A doctor from neck down wearing white coat, holding clipboard in one hand and bowl of fruit in the other.

Medically Tailored Meals and the Reverberating Impact of Public Demonstration Projects

Recent headlines highlighted a $40 million investment by a range of Blue Cross Blue Shield companies in Solera Health, a start-up focused on improving chronic disease management. Solera Health will use the investment to scale up its wellness programs, which seek to improve social determinants of health for patients.

One of Solera’s initiatives focuses on providing medically tailored meals to beneficiaries. The concept behind medically tailored meals is simple. Patients with diabetes, congestive heart failure, and other chronic illnesses can be treated only to a limited extent in doctor’s offices. By extending services like meal provision to beneficiaries—thus improving their long-term health—insurers can potentially avoid paying for more costly interventions down the line.

A variety of pilot programs, including several prominent Medicaid demonstration projects, have eased the path towards Solera’s initiative. One of the first of these pilots took place in Philadelphia, where researchers conducted a comparative study of Medicaid patients and clients enrolled in the city’s Metropolitan Area Neighborhood Nutrition Alliance. The study found that the average cost of health care services for clients in the Alliance were 31% lower than those of the comparison group.

In response to the success of city-scaled pilots, a handful of states have successfully applied for demonstration waivers seeking to provide coverage for medically tailored meals under Medicaid. A medically tailored meals pilot was launched in eight California counties in April 2018. The program is collecting data on the costs and health effects of medically tailored meal-provision for a population of 1,000 Medicaid patients, and the results of the study are expected to be published in 2020.  North Carolina is seeking to pilot delivery of medically tailored food boxes to Medicaid recipients as part of its recently approved demonstration project.

Similarly, Harvard’s Center for Health Law & Policy Innovation partnered with Boston-based non-profit Community Servings to implement a range of “Food is Medicine” initiatives in Massachusetts. The program seeks to treat and prevent chronic disease by offering clients with chronic disease medically tailored meals and providing clients who are food insecure with access to fruit and vegetables, among other programs. In studying these interventions, the “Food is Medicine” partnership has found that provision of medically tailored meals is associated with fewer inpatient and emergency department admissions.

It is meaningful that large, private companies have begun taking an interest in treating social determinants of health like access to food as a worthy investment. As Solera’s initiative moves forward, it is also noteworthy that the work and research done by public programs and non-profit organizations has laid the groundwork for this new venture. Recent headlines about the investment in Solera expose the role of Medicaid demonstration projects and non-profit entities in improving and re-shaping our health system as a whole.


Alexandra Slessarev is a 2018-2019 Petrie-Flom Center Student Fellow.


Alexandra Slessarev

Alexandra Slessarev graduated from Harvard's joint JD/MPH program in 2019, and she will be clerking for Judge Ronald Lee Gilman on the 6th Circuit beginning in August 2019. Her Petrie-Flom fellowship paper was entitled "Curbing Pharmaceutical Detailing Practices in the Opioid Era." Alex's public health research interests include maternal and reproductive health, state-level Medicaid implementation, and the intersection of health and the environment. Prior to starting her dual-degree program, Alexandra spent a year working as a research assistant at the Bixby Center for Global Reproductive Health at the University of California, San Francisco, where she worked on several projects related to long-acting reversible contraception provision and education.

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