About the Authors
Alice Hm Chen, MD, MPH, serves as Chief Health Officer of Centene Corporation. Dr. Chen is responsible for Centene’s strategies, policies and programs in support of improving population health for Centene’s members.
Michael A. Carson serves as Group President, Medicare and Specialty of Centene Corporation, with oversight of the company’s Medicare Advantage, Medicare Part D, Duals, and Specialty businesses.
By Alice Hm Chen, Chief Health Officer of Centene and Michael A. Carson, Group President of Medicare and Specialty Business of Centene
As the nation’s largest managed care company focused on underserved populations, we know evidence-based drivers of health interventions are key to better outcomes. Nutrition is a powerful tool — especially for our Medicare Advantage (MA) members, most of whom live with one or more chronic conditions. Robust evidence shows nutrition can improve outcomes for this population, yet it remains extremely challenging to offer nutritious food as a clinical intervention.
Fortunately, there’s a straightforward fix: The Centers for Medicare and Medicaid Services (CMS) can update its guidance to recognize nutritious food as a “primarily health related” supplemental benefit, allowing MA plans to provide it when clinically appropriate. CMS could likewise establish guardrails providing that primarily health-related nutritious food benefits must be aligned with the new Dietary Guidelines for Americans, by excluding non-healthy food categories.
As a partner to CMS and the states, Centene sees this as a practical step to better align high-value benefits with prevention and members’ health needs. We detailed this recommendation this week in Health Affairs in an article co-authored with Amanda P. Green, head of Medicare product at Centene, and Hilary Seligman, MD, MAS, a professor at the University of California, San Francisco.
Nutritious Food as a Supplemental Benefit
Supplemental benefits can improve outcomes for MA members through a range of services. Some, classified as primarily health related supplemental benefits, are easy for MA plans to offer to nearly anyone they cover. Others, including nutritious food, are classified as Special Supplemental Benefits for the Chronically Ill (SSBCI). These benefits are available only through narrow eligibility pathways triggered only after a person’s health condition has become very serious. For nutrition benefits, that’s often after they could have the greatest impact as part of a preventive care plan. This feels backwards — especially when primarily health related supplemental benefits that are easily offered include ski passes, which may offer less benefit for chronic condition management than nutrition and carry greater risk of injury.
Why CMS Should Expand Access to Nutritious Food Benefits in Medicare Advantage
As an organization focused on using data to drive better outcomes, we see this proposed change to recognize healthy food as a primarily health-related benefit as a natural one. Evidence suggests it will help MA members stay healthier by supporting them earlier — before their conditions worsen or lead to avoidable hospital stays and other interventions. It can also reduce medical costs: healthier members typically use fewer services, supporting responsible stewardship of public dollars.
This shift would also align CMS guidance with the current administration’s commitment to leveraging real food to tackle chronic disease, eliminating inefficiencies and waste, and ensuring “the flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes and disease prevention.” Beyond this, there is broad agreement that supplemental benefits — funded through taxpayer dollars — should be clinically effective and deliver value. Good nutrition fits that standard better than some other offerings, and does so exceptionally well.
We saw this in an analysis of a subset of our MA members, all of whom had at least one chronic condition. They received supplemental benefits on a restricted-use card for food and nutrition, transportation, and housing and living environment. Healthy food was the most-used benefit, and members in high-benefit plans used more benefits than those in medium- and low-benefit plans. The high-benefit group also had significantly lower total medical spending, driven by differences in inpatient, outpatient, and prescription drug spending (but not emergency department spending). While exploratory and not a formal evaluation, these results align with numerous studies showing that healthy food interventions can improve health outcomes and reduce utilization and costs.
A Practical Next Step: Update Medicare Advantage Rules to Support Nutrition
Nutritious food offers a straightforward way to support better chronic disease management for MA members. If CMS takes practical steps to update its guidance, Centene and other MA plans will have more flexibility to use nutrition to serve members.
To learn more about the evidence and policy considerations behind this recommendation, read the full article.