As most Americans look forward to the bounty of Thanksgiving next week, too many children and families in our country face a problem they must deal with all year round: hunger. And while the pain associated with hunger in this country pulls at our heart and soul, it is also hitting us in the wallet. I remember sitting in freshman-year college accounting, where Professor Callahan drilled into us how essential it is to invest today for strong returns tomorrow. As CEO and President of Benefits Data Trust (BDT) — a national, not-for-profit, social change organization committed to transforming how people in need access social service supports — I now find this lesson and its applicability in tackling hunger to be more important than ever.
As we struggle with big issues like tax reform, poverty and a balanced budget, helping people meet their most basic needs by investing in interventions that focus on the social determinants of health and well-being is a critical, necessary strategy for saving valuable tax payer dollars and achieving better outcomes. Accomplishing this important goal will entail expanding current efforts to build cross-program, cross-agency, integrated health and human service eligibility systems that serve people comprehensively. That’s one reason I think the new National Interoperability Collaborative (which you can read about here) is so important.
The good news is that, in a positive stride forward, we are finally moving in the U.S. from a sick-care system to a health-care system. Although 88% of national health-care expenditures are spent on medical care, 40% of overall health is attributed to socio-economic factors such as food insecurity and financial resource strain. Over 85% of physicians agree that unmet social needs lead directly to worse health for patients. As we necessarily shift to value-based health care and look to deliver on the Triple Aim of the Affordable Care Act (improve the patient experience, improve population health and reduce per-capita cost), it is essential to tackle hunger — a key determinant of health for the 42 million food-insecure Americans — head on.
Food insecurity is directly linked to poor health, and the costs reveal themselves in our Medicare and Medicaid budgets. Research conducted at the University of Kentucky Center for Poverty Research found that food-insecure individuals had greater annualized health-care expenditures by $1,863 per person. That totals over $77.5 billion in additional health-care spending annually. Food insecurity is a significant predictor of poor nutrition and negative health outcomes for older adults, particularly those with diet-sensitive chronic conditions. Low-income, food-insecure seniors are 53% more likely to report a heart attack, 52% more likely to develop asthma, 40% more likely to report an experience of congestive heart failure and 60% more likely to experience depression.
While we have long understood that food insecurity and poor health are connected, it was necessary to show the link between improved access to the Supplemental Nutrition Assistance Program (SNAP) and better health outcomes. So BDT, in partnership with the state of Maryland, Johns Hopkins University, University of Maryland Baltimore County and the Robert Wood Johnson Foundation, embarked on research to determine the impact SNAP participation had on the health-care utilization, costs and outcomes of older adults. The results were striking.
The study cohort comprised the entire senior dual-eligible population in Maryland, totaling 70,000 people. Their average annual income was just $5,860, but only 42% were receiving SNAP. Seniors who were able to access SNAP were 14% less likely to be admitted to hospitals and 23% less likely to be admitted to nursing homes. For individuals who were admitted, SNAP enrollment reduced the length of stay in both settings. Based on these findings, health economists from Northwestern University analyzed the health-care savings associated with greater access to SNAP. Their results showed that more access delivered $2,120 per year in health-care savings for every low-income senior enrolled. With 5.2 million older adults eligible but not enrolled in SNAP, now is the time to invest to make the greatest impact.
There are many comparable, actionable opportunities to improve investments to build better brains in young learners, enhance student achievement, help workers stay employed and enable seniors to age in place. Like any good investor, we must use data to assess opportunity and value. Because federal and state agencies house a robust source of data sets that can be leveraged to quickly identify individuals who are eligible for benefits, we can and should invest in building smarter, data-informed government to serve people across the health and human services eco-system, align on improving outcomes and save money.
To start, we should use data and streamlined processes to make sure all low-income seniors on Medicaid are enrolled in SNAP. Next, we can 1). further leverage already-verified data and 2). auto-enroll individuals into programs with similar eligibility guidelines in order to streamline access across benefit programs (which leads to smarter and more-efficient government and, significantly, saves money). To reiterate a key point: Accomplishing these goals will entail expanding current efforts to build cross-program, cross-agency, integrated health and human service eligibility systems that serve people comprehensively.
While the costs associated with hunger are steep, the opportunity to use strong cross-agency, cross-sector data to save valuable taxpayer dollars by reducing hunger and improving outcomes has a strong rate of return. Tackling “upstream” social factors like food insecurity alone can generate strong dividends in government spending. As a country, it is essential for us to make these critical investments in our future in order to improve the health of millions of Americans and to curb the unsustainable growth in health-care spending.