---
type: source
title: "Medically Tailored Meals Could Prevent 10.8M Hospitalizations and Save $111B Over 5 Years — But RCTs Show No Glycemic Benefit"
author: "Shuyue (Amy) Deng, Dariush Mozaffarian et al. (Tufts Food is Medicine Institute)"
url: https://www.healthaffairs.org/doi/10.1377/hlthaff.2024.01307
date: 2025-04-07
domain: health
secondary_domains: []
format: paper
status: enrichment
priority: high
triage_tag: claim
tags: [food-as-medicine, medically-tailored-meals, cost-effectiveness, SDOH, behavioral-health-infrastructure]
processed_by: vida
processed_date: 2026-03-18
enrichments_applied: ["SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action.md", "medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm.md"]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Population-based open-cohort simulation model estimating state-specific changes in hospitalizations, healthcare spending, and cost-effectiveness of medically tailored meals (MTMs) for patients with diet-related diseases and limitations in activities of daily living.

Simulation findings (Health Affairs, April 2025):
- 5 years of MTM intervention: 10,792,000 hospitalizations prevented, $111.1 billion net savings nationally (2024 dollars, 3% discounting)
- First-year savings: ~$23 billion
- Hospitalizations prevented: 2.6+ million annually
- Eligible population: 14+ million Americans
- Net cost saving in 49 of 50 states (Alabama cost-neutral)
- Largest per-patient savings: Connecticut $6,299, Pennsylvania $4,450, Massachusetts $4,331
- Eligible population: average $30,900 annual healthcare expenditure, 0.53 hospitalizations/year
- ~90% covered by Medicare/Medicaid
- Most efficient: Maryland (2.3 patients per hospitalization prevented)
- Mean program expense per meal: $11.15 (Food is Medicine Coalition 2024 survey)

CRITICAL COUNTER-EVIDENCE — RCTs show weaker results:

JAMA Internal Medicine 2024 RCT (intensive food-as-medicine for diabetes + food insecurity):
- Intervention: up to 10 healthy meals/week + diabetes education + nurse evaluations + health coaching for 1 year
- Result: HbA1c reduction NOT significantly different between treatment and control groups (adjusted difference: -0.10, 95% CI -0.46 to 0.25, P=.57)
- No significant differences in blood pressure, hospitalization, ED use, outpatient visits, or total claims

AHA Scientific Statement (Circulation, 2025) — systematic review of 14 US RCTs:
- Food Is Medicine programs "often positively influence diet quality and food security"
- BUT "impact on clinical outcomes was inconsistent and often failed to reach statistical significance"
- More than one-third were early-stage smaller-scale trials
- Called for "larger, higher-quality Food Is Medicine studies focusing on clinical outcomes"

Geisinger Fresh Food Farmacy (pilot, n=37):
- HbA1c dropped from 9.6 to 7.5 (2.1 points) — far greater than 0.5-1.2 from adding medication
- Healthcare costs dropped 80% ($240K to $48K PMPY)
- 27% lower ER usage, 70% lower hospital readmission
- BUT: pilot study, n=37, not RCT, self-selected participants

## Agent Notes
**Triage:** [CLAIM] — The food-as-medicine evidence reveals a critical gap between simulation models projecting massive savings and RCTs showing null clinical results — this is the most important methodological tension in the behavioral health infrastructure evidence
**Why this matters:** This source captures the central epistemological problem in non-clinical health interventions: simulation models use observational associations to project huge savings, but RCTs testing the actual intervention show no significant clinical benefit. The gap between "food insecurity predicts bad outcomes" (true) and "providing food improves outcomes" (unproven at RCT level) is a causal inference failure.
**What surprised me:** The JAMA RCT null result is devastating. An intensive program (10 meals/week + education + coaching for a year) produced no significant difference in glycemic control. If this intensive intervention doesn't work in an RCT, the $111B simulation projections are built on observational associations that may not reflect causal mechanisms. The Geisinger results are striking but n=37 and uncontrolled.
**KB connections:** [[medical care explains only 10-20 percent of health outcomes...]], [[SDOH interventions show strong ROI but adoption stalls...]]
**Extraction hints:** Claim candidate: "Food-as-medicine simulation models project $111B in savings but RCTs consistently fail to show significant clinical outcomes, exposing a causal inference gap between observational association (food insecurity predicts disease) and intervention efficacy (providing food improves health)"

## Curator Notes
PRIMARY CONNECTION: SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action
WHY ARCHIVED: The simulation-vs-RCT tension is the most important finding of this session. It challenges the assumption that addressing social determinants automatically improves health — the causal pathway may be more complex than "fix the determinant, fix the outcome."


## Key Facts
- Tufts simulation model projects 10.8M hospitalizations prevented and $111.1B net savings over 5 years from MTM intervention
- Eligible MTM population: 14+ million Americans with average $30,900 annual healthcare expenditure
- Mean MTM program expense: $11.15 per meal (Food is Medicine Coalition 2024 survey)
- JAMA 2024 RCT: intensive food intervention showed HbA1c difference of -0.10 (95% CI -0.46 to 0.25, P=.57) vs control
- Geisinger pilot (n=37): HbA1c dropped from 9.6 to 7.5, healthcare costs dropped 80%
- AHA 2025 review covered 14 US RCTs, found inconsistent clinical outcomes despite improved diet quality
