The Scoop on Food as Medicine

What do Medically Tailored Meals entail?

Nutrition Services in Medically Tailored Meals

One defining characteristic of Medically Tailored Meals programs is that they integrate community resources (prepared meals, meal delivery) with medical services (medical referrals, clinical nutrition). Nutrition as part of food and health programs covers a range of approaches, from introductory cooking classes up to clinical treatment from licensed providers. Meals-based food interventions can take a number of approaches to how they integrate different levels of nutrition services for their patients.

Factors to consider when designing a MTM Program:

For example, we can review the elements of MTMs that indicate which meal format is the best option for a patient:

• Patients have a combination of medical condition with clinically indicated dietary treatment and a level of complexity that makes the meal format necessary. 
• Dietary complexity includes advanced cooking skills – such as modifying textures, managing side effects of treatment (including impact on taste), and/or ability to layer meals to address multiple conditions / dietary constraints. 
• Other factors to think about when determining the appropriate type of meal format include: limited mobility, disability, housing instability, brief transition period to diet modification following new diagnosis, an intensive phase as part of structured lifestyle medicine program with later phases introducing new cooking & menu planning skills.

There are also common elements in integration with the health care system:

• Health care providers or payers make the referral to the meals program.
• Program includes access to Registered Dietitian (RD) services, including initial assessment and ongoing counseling & adjustments to dietary plan. This access is in addition to RD-designed menu templates.
• Participants have access to clinical services for monitoring progress towards health goals.
  • Ideally, this would include a “closed loop” between the primary care provider and the meal provider to share health information.
• Integration into health care payer plans – which includes policies for qualifying diagnoses, length of intervention (and recertification for extension), services codes, and credentialed providers.

Factors influencing MTM Success:

How a meals program is intended to impact health outcomes, for which conditions, and over what time frame also has implications for the design of the non-clinical elements of a food program, including:

• Amount of food provided (>50% of weekly food needs), plus storage capacity to match.
• Ability to handle food production complexity – including matching the RD specifications, tailoring to individual diets, adjusting individuals’ meal plans as treatments change, and managing turnover as some participants are enrolled for short durations while others have longer term needs.
• Options for home delivery and removing transportation barriers – including plan for food safety & temperature control.
• Communications systems with health care providers that can accept referrals, manage personal health information privacy concerns, and integrate with health care’s existing IT platforms.