ROI Calculator for Food as Medicine

Diet ID has developed a calculator to forecast the annual healthcare cost savings associated with improvements in diet quality as a result of a Food as Medicine intervention. This calculator and its assumptions has been published in the American Journal of Health Promotion. View the abstract here.

By improving Diet Quality in a population, you can divert the onset of disease in at-risk populations and treat disease among those who are already diagnosed with a chronic condition. Doing so can provide significant savings in healthcare costs. Investing in Food as Medicine can provide significant return on investment in less than one year.

The inputs for the calculator:

  • Total Population: How many eligible lives your organization services

  • Cost Per Participant: How much an intervention can cost per active participant per year. Some digital-only solutions are low cost, e.g. $5-$15 per participant per year, while more intensive interventions such as medically tailored meals can cost $500-$1,000 or more per year. However these are just examples and do not reflect the actual cost of any specific Food-as-Medicine intervention.

  • Population Activation Rates: What percentage of the total population will engage with the services to help them improve their diet quality? The estimates can vary by type of population, type of environment (e.g. clinical vs. employer), and general participation rates. We typically see 10%-60% activation within a given population.

  • Improvement in Diet Quality: We typically see 5% to 20% improvement in diet quality in a given population. Diet quality is measured using Diet ID’s instant dietary assessment tool, which uses images and pattern recognition to develop a comprehensive evaluation of someone’s dietary intake, including an objectve measure of their quality using the Healthy Eating Index 2015 as the scoring system.

  • Disease Prevalence Rates: The default disease prevalence rates in the calculator represent the U.S. averages. If you know the prevalence rates in your population, you can adjust those values to generate a more accurate calculation.

Results

The calculator estimates annual cost savings associated with the improvement in diet quality across the population you entered. The years to achieve ROI is a simple calculation of the annual cost of the intervention divided by the annual savings.

Assumptions in the calculator

  • Improvement in diet quality by 1 tier in Diet ID leads to 10% diversion in Chronic Disease Cases

  • Chronic Condition-specific assumptions (Note: when we work with a client who has actual incidence and prevalence data on their population, we adjust the calculator assumptions to match the population’s actual chronic condition profile)

    • Obesity

      • Prevalence in the US: 40%

      • Annual incremental cost of treating Obesity: $2,000

    • Hypertension

      • Incidence: 2%

      • Prevalence: 45%

      • Annual incremental cost of treating Hypertension: $1,900

    • Type 2 Diabetes

      • Incidence: 1%

      • Prevalence: 40%

      • Annual incremental cost of treating Type 2 Diabetes: $9600

    • Coronary Artery Disease

      • Incidence: 1.2%

      • Prevalence: 7%

      • Annual incremental cost of treating Coronary Artery Disease: $19,000

  • Discount to account for overlap in costs for people who suffer from more than one chronic disease: 25%

FAQs

What is Diet Quality?

An objective measure of the healthfulness of how someone eats. Diet Quality is strongly correlated with disease risk, mortality, and projected healthcare costs.

How do you measure it? The Healthy Eating Index (HEI) Score

The Healthy Eating Index (HEI) is the most robustly researched and validated index to measure diet quality, and represents how well a set of foods aligns with key recommendations of the Dietary Guidelines for Americans. This tool scores diet patterns on a scale of 0-100 (100 is the highest score). It takes into account 13 components (food groups and nutrients) that correlate with the 2015-2020 Dietary Guidelines for Americans, which reflects the current body of nutrition science and is designed to help design a healthful diet. Diet ID measures Diet Quality on a 10-point scale-equivalent of the HEI 100 point scale.

Why Measure Diet Quality?

Assess risk of population, identify who should follow a prevention path, and evaluate cost savings and efficacy of interventions. Average Diet Quality of 5 (50-60 in the HEI index) maps to approximately 60% elevated risk for chronic disease. Improving diet quality by just decile = 10% reduction in incidence of chronic diseases.

