Definition of Medically Tailored Meals
Medically Tailored Meals (MTMs) are a particular type of ‘food is medicine’ intervention - they are highly targeted meal plans designed to meet specific medical needs for patients who have barriers to sourcing and preparing meals without assistance. They focus on treatment for individual patients, which distinguishes them from many prevention-oriented food programs. MTM programs provide a significant amount of a household’s daily food needs, usually through direct delivery to the home. Often these meals are prescribed for a specific time frame, for example during cancer treatments, a high risk pregnancy or immediately following a hospital stay. Meals may also be longer-term supports, with ongoing engagement from medical providers to recertify and adjust the dietary plans.
The national Food is Medicine Coalition defines MTMs as the following:
Medically tailored meals are delivered to individuals living with severe illness through a referral from a medical professional or healthcare plan. Meal plans are tailored to the medical needs of the recipient by a Registered Dietitian Nutritionist (RDN), and are designed to improve health outcomes, lower cost of care and increase patient satisfaction.
The 2022 Food Is Medicine Research Action Plan from the Aspen Institute provides an overview of the history of Medically Tailored Meals, key research, and where MTMs fit within the broader “food is medicine” context. This report defines MTMs as:
Fully prepared meals designed by a Registered Dietitian Nutritionist to address an individual’s medical diagnosis, symptoms, allergies, and medication side effects . . . patients generally have complex and/or terminal illnesses and co-occurring conditions that make it difficult to shop or cook.
“Home delivered meals” are a defined benefit as part of Medicare Advantage plans. Often Medically Tailored Meals providers fulfill this benefit. The CMS definition is found in the MA Advantage Plan Manual Chapter 4, Sections 30.1 & 30.3. Key attributes are that they need to be prescribed due to an illness, consistent with medical treatment of that illness, and offered for a short duration.
For a more detailed introduction to Medically Tailored Meals, check out our interview with David Waters, CEO of Community Servings, in Season Three of the Policy in Plainer English podcast.
2020-2021 Capacity Assessment
Vermont has experimented with small scale MTM pilots, for example in Brattleboro and a pilot study with Dartmouth-Hitchcock that tested the feasibility of a program. The Age Well program in Northwestern Vermont has added a medically tailored component to their menu selection with their Meals on Wheels vendor partner, Trio. We do not currently have any full scale programs that meet all the criteria for Medically Tailored Meals.
In 2020, the Food is Medicine Coalition launched a Medically Tailored Meals accelerator program to offer technical assistance to organizations building new MTM programs. The New Hampshire Foodbank participated in the first cohort. Information on the Accelerator can be found here.
In the fall of 2020, a group of stakeholders interested in advancing Medically Tailored Meals in Vermont built a scope of work for a consultant and in January 2021 began work with Marydale DeBor of Fresh Advantage LLC. This work included extensive interviews in Vermont, and with programs in other states, in addition to a literature review of evidence-based MTM models. The goal was to outline key components of successful Medically Tailored Meals programs and map those onto assets currently in place in Vermont. It also investigated which elements of urban-based MTMs may need to be modified for a rural region, including options for combining statewide infrastructure with local programs to balance the need for scale with the need for community connection.
The final report from the 2021 Vermont Medically Tailored Meals study is available here.
Key Findings of Report (expanded, slide deck format)
MTM Readiness Assessment Tool (elements of MTM programs abridged to a single page)
MTM Food Production (summarizes information on the meal production component)
Reference / Bibliography page with links to research on the efficacy of Medically Tailored Meals (and closely related interventions). These studies review both clinical and cost data.
Please Note - Unless otherwise indicated, these materials are current only up to summer, 2021.
Funding for Medically Tailored Meals
Medically Tailored Meals have been a case study for mechanisms to achieve coverage for food as a covered benefit within health care plans. We have provided detailed information on this topic, including lessons for other intervention types, on the linked MTM Funding Options page.
