How healthy eating leads to reduced spending on prescription drugs, emergency room visits and hospitalizations
Milwaukee Journal Sentinel (WI)
In the spring of 2021, Jim Garvey's health insurer, Common Ground Healthcare Cooperative, asked if he would be interested in participating in a pilot program that would deliver 10 free meals a week to his home.
Garvey had been diagnosed with diabetes in 2014, and the meals were designed to help people manage the disease. He agreed to give the program, which included working with a health coach, a try.
It would change what he eats, the way he exercises and, in some ways, his day-to-day life.
"I feel a lot healthier," said Garvey, 55, who lives in Kewaskum, a village north of West Bend. "I do have more energy than I did before. And I definitely can do more."
Common Ground, which insures more than 63,000 people in eastern Wisconsin, introduced the program in the fall of 2020 in a partnership with the Dohmen Company Foundation.
It was modeled after similar initiatives throughout the country that see food as medicine. They are among the initiatives, most of them still in the early stages, to address the underlying social and economic conditions — such as housing, food, jobs, education, safety and social networks — that affect health.
Medically tailored meals can lead to less health care spending
Studies have shown that the so-called medically tailored meals can be effective in treating diabetes and, in some cases, even more effective than prescription drugs. The meals also have been shown to lower health care spending by reducing visits to emergency departments and hospitalizations.
That has been the result from the Dohmen Company Foundation's program — Food For Health — for Common Ground.
The medical bills and prescription drug costs of the first 81 participants fell by a total of $325,871 within the first six months of the program, based on Common Ground's claims data.
In the six months before the program, the participants incurred almost $1.1 million in costs for medical care and prescription drugs. In the six months after the program's start, those costs dropped to $764,751.
The number of visits to hospital emergency departments — costing Common Ground, on average, about $800 each — fell 74%.
The savings were in addition to the improvements in overall health.
Weight loss and lower blood pressure
So far, a total of 210 people have participated in the program. More than seven out of 10 — 74% — lost an average of 8.49 pounds, according to the Dohmen Company Foundation. And 36% have lowered their blood pressure.
The 12-month program now is a permanent benefit offered by Common Ground to people in its health plans who have diabetes.
"Food is a central part of being healthy," said Cathy Mahaffey, CEO of Common Ground Healthcare Cooperative.
The nonprofit health insurance company is thrilled with the program, she said, and how it has affected people's lives.
"The results we have received are really impressive," Mahaffey said.
People with diabetes benefit
More than 3,000 people insured by Common Ground have diabetes. They account for 18% of its medical claims — though that includes the cost of treating medical conditions, such as high cholesterol, high blood pressure and obesity, that commonly accompany the disease.
Nationally, an estimated 37.3 million people — more than one in 10 — have diabetes, according to the Centers for Diseases Control and Prevention. This includes an estimated 8.5 million who have diabetes but are undiagnosed.
The estimate includes people with Type 1 diabetes, in which the body can't make insulin, and Type 2, in which the body doesn't use insulin well.
Type 2 diabetes, once known as adult-onset diabetes, accounts for 90% to 95% of all diabetes cases.
The disease can be managed and controlled at least partly through changes in lifestyle. The meals in the Food For Health program, for instance, are low in sugar, carbohydrates, fat and salt.
The meals, which are cold-packed and delivered weekly, can be heated up in a microwave for about a minute or in an oven for about five minutes. They last seven to 10 days. A company now part of Food For Health developed a proprietary process that preserves the meals.
Breakfast can be potato turkey sausage and shirred eggs or a mixed berry smoothie bowl. Lunch can be an Asian chicken salad. Dinner can be sweet potato black bean enchiladas or plancha seared chicken salad.
"They are all very tasty," Garvey said.
Changes in cooking, eating habits
The meals introduced him to several foods and recipes that he started making on his own. He is eating more fish. He has always eaten vegetables but now eats a wider variety and more salads. He is again eating fruit, which he stopped doing when diagnosed with diabetes. And he now drinks flavored water instead of diet soda.
He also has learned about portion control. A one-pound ribeye steak now will feed three people, and sometimes there are leftovers. He is again eating rice, one of his favorite foods, but now it is brown rice and the portions are much smaller.
Garvey, who had lost a lot of weight after being diagnosed with diabetes, initially lost about 30 pounds when he began the program. He no longer is losing weight but instead is adding muscle mass. His waist size, for instance, is 4 to 6 inches smaller now.
His blood pressure also is lower and his cholesterol is much lower.
Participants in the program must agree to work with a health coach and track the food they eat through an app on their smart phones.
"We wanted some accountability," said Mahaffey of Common Ground.
"That's when you're going to have your real success," she said. "And not everyone's ready to do that."
Finding people to participate in the program initially took some work — despite the offer of 10 free meals a week.
"You think that would be enough for them to say, 'I'm going to finally do something,'" Mahaffey said. "But it's not. It's just not."
