Socioeconomic factors associated with uptake and satisfaction with a post-hospitalization meals benefit in Medicare Advantage

Anna L Richards; Jessica Vallejo; Lewei Duan; Mary P Dinsdale; Jaime Akiyama-Ciganek; Annet Arakelian; Janet S Lee; Ernest Shen; Huong Q Nguyen

doi:10.1111/jgs.18907

Socioeconomic factors associated with uptake and satisfaction with a post-hospitalization meals benefit in Medicare Advantage

J Am Geriatr Soc. 2024 Mar 29. doi: 10.1111/jgs.18907. Online ahead of print.

Authors

Anna L Richards¹, Jessica Vallejo², Lewei Duan³, Mary P Dinsdale⁴, Jaime Akiyama-Ciganek⁵, Annet Arakelian⁶, Janet S Lee², Ernest Shen², Huong Q Nguyen^{2

7}

Affiliations

¹ Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
² Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, Pasadena, California, USA.
³ Centers for Medicare and Medicaid Services, Washington, DC, USA.
⁴ Kaiser Permanente Southern Califorina, West Los Angeles, California, Los Angeles, USA.
⁵ Kaiser Foundation Health Plan, Pasadena, California, USA.
⁶ Kaiser Foundation Health Plan, Seattle, Washington, USA.
⁷ Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.

PMID: 38551247
DOI: 10.1111/jgs.18907

Abstract

Background: Kaiser Permanente Southern California began offering a 4-week supplemental benefit of home-delivered meals to Medicare Advantage members after discharge from a hospitalization for heart failure and other medical conditions in 2021. The purpose of this study is to explore the associations between socioeconomic disadvantage and food insecurity with patient uptake of and satisfaction with the meals.

Methods: Data for this cross-sectional study were drawn from survey and electronic medical record data for members referred for the meals benefit (n = 6169) and linked to a hospitalization encounter (n = 2254) between January and December 2021. Uptake was assessed using vendor records; measures of socioeconomic status included the neighborhood deprivation index (NDI) and prior receipt of medical financial assistance (MFA) from the health system. Patients were invited to complete an email or phone survey about their satisfaction with the meals and food insecurity. Multivariable log-binomial regression models were used to examine the association between socioeconomic disadvantage and food insecurity with meals uptake and satisfaction.

Results: Sixty-two percent of patients referred for the benefit accepted the meals (mean age: 79 ± 9, 59% people of color). While there was no significant relationship between NDI and meals uptake (RR: 0.99, 95% CI: 0.92-1.07, p = 0.77), patients who received prior MFA were more likely to accept the meals (RR: 1.09, 95% CI: 1.02-1.16, p < 0.01). Sixty-nine percent of patients who completed the survey (23% response rate) reported that meals were very or extremely helpful. Patients with food insecurity (29% of survey respondents) were more likely to report that the meals were helpful for their recovery compared to food secure patients (RR: 1.21, 95% CI: 1.09-1.35, p < 0.01).

Conclusions: The home-delivered meals appeared to be particularly utilized by and helpful to patients with greater financial strain and/or food insecurity, suggesting that supplemental benefits could be more targeted toward addressing unmet needs of vulnerable adults.

Keywords: Medicare Advantage; home‐delivered meals; socioeconomic factors; supplemental benefit.

Grants and funding

Kaiser Permanente Southern California Care Improvement Research Team