How to address nutrition and its impact on health: PwC

Trisha Swift

DNP, MS-MAVIM, Managing Director, Health Transformation, PwC US

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Leigh Ann Solomon

Director, Health Transformation, PwC US

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A four-part model to help address nutrition’s impact on health

Holistic healthcare may aim to go beyond treating solely the physical symptoms of a patient to considering emotional, mental, social, spiritual and financial aspects of health, providing what is known as “whole person care.”¹ This model treats patients as individuals participating in their own care, and it takes their preferences and beliefs into account instead of focusing strictly on their physical ailments. Nutrition plays a powerful role in advancing holistic care initiatives and in health transformation.

Based on the holistic care model, health outcomes can often be influenced by elements like clinical care, genetics, health behaviors, the environment and other social determinants of health (SDoH). SDoH are the conditions in the environments where people live, learn, work, play, worship and age — and they affect a wide range of health, functioning and quality-of-life outcomes and risks.

Health behaviors and social-environmental factors can determine up to 60% of an individual’s health,with some of the components including education, income and jobs, housing, access to care, transportation, environment and safety, isolation, literacy and nutrition.²

Nutrition plays an impactful role in an individual’s overall health outcomes and well-being. It’s believed that 1.6 million hospitalizations could be avoided with medically tailored meals.³ A healthy diet rich in fruits, vegetables, whole grains and lean protein can help reduce the risk of chronic diseases such as heart disease, diabetes and cancer.

In this blog we will focus on the powerful role of nutrition in advancing Holistic Care initiatives.

PwC’s model to address food and nutrition

The profound impact of nutrition on health

Given the significant impact of nutrition on health outcomes, payers, providers and pharma can try to prioritize nutrition interventions using the PwC model to help address food insecurity, access to nutritious food, medically tailored meals and food technology. These four essential levers range from community-based to personalized interventions:

Food insecurity: Improve consistent access to food. One in six Americans experiences food insecurity.⁴ These individuals or households do not have reliable access to sufficient, safe and nutritious food to meet their dietary needs and lead healthy, active lives. Some live in food deserts without access to food, often because supermarkets aren’t in their neighborhoods and they lack transportation to drive (or get a ride) to a supermarket, there are no community gardens and farmers’ markets don’t stop there. Some live in food swamps where the food that is accessible (i.e., local convenience stores, gas stations and fast food) is not nutritious.

Addressing food insecurity can help reduce healthcare costs by a significant amount. Food insecurity is often linked to an increased risk of chronic health conditions, including obesity, diabetes, hypertension and heart disease.⁵ Healthcare payers can potentially help reduce the prevalence and severity of these chronic diseases through produce prescriptions, “food pharmacies,” meals services, pantries and soup kitchens.
Nutritious food: Improve access to healthy food. Access to food is not enough; people need nutritious foods and healthy diets containing the essential nutrients, vitamins and minerals necessary for maintaining good health and supporting proper bodily functions. According to the US Department of Agriculture, as of September 2021, approximately 19 million people in the United States were living in food deserts.⁶ These areas are more commonly found in low-income neighborhoods, where access to transportation and quality food retailers, community gardens or farmers’ markets may be limited. The COVID-19 pandemic highlighted the vulnerabilities of food deserts, as disruptions in supply chains and economic challenges made it even more difficult for residents to access nutritious food during the crisis.
Medically Tailored Meals (MTM): Tailor meals to support disease management. Medically tailored meals are specialized, carefully crafted meals designed to meet the specific dietary needs of individuals with specific medical conditions or health concerns. MTM are nutritionally improved to address conditions such as diabetes, heart disease, cancer, gastrointestinal disorders and other chronic illnesses. Examples include meals for post-discharge (surgical wound healing) and meals for chronic conditions such as cancer, diabetes and metabolic disorders. Investing in MTM can lead to significant cost savings for payers. A recent study by Tufts University found that national implementation of MTM for patients with diet-sensitive conditions and activity limitations could potentially save $13.6 billion (about $42 per person in the US) annually from an insurer perspective.⁷
Food technology: Design food and individual interventions to help address an individual’s specific health needs. Advances in technology have created new possibilities within the food industry. The application of technology to various aspects of the food industry involves the use of innovative and advanced methods, techniques and tools to address challenges in the food supply chain and tackle food inequities.

