, the elderly have a lower intake of micronutrients and calories3.

Proper nutrition for those at risk improves patient outcomes following surgery or a hospitalization.  Many health plans are adding home-delivered meals to their supplemental benefits.

For more information on GA Foods’ home-delivered meals, click below.

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1 Kassin, MT, et al. J Am Coll Surg 2012;215(3):322-330
2 Tappenden, KA, et al. J Parenter Enteral Nutr 2013;37:482-497.
3 Kamp, B, et al. J Am Diet Assoc. 2010;110:463-472.
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Topics: Malnutrition in Elderly, MCO ROI

Does being underweight lead to unplanned hospital readmissions?

Posted by Maureen Garner, MS, RD, LD on Feb 2, 2015 9:19:00 AM

This is the second of a 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we will review original research that shows the impact nutrition care has on patient outcomes.

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Predictors for Rehospitalizations

Last week's blog post focused on a study that identified risk factors for avoidable hospital readmissions. This week, we will review a study1 that evaluated factors that could be used as predictors for unplanned readmissions. As the authors point out, very few studies have reported predictors of readmissions. The ones that have been published, focus on demographic and disease characteristics. While these studies help identify populations at high risk, they do not provide a basis for developing strategies for individual intervention.

Mudge and her colleagues studied 142 inpatients that were 50 years and older that had 2 or more unplanned hospitalizations within a 6 month period. Patients admitted from long-term care facilities or with a terminal illness were excluded. Patients with language or cognitive difficulties were also excluded.  

Being Underweight has a High Probability

The presence of a chronic disease had the strongest correlation to predicting unplanned readmissions.  Heart failure, renal disease, and diabetes were associated with a higher risk of readmission when present as a primary diagnosis or co-morbidity. When the data was analyzed using odds ratio, being underweight had the highest probability of unplanned hospital readmissionsThe risk of readmission was also increased in patients with depression.  The below chart summarizes the probability of different factors predicting readmission. 

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Factors that did not predict probability of unplanned readmissions include age, sex, medication adherence, length of hospitalization, and functional status impairment.

Post-discharge Meals as a Transition Care Strategy

The researchers concluded that post-hospitalization programs that address management of chronic disease, nutritional status, and depression have the potential to reduce hospital readmissions.  Including nutrition interventions in the transition care plan after a hospital discharge impacts both chronic disease and being underweight.

The need for nutrition intervention is further supported in the Academy of Nutrition and Dietetics' position paper2 on food and nutrition for older adults:

  • Five of the eight causes of death in adults 65 and older have a known nutrition effect.
  • In 2007, 68% of people needing home health care had chronic disease conditions, such as diabetes, heart disease, COPD, and hypertension. All are nutrition-related diagnoses and could be improved with appropriate diets.
  • Quantity of food and caloric intake decreases with age and can result in malnutrition, worsening of health conditions, and frailty.
  • Caregivers may lack the information and skills needed to adapt a diet to meet recommendations for chronic diseases.

Health plans are responding to these findings and many are adding post-discharge meals and chronic disease management meals to their supplemental benefits. The GA Foods' home-delivered meals program allows members to have nutritious, easy-to-prepare meals and remain independent in their homes.  The great news for the health plans adding home-delivered meals, is the return on investment is 3 to 1!  

Contact John Siegel at GA Foods

Download free ebook on questions to ask when choosing a home-delivered meals provider.

1Mudge, AM, et al. J Hosp Med. 2011;6(2)61-67.

2Bernstein, M, et al. J Acad Nutr Diet. 2012;112(8):1255-1277.

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Topics: Malnutrition in Elderly, Home Delivered Meals, MCO ROI

Weight Loss and Hospital Readmissions

Posted by Maureen Garner, MS, RD, LD on Jan 16, 2015 9:52:00 AM

This is the first of a 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we will review original research that shows the impact nutrition care has on patient outcomes.

Readmission Rates and Impact

Last year, 18% of Medicare patients were readmitted within 30 days of being discharged.  It is estimated that these readmissions cost the federal government about $26 billion. According to Kaiser Health News, about 65% of these health care costs came from readmissions that could have been avoided. 

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In October 2012, the Hospital Readmissions Reductions Program (HRRP) was launched as part of the Affordable Care Act.  It requires CMS to reduce payments to hospitals with excess readmissions. As a result, Medicare reimbursement will be reduced for 2,610 hospitals in fiscal year 2015 due to their high rates of readmissions for patients with certain conditions.

One Factor - Weight Loss - Is Preventable

A study published in 2011, evaluated clinical, operational, and sociodemographic factors associated with hospital readmission within 30 days for general medicine patients.1  The study didn’t attempt to predict who would be readmitted, but identified risk factors that would allow providers to target interventions to reduce avoidable readmissions.  The factors associated with hospital readmission within 30 days are:

  • Black race
  • Medicaid payer status
  • Inpatient use of narcotics and corticosteroids
  • Diagnosis of cancer, renal failure, and congestive heart failure
  • Weight loss

Post-Discharge Home-Delivered Meals Reduce Readmissions

Of the risk factors identified, weight loss is the only one that is preventable.  While in the hospital, all patients are screened for nutrition risk.  Care plans are developed to provide nutrition intervention during the hospitalization.  However, transition care plans often do not address nutrition risk after discharge. Weight loss, particularly in the elderly, is common after a hospitalization as a result of decreased energy, depression, and restricted diets for chronic conditions. Often times, the individual isn’t well enough to prepare meals. 

Providing home-delivered meals after discharge, has shown to be effective in preventing weight loss. In a CMS pilot2, post-discharge meals reduced hospital readmissions by 39%.  Home-delivered meals are also cost-effective. A single day in the hospital is 200 times the cost of three home-delivered meals.

For more information on malnutrition in the elderly, click here.

Download free ebook on questions to ask when choosing a home-delivered meals provider.

 

Download White Paper - Reducing Healthcare Costs and Improve Patient Outcomes

Allaudeen, N, et al. J Hosp Med. 2011; 6(2)54-60
FMQAI, Florida’s Medicare Quality Improvement Organization, under contract with CMS.
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Topics: Home Delivered Meals, MCO ROI

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