# Impact of Medicaid ACO funding for health-related social needs on dietary quality and health

> **NIH NIH R01** · MASSACHUSETTS GENERAL HOSPITAL · 2021 · $649,201

## Abstract

Despite major advances in therapies, disparities in cancer and cardiometabolic outcomes continue to widen
due to differences in socioeconomic status. Food and housing insecurity are social determinants of health that
are associated with morbidity from obesity, diabetes, cardiovascular disease, and psychological stress, and
food insecurity contributes to income disparities in cancer mortality. Although the associations between social
needs and health are well-defined, there is a research gap as to whether policies or programs to address food
and housing insecurity, particularly through health systems, improve diet, obesity, health, and healthcare
utilization. Some states are experimenting with Accountable Care Organizations (ACOs) in their Medicaid
programs with the goal of incentivizing providers and organizations to deliver higher value care, and some
ACOs are starting to address social needs. In January 2020, the state of Massachusetts will, for the first time,
provide funding directly to Medicaid ACOs to address food and housing needs through the Delivery System
Reform Incentive Payment Flexible Services program. Implementation of this program is a natural experiment
that could provide important knowledge about the impact of state-level funding for food and housing needs on
diet and health outcomes. The main objectives of this study are to evaluate how the Flexible Services program
affects the dietary quality, psychological stress, health, and health care utilization of adult ACO participants and
to assess program implementation. The project will take place at five community health centers (CHCs)
affiliated with Partners HealthCare, a large health care organization that has contracted with the state as a
Medicaid ACO. The project is time-sensitive because the pre-program implementation assessment of diet,
stress, food/housing insecurity, and access to resources must be completed before program implementation in
2020. A total of 800 Medicaid ACO patients (Med-ACO) and 200 non-Medicaid CHC patients with food/housing
insecurity (Control) will be enrolled and followed for 4 years. Survey, 24-hour dietary recall (ASA24), electronic
health record (EHR), and claims data will be collected. Primary outcomes will be change in dietary quality,
stress, and food/housing insecurity (Aim 1) and change in body mass index, blood pressure, and acute health
care utilization (emergency department visits; hospitalizations) (Aim 2) comparing: a) Med-ACO participants
who screen positive for food/housing insecurity pre-implementation vs. Control, and b) Med-ACO participants
who screen positive for food/housing and receive Flexible Services (exposed) vs. Med-ACO participants who
screen positive but do not receive Flexible Services (not exposed). Aim 3 will assess implementation factors
that influence the effectiveness of the program, guided by the RE-AIM/PRISM framework. Results will inform
policymakers and researchers about the effectiveness of a novel state-level pr...

## Key facts

- **NIH application ID:** 10249260
- **Project number:** 5R01DK124145-03
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Anne N Thorndike
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $649,201
- **Award type:** 5
- **Project period:** 2019-09-17 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10249260

## Citation

> US National Institutes of Health, RePORTER application 10249260, Impact of Medicaid ACO funding for health-related social needs on dietary quality and health (5R01DK124145-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10249260. Licensed CC0.

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