How Payers Can Expand Nutritional Benefits, Measure Impact

Payers face a variety of challenges in expanding nutritional benefits, particularly due to the lack of ability to measure outcomes, but there are ways to navigate this uncertainty, according to a report from McKinsey & Company (McKinsey).

Among American adults who have at least one chronic condition, 60 percent also have poor nutrition, the report noted. This social determinant of health tends to occur hand-in-hand with some of the most expensive conditions in the US such as hypertension, obesity, and diabetes.

Public payer beneficiaries also tend to face food insecurity. Nearly a quarter of all adults on Medicaid reported being food insecure in July 2020.

Payers face four key barriers to providing the needed nutritional benefits at a breadth that covers this large population of patients.

First, it is difficult to quantify how many beneficiaries struggle with food insecurity. 

Payer programs that are related to food insecurity tend to approach food insecurity programs in one of two ways: providing the nutritional benefits for the entire member population or providing them to populations with specific medical qualifiers such as having recently emerged from surgery. These tactics are not well-targeted and are not necessarily data-informed.

The McKinsey researchers recommended that payers ask providers to apply codes to food insecurity in order to help them gather data to identify member groups that need support with regard to food security. In addition to coding, payers can screen member groups or survey members to assess the demand for programs addressing food insecurity.

Also, payers’ programs are often band-aids; they do not address the actual underlying causes of food insecurity. The programs do not help members find sustainable sources of nutritious food once the benefit ends.

Again, the McKinsey researchers noted that member surveys can help elucidate who needs food security support. Applying these programs to specific populations can help better address the underlying causes of food insecurity. Payers can also connect members with federal resources for causes that are outside of the payer scope of influence.

Improving members’ access to educational resources about nutrition can support payers’ food security efforts and lead to long-term solutions.

“All benefits should be provided in a way that recognizes and respects members’ dignity,” the researchers added. 

“To avoid insensitivities, payers and providers can coach discharge coordinators on the appropriate language to use when asking patients how they expect to meet their food needs after being discharged. When evaluating outside contractors, payers can ensure those third parties adhere to the same principles of providing food support with dignity and respect.”

Third, depending on their partnerships, payers may find that their ability to expand nutritional benefits is restricted by their partners’ reach. Very local community-based organizations may be well-positioned to know members’ particular cultural or dietary needs, but they have less bandwidth to expand their services to a bigger constituency when compared to national organizations.

Payers are also limited by members’ and providers’ awareness of food access opportunities as well as the technological demands of referring members to such resources.

The researchers promoted developing more robust referral programs and systems. This may entail engaging care coordinators in nutritional education and integrating payer technology systems with food vendors’ systems.

Lastly, return on investment is unclear for most programs that address food insecurity.

“On the business side, nutrition benefits are rarely evaluated against traditional business goals, such as health-plan quality, cost of care, and member retention,” the researchers noted. 

“While the limited scope and scale of programs to date has discouraged robust evaluation, measuring outcomes against business goals can help payers understand how to make these programs sustainable and profitable.”

The researchers urged payers to embrace metrics for assessing outcomes such as reduced hospital visits, benefit utilization, member satisfaction, and medication adherence or impact on overall wellbeing such as number of healthy days.

Payers also should not underestimate the power of pilots and small, incremental steps toward a bigger change, the researchers noted.

“Beyond improving health outcomes for a vulnerable population, expanding nutrition benefits is also great business—with the potential not only to increase members’ health and happiness but also to lower overall care costs and provide a point of differentiation in a highly competitive market,” the researchers concluded.