Could 'medically tailored' rural food program work in southeastern Vermont?

Posted Sunday, October 14, 2018 7:39 pm

By Chris Mays, Brattleboro Reformer

WINDHAM COUNTY — Two local men are dedicating efforts to see whether a successful urban program to bring "medically tailored meals" to housebound folks with illnesses could be mimicked in southeastern Vermont and rural communities.

"It's just two of us pounding pavement," said Marty Cohn, a public relations professional who is working with Roger Allbee, former CEO of Grace Cottage Hospital, on the initiative.

The idea is that illnesses with some of the highest health care costs — cancer, diabetes, heart disease and stroke — could all be connected to nutrition, Allbee said. He and Cohn visited Community Servings in Jamaica Plain of Boston in December to learn more about the "food is medicine" movement.

The nonprofit started about 28 years ago with volunteers setting up meal deliveries for victims of the AIDS epidemic. Now, it has 60 employees and thousands of volunteers who "cook and deliver meals tailored to the dietary needs of clients managing various life-threatening conditions" in Massachusetts and Rhode Island, according to a New York Times article published in August.

Community Servings worked with the Massachusetts Institute of Technology and the Center for Health Law and Policy Innovation of Harvard Law School on a pilot program to deliver meals to housebound people. The organizations developed 15 menus geared to those with illnesses.

"They were able to make the matching," Cohn said. "So Roger and I are like, jaws are dropping, 'This is unbelievable. How come we don't know about this?'"

A study was released in April 2018, and a report from Community Servings following the study stated $2.4 billion was spent in Massachusetts on medical costs attributable to food insecurity in 2016.

"A growing body of research shows the promise of home-delivered meals to improve the health and well-being of homebound older adults," the report reads. "This research has laid the foundation for examining the potential of a more specialized intervention designed to meet the medical and nutritional needs of individuals coping with severe chronic illnesses, regardless of age, known as medically tailored meals."

While the average monthly cost of "medically tailored meals" from Community Services is $350 compared to $146 for Meals on Wheels, average monthly medical costs were $843 for consumers of the former versus $1,413 for those of the latter, according to the report.

A step forward

Meal delivery services, food banks and senior meal events are all good resources, but are not tailored to fit individuals' health needs, Allbee and Cohn said.

Allbee and Cohn began talking with Food Connects, a Brattleboro organization that delivers food from local farms to institutions such as Brattleboro Memorial Hospital and Grace Cottage.

"They're very into health and providing healthy food," Cohn said. "We said we want to take it a step forward and provide medically tailored nutritional meals."

He said Food Connects agreed to secure a $10,000 grant from the Vermont Community Foundation for a study on the feasibility of a southeastern Vermont program.

Rep. Tristan Toleno, Windham-2-3, who runs a catering business and an intensive local cooking class for the Strolling of the Heifers, was tapped to see how a new meal delivery program might work in southeastern Vermont.

"The other thing we wanted him to look at, and this is the thing that was the proverbially cherry on the sundae: Not only are these people at Community Servings providing these meals. They have developed a training program so that the people who are working at Community Servings preparing the meals and all that are being trained," Cohn said. "So it's an economic development tool, economic training."

Cohn said a proposal he and Allbee put together was one of 21 selected out of 35 total submitted to the Dartmouth-Hitchcock Tuck School of Business. Students were assigned to analyze how a program could be set up successfully in rural areas.

Cohn said both studies are expected to be completed by the end of the year. He is in talks with Community Servings about potential grant funding for implementation.

Fewer doctor's visits?

Allbee said the meals would cut down on doctor and emergency room visits. He pointed out that the illnesses the meals are tailored to are prevalent in older people and Windham County is one of the most aging counties nationwide.

"And the other thing that builds into this is, here's Vermont that decided it wanted to get all the Medicare money from the last administration to create an accountable care organization, OneCare [Vermont], to reduce hospital costs and the cost of health care," he said. "And this has been demonstrated to do it, but it's not being done in Vermont in this way."

Allbee recalled conversations with teachers from medical schools who did not spend much time on nutrition in their classrooms.

"I think that's changing," he said. "We never really looked at it as a way of reducing health care costs."

The Center for Health Law and Policy Innovation of Harvard Law School advocates for policy reform.

"The Food is Medicine Pilot would be a critical and innovative step toward improving the health of some of the most vulnerable members of our nation through facilitating access to healthy and medically-appropriate food," the center said in a report. "Inclusion of this innovative program in the Farm Bill is an opportunity to underscore the powerful role that food — and by extension, our food system — can play in addressing some of our nation's most complex and costly diseases."

Allbee and Cohn said they have been in contact with the Vermont congressional delegation.

"We're just kicking up some dust and I think it's all for the good," Cohn said.

Reach staff writer Chris Mays at cmays@reformer.com, at @CMaysBR on Twitter and 802-254-2311, ext. 273.