There are several ways to look at funding for Medically Tailored Meals:
Start up costs for establishing an MTM program
Ongoing costs for providing the food component of an MTM program
Costs of nutrition services connected to an MTM program
Coverage of meals as a medical benefit (as referenced above)
The 2020-2021 Capacity Assessment provided background information on different ways to consider funding for both establishing and maintaining a Medically Tailored Meals program in Vermont. A complementary funding pathways document provides examples of how other programs have funded their work after the initial start up phase.
Nutrition services can be provided as part of the food program itself or as part of clinical nutrition services within the health care system. Our Nutrition Services page provides information on this topic, including funding, for Vermont.
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). As discussed on our Nutrition Services page, 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. The linked Clinical Nutrition Services in Medically Tailored Meals provides an overview of current structures.
Therapeutic Meals and Other Interventions
The Medically Tailored Meals structure highlights elements of successful food and health care integration that may appear in other intervention types. As noted in the definitions section, MTMs are designed to be able to handle the highest complexity nutrition needs in an at-home setting. Other food-based interventions show common attributes of clinical integration, meals format, and treatment focus. Reviewing MTMs can help think program planners think about the component parts that come together in different formats and which are most critical for their particular goals.
For example, we can review the elements of MTMs that indicate a meal format is the best option:
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 indicators for 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 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.
Includes 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.
How a meals program is intended to impact health outcomes, for which conditions, and over what timeframe 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.
Some programs include many of these attributes without full Medically Tailored Meals status. One example is nutrition programs funded by the Older Americans Act, some of which have developed separate MTM programs to complement other offerings. Meals on Wheels, for example, offers home delivery, access to nutrition services and care coordination, and an RD-designed meal plan that reflects changing nutritional needs as we age.
The following resources provide more information on the capacity of non-MTM meals programs to integrate with the health care system to support treatment of diet-related health conditions:
Meals on Wheels America - Overview of OAA Nutrition Programs and health care integration research on Outcomes-Based Financing for Health Care Partnerships, Care Coordination, Malnutrition Across Transitions in Care.
Conversation with Age Well in Vermont (2022) - Part of Season 3 of the Policy in Plainer English podcast.
Conference Discussion on Integrating MTMs with Senior Nutrition Programs (August, 2019)
Panel on Food Is Medicine for Older Adults (2021)
See also the following Vermont organizations:
DAIL (Disabilities, Aging, and Independent Living) - Older Americans Act Reports and Older Americans Act Services (including regional plans and link to state plan)
The scope of FAHC work did not include meals provided by hospital-based food services. However, these services are a key connection to food & health care integration, and may have direct relevance to managing nutrition during transitions in care. For resources on this topic see the New England chapter of Healthy Food in Health Care / Health Care Without Harm and individual hospital dining services (see, for example, UVMMC Dining Services page and linked networks).
Next Steps
At the end of the 2022 strategic planning year, the Food Access and Health Care consortium has planned the following as regards Medically Tailored Meals in Vermont:
Monitoring national policy conversations about MTM reimbursement - this linked update following the White House announced strategy for Medically Tailored Meals (and other food & health initiatives) summarizes our findings on the topic.
Sources for reviewing the national policy conversation include: Food is Medicine Coalition Policy Work overview; Detailed Policy Recommendations Report (March, 2021); Issue Brief on Proposed MTM Payment Pilot (2022); White House Conference Recommendations (July, 2022).
Following coverage of Meals in Vermont health plans - see resources from our October, 2022, webinar with UVM Health Advantage (Slide Deck and Recording) and our brief Update posted when UVM Health Advantage first announced Meals coverage.
Although meals are not covered in Vermont Medicaid, the updated 1115 waiver may introduce this option in the future.
Supporting collection of the data necessary to assess potential coverage of Meals as part of Essential Health Benefit design - see background update here.
Supporting expansion of therapeutic meal options through Vermont’s Area Agencies on Aging and Meals on Wheels programs.
See also Older Vermonters Nutrition Coalition