HIMSS: Food Services and the Care Team

Nutrition is essential to good health—as essential at times as any medication. Yet the healthcare teams serving many communities’ most vulnerable patients have little way to incorporate diet-adherence data into their bigger health picture, and that bigger health picture may not be shared back to the food services on which many patients rely.

A health information exchange in the Philadelphia area has found a way to do that, potentially maximizing the benefits of both specialized diets and coordinated care. MANNA, a provider of medically tailored nutrition services, has joined the HealthShare Exchange (HSX), an HIE serving the Delaware Valley region, in a partnership that basically treats food as medicine.

HSX is a bit more than a standard HIE, President Martin Lupinetti told attendees at HIMSS February 12 in Orlando. It’s a healthcare data aggregator that also offers population health and analytics services. Six major health plans contribute data to it. Besides its aggregate clinical data repository, HSX also provides an ENS—an encounter notification service—to let participants know when one of their patients has been admitted, discharged, or transferred at another facility.

HSX is recognized for its data quality, Lupinetti said, but it wanted more—it wanted to “surround patients with more of their care team.” To that end it looked outward for nontraditional partners.

MANNA began its services nearly 30 years ago for sufferers of HIV and AIDS, then expanded to all types of critically ill patients in 2006. A volunteer-driven collection of dietitians, chefs, and drivers, the organization prepares special medically appropriate meals at no cost for its clients—victims of diseases like cancer, renal failure, and HIV/AIDS across the Philadelphia area and southern New Jersey—and delivers them weekly, along with nutrition counseling and education. Almost all its clients (95%) are below the poverty line.

Taking this medical-type approach to patients’ diets has benefits: A 2013 study in the Journal of Primary Care and Community Health reported a significant decrease in overall healthcare costs for MANNA clients compared to a control group. Their average monthly care costs dropped from $38,937 to $28,183—a reduction of 28%. Average monthly inpatient costs also fell by more than 30%, though a look at ED costs was inconclusive.

The costs and frequency of hospital admissions were also lower in the MANNA group, with fewer inpatient visits and shorter lengths of stay. Notably, in their first year of MANNA services, 93% of clients with inpatient hospitalizations were discharged to their homes, while 72% of the comparison group were discharged to acute care facilities.

What the organization needed, though, was a way to stay up to date on its clients’ other medical events—from integrating new nutrition needs to suspending meal service if someone was hospitalized. For this it had to rely on reports from hospitals and primary care physicians, as patients themselves aren’t always reliable reporters. So last summer it became the first nonmedical community healthcare organization to join HSX.

The big hurdle to that was squaring a food service with HIPAA requirements for protected health information. MANNA had to meet mandates for handling PHI and meet the law’s definitions of healthcare provider and treatment. The solution: It accesses HSX data only with a physician’s order for dietary services. This is a model, Lupinetti noted, that can be used to onboard other specialized entities and other HIEs can use to partner with nonmedical community services.

The HSX notification service encompasses 94% of healthcare providers and facilities in the Philadelphia area—“It’s a very good view of what’s going on with the patient,” Lupinetti said. Meanwhile, MANNA’s footprint covers 78% of the counties in Pennsylvania. So MANNA personnel can now query HSX for the latest information on those it serves, including things like medications, allergies, and other treatment around the region.

The next goal is including MANNA encounter data within HSX, so other providers can access the dietary info. Says Lupinetti: “We think our missions share some of the same values and directions.”