Meals as Medicine: How Home-Delivered Meals Reduce Hospital Readmission and Death

Providing meals may be an overlooked, but lifesaving, aspect of health care.

The 2018 Chronic Care Act enabled Medicare Advantage (MA) plans to offer supplemental benefits, including in-home support, transportation, and meals. According to the Kaiser Family Foundation, almost 3 out of 4 MA plans offered meals as a benefit in 2022.

A recent cohort study, published this week in JAMA Health Forum, sought to determine the correlation between a 4-week posthospitalization home-delivered meals program and 30-day all-cause rehospitalization and mortality. The investigators evaluated these outcomes for patients admitted with heart failure and all other acute medical conditions.

Kaiser Permanente Southern California (KPSC) first offered home-delivered meals as an MA supplemental benefit on January 1, 2021. Eligible patients primarily included those hospitalized for heart failure, who received 2 meals a day. The study authors note this is because heart failure is considered a nutrition-sensitive condition, and thus there is a proven clinical benefit for patients to receive nutritional meals after hospital discharge. A subset of MA members could be eligible for 3 meals a day, if they were covered under select employer group plans for any hospitalized condition.

The comparative cohort study was conducted across 15 hospitals within KPSC. The primary study group included MA members who received home-delivered meals for 4 weeks after hospital discharge, during a study period of January 1, 2021–January 31, 2022. There were 2 no-meals comparators, a 2019 historical cohort and a 2021–2022 concurrent cohort.

All patients were enrolled in the Kaiser Foundation MA plan, 30% as individual members and 30% through their employer groups. Because all individual MA plan members hospitalized with a principal diagnosis of heart failure were eligible for the 2-meals-a-day benefit, while selected group MA plan members were eligible for the buy-in, 3-meals-a-day benefit regardless of their hospital diagnosis, the analytical cohorts were stratified by principal diagnosis of heart failure versus all other acute medical diagnoses.

A total of 4032 adults admitted to the hospital with heart failure were included in the final analyses, averaging 48% White, 50% female, and 79 years of age. There were 7944 non-heart failure hospitalizations, averaging 49% White, 52% female, and 78 years of age.

The unadjusted rate of 30-day death and rehospitalization was 23.3% for the meal recipients with heart failure and 16.5% for the meal recipients hospitalized with other acute diagnoses. For heart failure patients, receiving meals significantly reduced the risk of 30-day death and rehospitalization when compared to the no-meals 2021–2022 cohort, but this risk reduction was not significant compared to the no-meals 2019 cohort.

For patients hospitalized with non-heart failure diagnoses, receiving meals significantly reduced the risk of 30-day death and rehospitalization compared to both the no-meals 2021–2022 cohort and the no-meals 2019 comparator cohort.

The investigators concluded that receiving home-delivered meals post-hospitalization was associated with lower 30-day rehospitalization and mortality. “While this home-delivered meals benefit was intended to be a short-term bridge for patients during a vulnerable period after discharge from the hospital,” the study authors wrote, “it was encouraging to see this association persisting into the 60-day period.” They noted that additional prospective clinical studies should be conducted to confirm these findings and better understand the mechanisms that can support posthospitalization nutritional support.