The Dollars and Sense of Making Diet Quality a Vital Sign

Contributors: Leanne Mauriello, PhD, Rachna Govani and David Katz, MD, MPH, FACPM, FACLM
To learn more about Leanne, Rachna, and David, click here.

 

The transition to value-based care requires tools and tactics to tackle disease prevention and health promotion efficiently in clinical encounters. We routinely measure and monitor vital signs to manage chronic disease progression, e.g., blood pressure, blood sugar, lipids, BMI, but we have yet to implement a more upstream diagnostic that facilitates chronic disease prevention and mitigation as a standard of practice. To deliver on the promise of value-based care, it is imperative that we do so.

Objectively measured diet quality is the single leading predictor of chronic disease and premature death in much of the modern world.1 We all know that how we eat affects our health, but how can a clinician get a pulse check in a standardized, low-friction way that generates a longitudinally tracked, discrete variable like blood pressure or BMI?

In 2020, the AHA published a statement recommending that diet be assessed and addressed at all clinical encounters.2 Little action has been taken because providers aren’t equipped to screen for diet quality at such scale. As Bailey (2021) delineates, each of the historical instruments to assess diet quality including food frequency questionnaires, 24-hour recalls, food diaries, etc., have substantial limitations, which have made their use at scale impossible.3 Until recently, all the methods accessible to measure the healthfulness of someone’s diet have been so burdensome for patient and provider that there has been no path to wide adoption.

How might we efficiently and effectively measure diet quality at scale? 

The optimal workflow to understand a person’s diet quality involves limited, easy, patient-reported data and would equip rather than burden the healthcare provider. Similar to the PHQ-9, a now standard depression screening tool, the current healthcare system needs less ‘paperwork’ but more data to power better, prevention-oriented decision-making in every clinical encounter.

Enter the invention of the patented and extensively validated Diet ID tool, and now diet quality can be measured and managed rapidly, reliably, and at great scale – in as little as 60 seconds. Through a sleek and simple-to-use, web-based assessment, patients select digital images that represent their typical way of eating.

The Diet ID system analyzes a person’s responses to report the Healthy Eating Index score, a robustly validated measure of overall dietary quality as it relates to health outcomes.4 Diet ID also generates nutrient and food group intake of over 200 foods and macro and micronutrients to generate a personalized, condition-specific, nutrition plan for each respondent and equips clinicians with access to critical data about the person’s dietary risk, details about current food intake, and details about goal food intake, empowering them to ‘address’ diet in a standard clinical encounter. Diet ID is also now integrated into Epic, to allow seamless workflow implementation of this critical metric.

The research on the validation and performance of Diet ID is robust.5-8 Further, when Diet ID has been deployed alongside digital and/or human-powered nutrition counseling, meaningful improvements in diet quality have resulted.9

Diet quality now can be measured and managed at scale and with substantial efficiencies, but what about the dollars and cents of the matter? What’s the business imperative? Healthcare, like other industries, must reap a positive financial return on investment to justify such significant transformation.

 

How does measuring and managing diet quality improve the economic headwinds facing healthcare?

There are several financial wins to scaling diet quality as a vital sign within traditional fee-for-service models as well as within value-based care models. This allows healthcare systems on either side or those straddling the old and new payment models to create a winning business case and generate a 95% margin on the investment needed to scale diet quality as a vital sign.

Increase utilization - identify those who need additional services

  • Increase engagement in disease management prevention and management programs with incremental billing (diabetes prevention program, diabetes education, cardiac rehabilitation)
  • Drive utilization of Registered Dietitian (RD) billable services and create vast efficiencies for those visits
  • Increase engagement of healthy consumers by offering “health” care in addition to sick care.
  • Improve patient experience by effectively addressing and supporting their lifestyle and offering opportunity for true health optimization

Improve outcomes to generate cost savings in standard care models

  • Empower primary care and other specialties to measure and improve diet quality in their populations.
  • Enhance risk stratification capabilities to include a metric that is relevant across the risk continuum and drive early intervention
  • Improve outcomes from medical procedures and reduce readmissions by intervening on diet quality

Save money

  • Reduce pharmacy spend when diet is measured and managed and disease is mitigated
  • Reduce time and resources needed to manually conduct dietary assessments by in-house RDs.
  • Improve diet quality in capitated populations to drive long-term healthcare cost savings.