For example, food tech can be used to created personalized nutrition, which can help address specific medical issues that individuals face. Precision nutrition includes tailored supplements and diets for specific diseases or deficiencies requiring phytonutrients and minerals. Microbiome analytics (the use of advanced technology to study microbial communities found in and on the human body) can also influence nutrition, with microbiome considerations for care plans looking at the gut/brain axis, mental health and bacterial diversity, leaky gut and inflammation. Food tech is of interest to consumers, who have been demanding more convenient, healthier and sustainable food options in recent years, leading an increase in the number of food tech companies. Food tech innovation is also of keen interest to venture capitalists and investors due to its potential for disruption and growth.

There are steps that can be taken now by providers, payers and pharma to treat food as medicine.

What payers can do

Implement innovative nutritional interventions that address food insecurity such as collaborations with community food banks, “food pharmacies” and government programs, and reimburse or subsidize healthy eating to meet the needs of their members enrolled in WIC (women, infants and children) or Supplemental Nutrition Assistance Programs (SNAP). Formerly known as “food stamps,” SNAP helps low-income individuals and families by providing monthly benefits to purchase food.

Impact: Implementing healthy food prescriptions within large government healthcare programs to promote healthier eating could generate substantial health gains and be highly cost-effective.⁸ Additionally, by supporting food programs, payers can help improve patient satisfaction and engagement, which can lead to better retention rates and increased revenue.

What providers can do

Providers can adopt alternative strategies such as Community Supported Agriculture (CSA) prescription programs, mobile food markets and telehealth nutrition counseling to mitigate diet-related health issues and improve access to affordable and nutritious food options.

Impact: The impact of adopting these strategies includes ensuring that providers supply leading-edge patient care, research and education to achieve better patient outcomes.

Modelling studies indicate that prescriptions for an array of healthful foods can be very cost-effective. By targeting key sociodemographic subgroups at high risk, such as elderly people, adults with disabilities and low-income individuals, it may even save the healthcare system money.⁹

What pharma can do

Pharma can tailor nutritional supplements based on bloodwork and lifestyle analysis, develop and market supplements to compensate for nutrient deficiencies, educate the community through public health campaigns and invest in research and development for drugs that could help counteract negative health effects.

Impact: Establishing cross-disciplinary collaboration — and investing in infrastructure, education and employment opportunities — can help combat food insecurity and its underlying socioeconomic determinants.

How all companies can help

Equitable access to nutritious food is important. The entire healthcare value chain has a role to play, including payers, providers and pharma. Here are some steps all companies can take to improve their health and nutrition strategy:

Introduce food-as-medicine programmatic design, operating model, tech strategy and implementation
Use SDoH assessment to identify population hot spots and areas of vulnerability to inform care model design and improvement, business architecture, and technology and analytical capability needs
Model systems and accelerators that leverage predictive analytics and AI to provide multi-level data, predictions and insights
Use economic modeling to predict investment impacts on health and medical costs
Leverage PwC's solutions and commitment to help reduce health disparities

Our next blog will highlight examples of actions that payers, providers and pharma are already taking to support the powerful role of nutrition in advancing holistic care and transforming health.

(Ethan Meth, Alice Artica, Valery Maya and Sylvia Huq also contributed to this article.)

Endnotes:

_{1. The Six Components of Holistic Health & Wellness | HWP

2. Social Determinants of Health: Evidence for Interventions

3. Meals catering to different health needs could help save lives—and billions of dollars

4. Health-and-socioeconomic-disparities-of-food-deserts/

5. Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants - PMC

6. Exploring America’s Food Deserts - The Annie E. Casey Foundation

7. Supporting Food & Nutrition Security through Healthcare

8. Food for Thought 2020: Food is medicine: actions to integrate food and nutrition into healthcare - PMC

9. Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study | PLOS Medicine}