COVID-19 shined a spotlight on food insecurity. Here's how payers are tackling the issue

Health insurers have recognized the importance of nutrition ever since they began to address the social determinants of health as a way to keep individuals away from expensive hospitals and emergency departments.

Lately, though, the focus on food seems to be increasing.

“The pandemic was a wake-up call, laying bare how many families live paycheck to paycheck without a safety net,” Richard Stefanacci, D.O., of the Jefferson College of Population Health at Thomas Jefferson University, told Fierce Healthcare in an email. “The implications are clear, as cheap but poor nutrition drives skyrocketing rates of chronic illnesses like obesity, diabetes, and heart disease, especially among lower income groups.”

Jeff Levin-Scherz, M.D., the population health leader for health and benefits in North America at Willis Towers Watson, told Fierce Healthcare that “health plans are very interested in addressing issues of diversity, equity and inclusion and addressing disparities. Very clearly, people who live in some areas have worse access to good food, worse access to personal security, worse access to housing.”

For example, Florida Blue Foundation donated $3.3 million earlier this month to nine community organizations across the state that are battling food insecurity.

The insurtech Alignment Health wants to carve out a niche in Medicare Advantage whereby it supplies concierge-type benefits, many of which focus on food. Alignment Health recently announced a partnership with the grocery delivery service Instacart in 13 counties in California and Nevada in which Alignment has a footprint.

Some health plans see a return on their food investment in better outcomes. For instance, Blue Cross and Blue Shield of North Carolina announced in March that its food program resulted in better outcomes for diabetes patients.

Stefanacci said he believes that the entire healthcare system’s interest in food security stems in part from a shift toward value-based care and away from acute fee-for-service care. He said that “we’re seeing hospitals implement programs like produce prescriptions, food pharmacies, and community gardens. No longer can we simply treat illness; we must take a community approach to maintain health.”

Levin-Scherz said educational systems aren’t as good in ZIP codes with poorer individuals, which often translates to the breakfasts and lunches served in those schools being of poorer quality.

“We also have this terrible divide where in well-off neighborhoods with highly educated people, we continue to see improvements in life expectancy,” Levin-Scherz said. “And in impoverished neighborhoods with people with lower educational levels, we’re actually seeing life expectancy drop off the cliff.”

Stefanacci agreed, saying that “food insecurity has grown into a public health crisis we can no longer ignore. Simultaneously, health systems recognize nutrition’s central role in prevention. This is driving overdue attention and, hopefully, action.”

He added, though, that the burden of addressing food insecurity should not fall totally on health plans.

“The time has come to implement comprehensive policies and programs to address this food and health crisis, especially given the magnitude of the problem and shifting incentives favoring action,” said Stefanacci.

What’s being discussed, said Levin-Scherz, represents enormous societal change. “In the end, we will need more than the activities of health plans to improve the overall social determinants of health, which is really important and often—for a whole population—ends up being more important than access to wonderful cardiac surgery.”

Staci Lofton, senior director of health equity at the patient advocacy organization Families USA, told Fierce Healthcare that “screening for and addressing food insecurity is key to addressing a host of medical issues that are typically addressed by a healthcare system; by the providers and payers within that system.”

Lofton cites the ability of health plans to understand and address food insecurity on the population level and being able to pinpoint the parameter and the depth of the problem in particular food deserts.

“Even prior to the pandemic, when providers began to screen and ask questions about overall needs, there was a recognition that food insecurity was a significant barrier to health,” Lofton said. “The pandemic only highlighted what we already set a light on, but for a larger swath of our population.”  

Employers have long been trying to nudge workers toward a more nutritious lifestyle, Levin-Scherz said. “So many employers have company cafeterias and vending machines. They’ve been thinking for a long time about how we can be sure to use behavioral economic nudges to improve the quality of the calories that people are taking in.”

Lofton speaks of the “silver tsunami” coming our way and applauds Medicare Advantage plans that attempt to help the elderly eat right. 

“We really need to begin to comprehensively think about the role each stakeholder within the healthcare system will play in ensuring that folks have access—particularly our aging population—to what they need to be healthy, starting with nutritious food.”

A study in JAMA Health Forum in June stated that “nearly three-quarters of MA plans offered meals as a supplemental benefit in 2022, mostly driven by expectations of downstream cost savings based on findings from earlier observational studies of community-based nutrition programs, and desires to maintain market parity in an increasingly competitive MA space.”

Lofton said that “we have not begun to explore all of the non-medical health needs that individuals in our aging population will need and the extent to which they’ll need them. What we saw during COVID-19 is only the tip of the iceberg in terms of what’s coming down the pike.”