Today’s Special: The Healing Power of Food

Stories that caught our attention this week

Cooks making bread at DV8, a restaurant that hires only people recovering from substance use disorders.
Kitchen staff at DV8, a year-old restaurant in Lexington, Kentucky, that only employs people recovering from substance use disorders. Photo: Sam Perez

The healing power of food is making its way from grandma’s kitchen into America’s restaurants and a health plan near you.

Rob and Diane Perez had been in the restaurant business for a decade when they had a sinking — and life-changing — realization: During their time as restaurateurs, they had lost a half dozen employees to fatal overdoses of opioids. The couple opened DV8, a restaurant where the entire business model is built on hiring workers recovering from substance useEssential Coverage disorder. Though business was slow initially, DV8 was a welcome addition to Lexington, Kentucky, a community that has been devastated by the national opioid crisis. Lexington Fire Department spokeswoman Jessica Bowman told the New York Times that paramedics have administered Narcan, the lifesaving drug that reverses opioid overdoses, to at least one person every day since July 2016. In 2016, the state of Kentucky had an opioid-related death rate almost double the national average.

DV8 has been open for almost a year, and business has grown as word spread about its mission — and its baked goods. Employees are hired directly from treatment centers and held to high standards, including adhering to a zero-tolerance policy for tardiness and attending mandatory weekly workshops related to recovery. Hoang Dong, DV8’s general manager, said the model works because “everyone is wanting to turn their lives around, and they hold each other accountable.” In fact, the restaurant doesn’t have enough vacancies to keep up with the number of applicants. It seems appropriate that DV8’s tagline is “life-changing food.”

Like the Perezes, the state of California has recognized the power that food has to save lives while restraining health care costs. Kaiser Health News’ Phil Galewitz reports that Medi-Cal recently began a three-year pilot project to provide meals to several thousand adults with chronic diseases. The project is based on a successful program in Philadelphia run by the Metropolitan Area Neighborhood Nutrition Alliance (MANNA), which provides nutritional counseling and medically appropriate food to people with serious illnesses.

Health Partners Plans, a Philadelphia-based Medicaid health plan, has offered its members MANNA services since 2015, with positive results. Health Partners CEO William George, MBA, said, “We are quite pleased that with the cooperation of our members we did see a dramatic reduction in their costs” and an improvement in patient outcomes. A study published in the Journal of Primary Care & Community Health found that Medicaid patients who received MANNA services had lower average monthly health care costs, fewer hospital admissions, and shorter inpatient hospital visits than Medicaid patients who did not receive the services.

Now seven California counties will try out similar programs with Medi-Cal patients who have congestive heart failure and other chronic illnesses. David Gorn writes in CALMatters that these efforts are part of the state’s attempt “to make people healthier overall rather than just treat the pain or discomfort of chronic illness.”

The idea of prescribing food as medicine reflects a growing emphasis on having health care systems address the total health and well-being of their patients. California’s five-year Whole Person Care (WPC) pilot is putting this idea to the test with some of the state’s most vulnerable populations by coordinating their medical and behavioral health care along with their social service needs. WPC recognizes people who are homeless or recently incarcerated, for example, have complex needs, leading some to be heavy users of medical services. Watch Brad Gilbert, MD, MPP, CEO of Inland Empire Health Plan and CHCF Board member, talk about the consequences for one man with a history of mental illness when the system failed to coordinate his care. The $3 billion WPC pilot aims to help individuals like him navigate the health care system while accessing the social services they need.

What a Kavanaugh Supreme Court Could Mean for Health Care

It wouldn’t be Essential Coverage without mentioning President Trump’s Supreme Court nomination. While there’s no shortage of stories on nominee Brett Kavanaugh’s credentials, we want to highlight some articles analyzing his potential impact on health care policy.

If Kavanaugh is confirmed, he will shift the court significantly to the right. According to FiveThirtyEight, Kavanaugh lands ideologically to the right of Justice Neil Gorsuch and to the left of Justice Clarence Thomas. The national nonprofit Families USA is concerned that this ideological shift could threaten health care in numerous ways, including overturning the Affordable Care Act (ACA) and rolling back access to reproductive health care. However, the Heritage Foundation’s Thomas Jipping, JD, thinks those fears are overblown and contribute to “mislead-and-manipulate scare tactics” employed by Kavanaugh’s opponents. He writes, “They want to frighten people into thinking that Kavanaugh’s appointment will somehow change how health insurance covers preexisting conditions.” Jipping argues that Kavanaugh is a fair and impartial judge who decides cases by looking at the law as written, rather than relying on his personal views.

Kavanaugh has a record of upholding key parts of the ACA, but Carmel Shachar, JD, MPH, a health law expert at Harvard Law School, cautions that it is misleading to take those rulings out of context. She writes for WBUR, “In his health law decisions, Kavanaugh found that Congress explicitly authorized the challenged portions of the ACA. It’s likely he would uphold health law regulations, as long as there is explicit congressional authorization to do so [emphasis added].” But because Congress is increasingly unable to pass such laws, federal agencies like the Department of Health and Human Services are carrying out more of our health policies, Shachar says. A consequence of this shift, she argues, is that Kavanaugh would likely strike down portions of the ACA and future health care policies based on the technical grounds of administrative overreach.

Similar complexity surrounds Kavanaugh’s stance on Roe v. Wade. Vox’s Jane Coaston reports that some social conservatives are disappointed by Kavanaugh’s nomination because they view his past rulings as “insufficiently anti-abortion.” On the other hand, Marjorie Dannenfelser, president of the national pro-life group Susan B. Anthony List, writes in the Washington Examiner, “Along with some of the most eminent pro-life legal scholars around, I strongly believe Kavanaugh is a worthy nominee whose record stands up to scrutiny.”

Conservative political commentator Ben Shapiro says it’s unlikely that Chief Justice John Roberts and Kavanaugh would agree to review a “straight-up challenge to Roe.” In The National Review, he writes that it’s “far more likely that we’ll see Roberts and Kavanaugh review cases that pare away at Roe via the ‘undue burden’ standard articulated in Planned Parenthood v. Casey (1992).”

Kavanaugh needs a simple 51-vote majority to clear the Senate. Stay tuned.

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