Support providers

  • Improve provider fulfillment by equipping them with a meaningful yet efficient way to address nutrition and chronic disease that doesn’t require deep nutritional education

Reduce health inequities

  • Reduce health inequities by addressing not only food insecurity but also diet quality as low income and food-insecure adults are at increased risk for obesity and diet-related chronic disease.10 The financial case for measuring and managing diet quality is solid regardless of payment model and includes substantial direct and indirect return on investment. With the published return on investment calculator, you can do the math for your population and estimate the financial benefit for your organization to make diet quality a vital sign.11

With a scalable and effective method and a solid business case to support, the time is now for healthcare to address diet quality at every clinical encounter. By measuring and managing the root cause of chronic disease, providers will be equipped to counsel and empower patients to make incremental improvement to their diet and be able to monitor change longitudinally. With diet quality as a vital sign, a new way to curb the prevalence of chronic disease and the unsustainable healthcare spend, as well as a new standard of care, beckon.


Contact Leanne at: [email protected]
Contact Rachna at: [email protected]
Contact David at: [email protected] 

 

References

  1. GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958-1972. doi: 10.1016/S0140-6736(19)30041-8.
  2. Vadiveloo M, Lichtenstein AH, Anderson C, et. al. Rapid Diet Assessment Screening Tools for Cardiovascular Disease Risk Reduction Across Healthcare Settings: A Scientific Statement from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2020;13(9):e000094. doi: 10.1161/HCQ.0000000000000094.
  3. Bailey RL. Overview of dietary assessment methods for measuring intakes of foods, beverages, and dietary supplements in research studies. Curr Opin Biotechnol. 2021;70:91-96. doi: 10.1016/j.copbio.2021.02.007.
  4. Reedy J, Lerman JL, Krebs-Smith SM et. al. Evaluation of the Healthy Eating Index-2015. J Acad Nutr Diet. 2018 Sep;118(9):1622-1633. doi: 10.1016/j.jand.2018.05.019.
  5. Dansinger ML, Breton GL, Joly JE et. al. Rapid, Digital Dietary Assessment in Association with Cardiometabolic Biomarkers. Am J Health Promot. 2023; 11:8901171231156513. doi: 10.1177/08901171231156513.
  6. Radtke MD, Chodur GM, Bissell MCS, et. al. Validation of Diet ID™ in Predicting Nutrient Intake Compared to Dietary Recalls, Skin Carotenoid Scores, and Plasma Carotenoids in University Students. Nutrients. 2023;15(2):409. doi: 10.3390/nu15020409.
  7. Turner-McGrievy G, Hutto B, Bernhart JA, et. al. Comparison of the Diet ID Platform to the Automated Self-administered 24-hour (ASA24) Dietary Assessment Tool for Assessment of Dietary Intake. J Am Nutr Assoc. 2022;41(4):360-382. doi: 10.1080/07315724.2021.1887775.
  8. Katz DL, Rhee LQ, Katz CS, et. al. Dietary assessment can be based on pattern recognition rather than recall. Med Hypotheses. 2020;26;140:109644. doi: 10.1016/j.mehy.2020.109644.
  9. Govani R, Baptiste C, Katz D, et. al. How Digital Tools Can Help Scale Diet Quality Improvement in Home-Based Cardiac Rehab. J Am Coll Cardiol. 2023;81(8_Supplement)1641. https://doi.org/10.1016/S0735-1097(23)02085-5.
  10. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140(2):304-310. doi: 10.3945/jn.109.112573. Epub 2009 Dec 23.
  11. Katz DL, Govani R, Anderson K, et. al. The Financial Case for Food as Medicine: Introduction of a ROI Calculator. Am J Health Promot. 2022;36(5):768-771. doi: 10.1177/08901171211070751.