Value-based care evolved from a pipe dream to a reimbursement code. The “food is medicine” movement is materializing from a pie in the sky into a pie on the table.
As the industry continues to pursue payment models focused on keeping patients healthy rather than just the volume of services provided, health systems, hospitals, providers and startups are looking to solutions that a generation ago would have not been considered a part of healthcare.
The American Academy of Pediatrics developed the first value-based care payment model in 1967, dubbed The Patient-Centered Medical Home and designed for children with complex illnesses. Their push for care coordination acknowledged a siloed healthcare system and the nebulous definition of what constitutes care.
Today, companies and providers are pushing the boundaries further. Freelance companions are helping elderly seniors combat loneliness, Eastern food therapy and nutrition are being explored as a way to address maternal mortality and patients with depression are spending time with Jeremiah, an eight-year-old golden retriever.
Startups tap into the health benefits of meeting the bare necessities
“Papa strives to meet the needs of the whole person and their individual social drivers of health with personalized support brought right to a person’s front door when they need it,” Ellen Rudy, Ph.D., vice president of health and social impact at Papa, told Fierce Healthcare. “This includes loneliness and social isolation, which are independent and significant drivers of poor health and higher healthcare costs but are often not included in social needs screenings.”
Papa, a startup assuaging loneliness among seniors through companionship and support, uses "Papa pals" to address social determinants of health for older Americans and others who often face social isolation.
Americans ages 65 and older are expected to mushroom over the next four decades with 1 in 9 stating that aging at home is a top priority. For a country that tends to move and not live in intergenerational households, the shift in aging priorities presents a challenge.
Papa pals have been called “family-on-demand.” The gig workers who visit Papa enrollees do everything from assist in light housework to grocery shopping, technology navigation or transportation to doctors’ appointments.
With the added support, users have experienced increased cancer screenings and diabetic eye exams and reduced emergency department utilization and hospital readmissions. Papa reports healthcare cost savings between 6% to 33% across various populations.
“We have been evaluating the range, complexity and nuances of unmet social needs among members and the data is unequivocal that the more unmet social needs a person has, the more likely they will go to the emergency department multiple times in a year,” Rudy said.
Of chronically ill users of Papa's services, 69% reported a significant reduction in loneliness, while 39% reported no longer experiencing loneliness at all. Loneliness has been linked to an increased risk of heart disease, stroke, diabetes, depression and dementia. It is estimated that social isolation among people aged 65 and over costs Medicare roughly $6.7 billion annually.
Papa launched in 2017 and now partners with more than 40 insurers including Medicare Advantage, Medicaid and employer plans. It has also partnered with Uber Health to provide transportation to care.
This spring, the Centers for Medicare & Medicaid Services (CMS) released its Accountable Health Communities Model Evaluation revealing a gap between the availability of resources and beneficiaries’ needs. Lack of transportation was highlighted as one of the reasons for the chasm.
The CMS report also revealed that food insecurity was the most prevalent and persistent “health-related social need.” Government investment in food is medicine programs has increased in the past few years as a way to research what prescribing food looks like on a large scale.
Chiyo offers pregnancy, postpartum and fertility meal delivery. The service was born out of Eastern food therapy and nutritional science reflecting the needs of mothers at every stage of pregnancy.
“Right before I had the idea for this, my aunt had a baby and my mom was taking care of her in this way of eating a very specific regimen for every week of her recovery and talking about nutrition in such a different way of recovery and intentionality,” Chiyo co-founder Irene Liu told Fierce Healthcare. “There’s a lack of education about what is possible around care and how to bridge traditional healthcare systems with evidence-backed medicine.”
Public policy dietary guidelines only began including recommendations for infants, toddlers and pregnant women in 2020.
Recent research has shown that an increase in plant-based food and vegetable oil consumption coupled with a decrease in fat, sugar and salts leads to improved maternal and fetal outcomes.
Chiyo lunches meet Western nutritional standards while being packed with Eastern superfoods, all meals follow the low glycemic index and early pregnancy foods are designed to bring down blood pressure and sugar to help lower rates of gestational diabetes and preeclampsia.
Beyond preventing death, healthcare players look to help patients thrive
Simple comforts are being reevaluated for their health merits. Comfort dogs have been increasingly seen around hospitals wearing bright vests and visiting patients in what is called animal-assisted intervention (AAI).
Inova Loudoun County Hospital named three facility dogs, Jeremiah, Bartley and Moo, chief comfort officers earlier this summer. The dogs spend most of their days with child life specialists visiting pediatric patients.
Jeremiah lives with Jill McCabe, M.D., who practices pediatric emergency medicine at the hospital. She said that with a notable recent increase in pediatric behavioral health emergencies, her patients greatly benefit from time with the dogs.
“I think it fits into taking care of the whole patient,” McCabe said. “Not even just our recent focus on social drivers of health, but having a better understanding of the entire patient, what helps them need less pain medicine or less anxiety medicine or recover faster from a brain injury. I think understanding that would certainly help decrease the cost of the care that we provide.”
Since Jeremiah was placed at Inova Loudoun as its first facility dog in 2017 through Hero Dogs, the organization has brought other dogs to the facility, along with bringing dogs to Children’s National and the University of Maryland. “So even in this region, it's really grown over the last six years,” McCabe said.
When comfort dogs visit intensive care units, patient symptoms of anxiety and depression have been shown to lessen, engagement in rehabilitation therapies increases and distressing physiological symptoms like pain decrease, according to a study published in BioMed Central.
“As critical care medicine is increasingly successful in preventing death, the field is more focused on optimizing patients’ survivorship experience,” the study authors wrote. “Through creating humanized ICU environments and implementing non-pharmacologic interventions, patients no longer must wait for hospital discharge before they begin to live again. Non-pharmacological intervention programs, such as AAI, may reduce suffering and help patients take an active role in their recovery.”