Identify (potentially) high cost segments and project cost savings of interventions early

Diet ID’s 1-minute digital assessment can be deployed effortlessly at scale to quickly understand a population’s current diet quality and associated risk for future disease, project future changes, and track improvement over time. The web-based solution easily gathers critical information about who should receive interventions - identifying candidates earlier than biomarker analysis. The data generated by Diet ID can also rapidly measure efficacy of interventions and project cost savings well before the typical 2-year timeline to track ROI using claims data.

Diet ID’s Navigation platform is a longitudinal digital daily coaching experience that acts as an intervention to improve diet quality over time. It can be deployed as a stand-alone offering or can be paired with another nutrition intervention such as a healthy food provider.

Sources

  • Type 2 Diabetes incidence: ~1% per year and Prevalence - Adults, US: ~40%

  • Among US adults aged 18 years or older, crude estimates for 2018 were: 1.5 million new cases of diabetes—or 6.9 per 1,000 persons—were diagnosed.

  • Hypertension incidence: ~2% per year and Prevalence: 45%

    • Centers for Disease Control and Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. High Blood Pressure: Facts About Hypertension. https://www.cdc.gov/bloodpressure/facts.htm. Page last reviewed: July 19, 2021. Accessed August 11, 2021.

  • The prevalence of hypertension increased with age. The prevalence was 22.4% among adults aged 18–39 and increased to 54.5% among those aged 40–59, and 74.5% among those aged 60 and over. For both men and women, a similar pattern of increasing prevalence of hypertension by age was observed.

  • Coronary Artery Disease Incidence: ~1.2% per year and Prevalence: ~7%

    • Heart Disease Facts. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. https://www.cdc.gov/heartdisease/facts.htm. Page last reviewed: September 8, 2020. Accessed August 11, 2021.

    • Pandya A, Gaziano TA, Weinstein MC, Cutler D. More Americans living longer with cardiovascular disease will increase costs while lowering quality of life. Health Aff (Millwood). 2013;32(10):1706-1714. doi:10.1377/hlthaff.2013.0449. https://doi.org/10.1377/hlthaff.2013.0449

  • Roughly 10% reduction in incident chronic disease with 10 point (1 tier) improvement in HEI score

    • Wang DD, Li Y, Chiuve SE, Hu FB, Willett WC. Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999-2012; Overall Diet Remains Poor. Health Aff (Millwood). 2015;34(11):1916-1922. https://doi.org/10.1377/hlthaff.2015.0640

    • McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, Spiegelman D, Hunter DJ, Colditz GA, Willett WC. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002 Dec;76(6):1261-71. https://doi.org/10.1093/ajcn/76.6.1261

    • Fanelli SM, Jonnalagadda SS, Pisegna JL, Kelly OJ, Krok-Schoen JL, Taylor CA. Poorer Diet Quality Observed Among US Adults With a Greater Number of Clinical Chronic Disease Risk Factors. J Prim Care Community Health. 2020 Jan-Dec;11:2150132720945898. https://doi.org/10.1177%2F2150132720945898

  • Incremental cost of Hypertension

    • Kirkland EB, Heincelman M, Bishu KG, Schumann SO, Schreiner A, Axon RN, Mauldin PD, Moran WP. Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003-2014. J Am Heart Assoc. 2018 May 30;7(11):e008731. doi: 10.1161/JAHA.118.008731. https://www.ahajournals.org/doi/10.1161/JAHA.118.008731

  • Incremental cost of Obesity

  • Incremental cost of Heart Disease

    • Heart Disease Facts. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. https://www.cdc.gov/heartdisease/facts.htm. Page last reviewed: September 8, 2020. Accessed August 11, 2021.

    • Nichols GA, Bell TJ, Pedula KL, O'Keeffe-Rosetti M. Medical care costs among patients with established cardiovascular disease. Am J Manag Care. 2010 Mar;16(3):e86-e93. PMID: 20205493. https://www.ajmc.com/view/ajmc_10marnicholswebx_e86to93