Post-Discharge Nutrition is Key to Reducing Costly Hospital Readmissions

Healthy meals, nutrition education and consumer experience key to developing nutrition solutions for vulnerable members after a hospital stay.

It’s well-known that proper nutrition can improve one’s health. Appropriate nutrition can also prevent disease, reverse chronic health conditions and support healthy aging and healing.

However, malnutrition is a major problem for many Americans, especially for at-risk Medicare Advantage members. Health providers can recognize and combat the risk of malnutrition in the hospital setting, but there’s a gap in understanding what effective nutrition interventions should look like post-discharge to improve health outcomes and reduce costly readmission rates.

Since 2018, when CMS announced that Medicare Advantage plans would have more flexibility to offer supplemental benefits, organizations began implementing programs that address the social determinants of health.

Nutrition is a major determinant of health but remains a relatively new focus for some plans. Although offering healthy home meal delivery programs is a great start, it’s important to ensure that eligible members are utilizing their benefits, remaining fully engaged with programming and able to easily continue healthy eating when benefits end.

Malnutrition Prevalence for Hospitalized Members

Malnutrition is a nutrition imbalance that that is not restricted to people who are underweight. For example, members who are overweight can still be undernourished because they lack the appropriate level of nutrients in their diets. What’s more, patients can be admitted to the hospital malnourished, or become malnourished during their stay.

Research has revealed that more than 50% of people who stayed in the hospital for 7 days or more were malnourished upon admission. What’s more, 63% of people were discharged with the same nutritional status while approximately 20% of patients deteriorated. Furthermore, another study found that approximately one-third of members who are not malnourished upon admission may become so during their stays in the hospital, emphasizing the importance of appropriate nutrition once they are discharged.

In recent years, there has been an increased focus on screening patients for malnutrition. The Joint Commission requires hospitals to do so within 24 hours of admission, whether patients have been identified as food insecure or not.

If malnutrition is left unaddressed, many patients will continue to experience nutritional deficiencies after leaving the hospital, which dramatically increases their risk for costly hospital readmissions.

In fact, hospitalized adults who are malnourished have 50% higher readmission rates than those who are not. What’s more, according to an October 2010 study in the Journal of Hospital Medicine, 10% of all 30-day readmissions were due to malnutrition.

Best Practices for Home Meal Delivery and Nutrition Interventions

An effective way to reduce costly hospital readmissions and support malnourished members is through healthy home-delivered meals, which studies show can increase diet quality and nutrient intake.

In fact, a 2019 analysis by the Bipartisan Policy Center found that providing home-delivered meals to chronically ill, Medicare fee-for-service members for seven days post-discharge could lead to 9,719 fewer hospital readmissions, and result in a net savings of $1.57 per patient for every dollar spent on the program.

As Medicare Advantage plans look to identify healthy home meal delivery programs and nutrition interventions, they should consider the following factors.

• Meals Should Be High Protein and Nutrient Dense

Since malnourished members can be underweight, overweight or obese, meals must be nutrient-dense but also have the appropriate calorie count. Not only should meals include fruits and vegetables, whole grains, and healthy fats, but the right amount of quality, lean protein sources are key too. To be considered an excellent source of protein, meals must include at least 20% of the daily value (DV) for protein, which is equivalent to at least 10 grams.

Protein is important for energy, lean muscle mass and wound healing, and is associated with a lower incidence of complications such as fractures and ulcers. What’s more, the average cost of readmissions is between 26 and 34% higher for members who are protein-calorie deficient than for patients without malnutrition.

• Focus on the Consumer Experience

While providing nutrition is of the upmost importance, health plans should recognize that members want food that tastes great too. Delicious meals will ensure members eat and enjoy the food. Frozen foods are convenient for discharged members but also allow ingredients to stay at their peak freshness, retaining the greatest nutritional value and ensuring the best flavors and textures.

According to the American Diabetes Association’ 2019 consensus statement, one of the recommended goals for nutrition therapy is to help people maintain the pleasure of eating. While the appropriate level of nutrition is fundamental, meals should also take into account food preferences and palatability as well.

Recognizing that the consumer experience is about more than the food alone is also important. Health plans should seek partners that design meals based on consumer research, partners who have a comprehensive understanding of the types of foods and cuisines members enjoy, and packaging designed to appeal to members. A product designed with focus on the consumer ensures members will participate, eat and enjoy the food that provides the nutrition they need to recover.

• Provide Nutrition Education and Counseling

It’s important to get the food to members, but nutritional education, counseling and support are essential to help members transition to eating healthy on their own and support their adherence to new lifestyles.

In fact, a September 2011 study found that nutrition advice may improve weight, body composition and grip strength, whether or not oral nutritional supplements were a part of the intervention.

Solutions that offer nutrition education and counseling should offer evidence-based information to members. It’s also important to work with partners that can meet members where they are and allow them to connect with support via phone, email and chat, 7 days a week.

• Ensure Scalability

The risk of readmission is highest in the week following discharge, and it’s important to provide the appropriate nutrition during this critical period.

When developing nutrition solutions, health plans should consider partners that have a national scale and can deliver nationwide efficiently, be able to scale and meet surge demand.

Partners should offer flexible delivery based on the member’s discharge date, supporting a discharged patient with food they need immediately.

• Implement Nutrition Care Coordination

Whether Medicare Advantage plans have been offering healthy meal delivery benefits for some time, or are looking to identify solutions now, one of the services that many solutions fall short on is nutrition care coordination.

Health plans must have a member outreach system in place to ensure eligible members know about—and are utilizing— their benefits, and are fully engaged post-discharge and beyond.