That may be understandable. Most people know they should eat better or exercise more, and they may have thought that the coaches would nag them or make them feel guilty each week.
Willingness to make changes
People need to be ready to make changes in their life, said Kathy Koshgarian, former president and chief operating officer of the Dohmen Company Foundation and now president and CEO of Food For Health.
"That often is not easy," she said.
Some of the participants, though, already were working to improve their health.
Pat Lowney of Neenah had lost 65 pounds and was exercising regularly when Common Ground contacted him. He began the program in May of last year and lost an additional 20 pounds.
The program taught him the value of eating healthy as opposed to focusing on losing weight. He learned that he doesn't get as hungry, for instance, when he includes protein, such as eating a salad with chicken, in his meals.
His favorite meals included whole wheat lasagna, salmon with vegetables and the salads.
"They have terrific salads," Lowney said. "Their salads are outstanding."
The coaching has been even more important for him.
"The biggest part has been the encouragement and the feedback," he said. "That's been really important."
Lowney had been on medication for high blood pressure for 10 years. Late last year, his physician dropped the medication. His physician also took him off one prescription for diabetes and lowered the dosage of another. And his cholesterol is lower than it has been in years.
Garvey, too, exercised regularly. But his health coach put him in touch with another coach who also is a fitness trainer. She changed his workouts, reducing the number of reps but increasing the resistance when he lifts weights.
An added benefit of the program Garvey cooks for his parents, and now they are eating healthier.
Food is Medicine Coalition
The Dohmen Company Foundation worked with Food is Medicine Coalition to develop the meals and program.
The organization launched a program to provide technical assistance and training to nonprofit food agencies that were interested in preparing and delivering medically tailored meals to people, particularly to people who have low incomes, who have diabetes, kidney disease, heart failure and other medical conditions.
"We want this to be sort of a pipeline into the Food is Medicine Coalition," said Jean Terranova, director of food and health policy at Community Servings, a Boston nonprofit that was one of the founders of the coalition.
Community Servings was founded in 1990 by AIDS activists, faith groups and community organizations through the leadership of the American Jewish Congress to provide home-delivered meals to people with HIV/AIDs.
The Food is Medicine Coalition's goal is to expand access to medically tailored meals nationwide and to have Medicare and state Medicaid programs cover the meals the same way they cover other health care costs.
The coalition's clinical committee, overseen by an advisory board, has issued guidelines based on tailoring meals for specific medical conditions. Its members must meet standards for nutrition and food quality, nutrition counseling and education, data collection and health care referrals.
Food For Health, the organization started by the Dohmen Company Foundation, became certified in June. It now is one of roughly 30 organizations that belong to the coalition.
The Dohmen Company Foundation has spun out Food For Health as a separate nonprofit organization. That will encourage other foundations and organizations to support the program. It also will enable Food For Health to lobby for Wisconsin's Medicaid programs to cover medically tailored meals and services.
North Carolina, California, New York and Massachusetts have programs or pilot programs that do that.
Food For Health — which also hopes to contract with health plans to provide medically tailored meals and services — is moving its commercial kitchen from Chicago to Milwaukee. The new kitchen is expected to open in October. It will be able to produce 55,000 meals a week.
The Dohmen Company previously bought Cooked in Chicago and Focused Fork, two companies that prepared and delivered healthy meals. And Adel Korkor donated Salus Corporate Wellness to the foundation. Their operations now are part of Food For Health.
Separately, the Dohmen Company Foundation also has started a for-profit company — the Food Benefit Co. — that hopes to contract with employer health plans to provide healthy food and an array of wellness services, including medically tailored meals, for employees. Profits will go to support the foundation's philanthropy.
Dohmen transitioned to philanthropy
All this took place after the conversion of the Dohmen Company in 2019 to a so-called philanthropic enterprise in which its profits would support its charitable giving.
The conversion came after the company — founded in 1858 and in its sixth generation as a family-owned business — had completed a string of profitable sales and acquisitions.
They included selling its wholesale drug business to Cardinal Health for more than $100 million 2016, selling Restat, which managed prescription drug benefits, to Catamaran Corp. for $409.5 million, in 2013 and selling its subsidiary that provided services to drug and medical device companies for an undisclosed amount to two private equity firms in 2018.
"It all led to where we are today," said Koshgarian, who also is president of the Food Benefit Co.
Now its focus is on preventing disease lowering health care costs.
The Food For Health program, she said, shows that with encouragement, support and access to the right food, eating healthy can become part of people's lifestyle.
For Garvey, the program has been a constant reminder of how to eat well.
He would recommend the program, especially for anyone with diabetes, and he has become a supporter of the idea that food is indeed medicine.
"It's very much a real thing," he said.
Annie Mattea reported this story while attending Marquette University and working as a research assistant to Journal Sentinel reporter Guy Boulton. Boulton spent the 2021-22 academic year as an O'Brien Fellow in Public Service Journalism at Marquette University examining the social determinants of health. Angela Peterson is a photojournalist with the Journal Sentinel.