Food Is Medicine: Innovative Partnerships in Medically Tailored Meals
God’s Love We Deliver (God’s Love) is a provider of medically tailored home-delivered meals and nutrition counseling to severely ill men, women and children in the New York City metropolitan area. God’s Love provides 1.7 million meals annually to 7,000 individuals living with more than 200 individual diagnoses. Meals are medically tailored for each client by Registered Dietitian Nutritionists according to evidence-based nutrition practice guidelines to address medical diagnoses, symptoms, allergies, medication management, and side effects to ensure the best possible nutrition-related health outcomes.
Q: God’s Love is engaged in several innovative projects involving alternative healthcare payment models. Tell us about the genesis of these partnerships.
A: With our mission to address illness through nutrition as a base, God’s Love has always been a natural partner with the healthcare field. Our first reimbursable partnership with healthcare started in 2005 when Medicaid Managed Long Term Care (MLTC) plans approached us to provide medically tailored meals (MTM) for their highest risk members. From this beginning, God’s Love took an active role in building these partnerships with two mission-oriented goals in mind: to fulfill our commitment to finding and serving the most vulnerable members of our communities, and to support our organizational growth.
Two of the founding principles of God’s Love are that we will never have a waiting list and clients will never pay for their meals. With double digit growth in meals each year, it was important to diversify our funding streams to stay true to these principles. We privately raise the majority of the funds that support our clients, as there is currently no federal funding for MTM. This leaves a huge gap in our safety net, especially with chronic disease on the rise. The opportunity to access new revenue by receiving reimbursement for MTM as a covered benefit in our state MLTC program facilitated the growth of the partnership.
The passage of national healthcare reform has brought many new opportunities, and with our years of contracting experience, we have successfully engaged in several innovative programs including the Duals Demonstration Project, the Delivery System Reform Incentive Payment (DSRIP) program, and the Balancing Incentives Program (BIP). We are gradually moving into the new, New York State Department of Health-mandated world of Value Based Payment through partnerships with Accountable Care Organizations, Independent Practice Associations and other provider networks.
Q: In many ways, these partnerships with healthcare represent a fundamentally different way of operating for many nonprofit service providers. What steps has God’s Love taken to prepare to engage in this work?
A: Data collection and analysis have always been a focus at God’s Love. Because of the medical, nutrition and health-related data we already collect through our proprietary data system to facilitate successful meal delivery to clients, we understand the issues around protected health information, client confidentiality and data sharing, and comply with HIPAA. Over the years, we have adjusted our data practices based on what each healthcare partner needs.
As our relationships with plans grew, we added capacity to our Finance Department. We purchased billing software and added new staff. Fiscal planning was necessary to weather the delay in payment that contracting often entails and we built the in-house resources to conduct outreach and negotiate contracts.
Partnership with healthcare has a number of effects on program design and delivery, including referral and intake processes, meal delivery and customer service. Some partners asked to change aspects of our delivery model and implement compliance programs. Flexibility was key, but we also had to have clear priorities and know when a relationship would not work. It was important for us that our commitment to our clients stayed paramount.
Finally, understanding the opportunities offered by the policy landscape in our state was vital. Over the years, we built advocacy and research capacity to work with policymakers on creating opportunities that support our clients in meeting their food and nutrition needs.
Q: God’s Love is the convener of the Food is Medicine Coalition (FIMC), a national association of medically tailored food and nutrition service providers. How are peers in this group pursuing similar work?
A: The amazing legacy of the Affordable Care Act has been a focus on innovation. The challenge has been the fragmented, state-by-state nature of that innovation, which makes national advocacy more complex and state-based advocacy more difficult to learn. In forward thinking states this has been an advantage, like in California, where the Governor recently signed a bill that provides $6 million in funding for a statewide medically tailored meals pilot. In less progressive states that do not have Medicaid waivers, did not expand Medicaid, and/or did not take advantage of innovations funds, there is still a massive gap in services.
Nevertheless, many FIMC agencies have worked diligently to partner with healthcare and have been strikingly successful. For example, our sister organization in Philadelphia, MANNA, delivers MTM to members of Medicaid Managed Care Organizations struggling with uncontrolled diabetes; Community Servings in Boston has contracts with several healthcare plans serving diversified populations; and Moveable Feast in Baltimore partners with the state of Maryland to deliver meals to vulnerable community members through Medicaid waivers. And, there are so many more success stories. As a Coalition, we had the privilege of working with NFF through the Healthy Outcomes Initiative this year, to further shore up the work that we have done on this front.
As our nation slowly begins to understand the impact of the social determinants of health, our message is gaining traction. Unfortunately, many of the healthcare innovations that theoretically integrate social supports into the clinical spectrum fail to reimburse for the delivery of services. Working toward a nationwide insurance demonstration project, a focus of FIMC, will go a long way towards changing that.
Finally, FIMC agencies are not in every community and we hope to make that a reality. The Food Is Medicine Accelerator, a partnership among Community Servings in Boston, the Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School and God’s Love, is designed to address this by supporting the genesis of new MTM programs and helping existing food and nutrition services agencies develop the capacity to address the needs of their communities through MTM. NFF has been so helpful in thinking this concept through.
Q: What advice would you give to other nonprofit service providers pursuing partnerships with healthcare? What is one aspect of this work you wished you had known at the onset?
A: God’s Love wrote the Food Is Medicine Advocacy Toolkit with CHLPI to help answer these questions. While the focus is on MTM providers, the principles are broadly applicable:
- Foremost, nonprofits need to understand the healthcare landscape in their state to know if they are seizing an existing opportunity, expanding an opportunity, or creating a new one. Depending on the research, the target for relationship building may be a healthcare plan or hospital, elected officials or administrative regulators. Agencies need to be prepared to prove their value proposition with data, which means articulating how they will help healthcare entities achieve their goals.
- Simultaneously, there must be organizational self-assessment that helps providers revamp their model to prepare for the partnership. I’ve mentioned some areas above, but a focus on mission, the mechanics of contracting and billing, administrative and financial burdens, and program delivery models are crucial.
- Lastly, nonprofits need to recognize up front that there will be bumps in the road so they don’t become discouraged – keeping in mind that the work that they are doing is valuable and making sure to celebrate successes. The time, energy and dedication invested in this process will result in more people gaining access to services that they so desperately need.
God’s Love We Deliver is engaged in NFF’s Healthy Outcomes Initiative, a national effort supported by the Kresge Foundation to provide advice, financial support, tools, convenings, knowledge-sharing, and other assistance to help human services providers understand and build the capabilities and capacity to work with healthcare organizations in new ways. For more resources on health partnerships, visit nff.org for case studies, assessment tools and readiness tools.