'This Program has Given Me the Proper Nutrition that I Deserve': Participant Perspective on a Medically Tailored Meal Intervention

Top Things to Know

Although many Medicare Advantage plans offer food and nutrition benefits, this study found no evidence that MA enrollment translated into lower food insecurity or better diabetes-related clinical outcomes compared with Original Medicare.

The findings highlight an implementation gap: availability of food-related supplemental benefits may not be sufficient to improve outcomes if beneficiaries do not access, use, or receive these benefits effectively.

For Food Is Medicine stakeholders, the results underscore the need for research that evaluates actual utilization and effectiveness of specific nutrition benefits rather than comparing insurance models alone.

Summary of Conclusion/Findings

This longitudinal cohort study used a target trial emulation approach to compare outcomes among 34,648 adults with type 2 diabetes who enrolled in either Medicare Advantage (MA; n=15,594) or Original Medicare (OM; n=19,054) across community health centers in 44 U.S. states. Twelve months after Medicare enrollment, MA was not associated with improvements in glycemic control, blood pressure, or low-density lipoprotein cholesterol compared with OM; adjusted differences were small and nonsignificant for HbA1c (0.01 percentage points; 95% CI, −0.04 to 0.05), systolic blood pressure (−0.15 mm Hg; 95% CI, −0.54 to 0.24), diastolic blood pressure (0.06 mm Hg; 95% CI, −0.15 to 0.27), and LDL cholesterol (−0.41 mg/dL; 95% CI, −1.24 to 0.42). MA enrollment also was not associated with lower risks of food insecurity (RR, 1.00; 95% CI, 0.94-1.05), housing instability (RR, 1.00; 95% CI, 0.91-1.09), or transportation barriers (RR, 1.00; 95% CI, 0.93-1.07). Results were consistent across follow-up periods through 24 months, multiple sensitivity analyses, and subgroups defined by Medicare eligibility pathway. Mortality did not differ between groups over two years of follow-up. The authors conclude that, despite MA plans’ ability to offer supplemental benefits such as food and nutrition assistance, MA enrollment was not associated with better diabetes outcomes or fewer health-related social needs than OM in this population.