Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives
IntroductionMedically tailored meals (MTMs) are home-delivered, nutritionally tailored meals for individuals living with complex or advanced diet-sensitive medical conditions. In 2020, Massachusetts Medicaid implemented the Flexible Services Program (FSP) through a Section 1115 Demonstration, which...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1526564/full |
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| author | Sara C. Folta Jessica Burch Matthew Alcusky Arlene S. Ash Kurt Hager Jean Terranova Fang Fang Zhang Oyedolapo Anyanwu Zhongyu Li Dariush Mozaffarian |
| author_facet | Sara C. Folta Jessica Burch Matthew Alcusky Arlene S. Ash Kurt Hager Jean Terranova Fang Fang Zhang Oyedolapo Anyanwu Zhongyu Li Dariush Mozaffarian |
| author_sort | Sara C. Folta |
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| description | IntroductionMedically tailored meals (MTMs) are home-delivered, nutritionally tailored meals for individuals living with complex or advanced diet-sensitive medical conditions. In 2020, Massachusetts Medicaid implemented the Flexible Services Program (FSP) through a Section 1115 Demonstration, which funded novel nutrition programs, including MTMs, for high-risk patients through Accountable Care Organizations (ACOs). Little is known from the practitioners’ perspective regarding the facilitators and barriers to reaching and enrolling patients in MTM programs.MethodsWe interviewed 19 staff across four ACOs that had implemented MTM interventions. Interviews were conducted from Feb to Aug 2023 and included staff who participated in patient screening, referral, or enrollment. The interview guide was informed by the Health Equity Implementation Framework. Interviews were recorded and transcribed and coded using NVivo software. We used directed qualitative content analyses. The study team identified and discussed common themes and presented them back to our ACO partners.ResultsStaff described facilitators of and barriers to reach and enrollment related to several domains of the Health Equity Implementation Framework. For program (innovation) factors, facilitators included perceived positive effects on patient health outcomes and a relative advantage over both the status quo and other nutrition assistance programs; outreach by care team members rather than other staff; the eligibility criteria, which were viewed as appropriate and evidence-based; and the simplicity of the program, which aided communication with patients. Patient-related facilitators included patients being more in need of the program due to more severe illness and being more motivated to change dietary behaviors. Patient-related barriers included lacking a working phone or stable housing and concern about meals meeting taste and cultural food preferences. Staff-related barriers included limited time and especially knowledge about the MTM program.DiscussionThis study highlights the perspectives of front-line staff during the implementation of an MTM program in a state-wide 1,115 Demonstration. Staff may require multiple trainings to gain full knowledge about the program and increase self-efficacy in describing it with sensitivity. These new findings elevate voices from front-line healthcare staff in MTM delivery and can help inform strategies for effective, equitable implementation of MTM programs. |
| format | Article |
| id | doaj-art-5c47971095b24b2cb90f22744cad9ac9 |
| institution | Kabale University |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-02-01 |
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| series | Frontiers in Public Health |
| spelling | doaj-art-5c47971095b24b2cb90f22744cad9ac92025-02-05T07:32:41ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-02-011310.3389/fpubh.2025.15265641526564Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectivesSara C. Folta0Jessica Burch1Matthew Alcusky2Arlene S. Ash3Kurt Hager4Jean Terranova5Fang Fang Zhang6Oyedolapo Anyanwu7Zhongyu Li8Dariush Mozaffarian9Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United StatesCommunity Servings, Boston, MA, United StatesT.H. Chan School of Medicine, University of Massachusetts, Worcester, MA, United StatesT.H. Chan School of Medicine, University of Massachusetts, Worcester, MA, United StatesT.H. Chan School of Medicine, University of Massachusetts, Worcester, MA, United StatesCommunity Servings, Boston, MA, United StatesFood is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United StatesFood is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United StatesFood is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United StatesFood is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United StatesIntroductionMedically tailored meals (MTMs) are home-delivered, nutritionally tailored meals for individuals living with complex or advanced diet-sensitive medical conditions. In 2020, Massachusetts Medicaid implemented the Flexible Services Program (FSP) through a Section 1115 Demonstration, which funded novel nutrition programs, including MTMs, for high-risk patients through Accountable Care Organizations (ACOs). Little is known from the practitioners’ perspective regarding the facilitators and barriers to reaching and enrolling patients in MTM programs.MethodsWe interviewed 19 staff across four ACOs that had implemented MTM interventions. Interviews were conducted from Feb to Aug 2023 and included staff who participated in patient screening, referral, or enrollment. The interview guide was informed by the Health Equity Implementation Framework. Interviews were recorded and transcribed and coded using NVivo software. We used directed qualitative content analyses. The study team identified and discussed common themes and presented them back to our ACO partners.ResultsStaff described facilitators of and barriers to reach and enrollment related to several domains of the Health Equity Implementation Framework. For program (innovation) factors, facilitators included perceived positive effects on patient health outcomes and a relative advantage over both the status quo and other nutrition assistance programs; outreach by care team members rather than other staff; the eligibility criteria, which were viewed as appropriate and evidence-based; and the simplicity of the program, which aided communication with patients. Patient-related facilitators included patients being more in need of the program due to more severe illness and being more motivated to change dietary behaviors. Patient-related barriers included lacking a working phone or stable housing and concern about meals meeting taste and cultural food preferences. Staff-related barriers included limited time and especially knowledge about the MTM program.DiscussionThis study highlights the perspectives of front-line staff during the implementation of an MTM program in a state-wide 1,115 Demonstration. Staff may require multiple trainings to gain full knowledge about the program and increase self-efficacy in describing it with sensitivity. These new findings elevate voices from front-line healthcare staff in MTM delivery and can help inform strategies for effective, equitable implementation of MTM programs.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1526564/fullfood is medicinemedically tailored mealsenrollment analysisqualitative researchhealth equity (MeSH) |
| spellingShingle | Sara C. Folta Jessica Burch Matthew Alcusky Arlene S. Ash Kurt Hager Jean Terranova Fang Fang Zhang Oyedolapo Anyanwu Zhongyu Li Dariush Mozaffarian Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives Frontiers in Public Health food is medicine medically tailored meals enrollment analysis qualitative research health equity (MeSH) |
| title | Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives |
| title_full | Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives |
| title_fullStr | Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives |
| title_full_unstemmed | Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives |
| title_short | Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives |
| title_sort | facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 medicaid pilot clinic staff perspectives |
| topic | food is medicine medically tailored meals enrollment analysis qualitative research health equity (MeSH) |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1526564/full |
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