OBJECTIVES

: Quantifying the value of a community program is challenging. This study estimated the value of a meal for a home meal delivery service targeted toward low-income, homebound seniors and quantified the health impact of the service on health conditions to determine the return on investment.

METHODS

: A virtual population, consistent with the demographics and health states of the clients served, was created. A validated, computational biology model of individual human metabolism was used to forecast the population’s health. The metabolism model continuously forecasts individual’s biomarkers (weight, FSG, HbA1c, blood pressure, lipids) as a function of daily diet (consumption of fats, carbohydrates, protein) over time to predict onset of diabetes, obesity, hypertension, and hypercholesterolemia.

Five year health trajectories of individuals with and without the meal service were simulated. Forecasted biomarkers were used to compare incidence and progression of chronic disease directly predicted by the metabolism model. A stochastic, agent-based model was developed and used to assign discrete health events (stroke, myocardial infarction, dementia) to individuals based on outputs of the metabolism model, individual demographics and reduction in loneliness resulting from visits by the service’s volunteers. The accumulated health conditions and acute events across the population were used to calculate healthcare costs over simulation period.

RESULTS

: Across a virtual population of 4,700 individuals, the simulation showed the service led to individual biomarker improvements, resulting in an overall 7% reduction in healthcare costs. Top health improvements contributing to cost reduction were cardiovascular (21%), dementia (25%), and home health and skilled nursing facility utilization (48%) resulting in an estimated annual ROI of 48% based on the current cost of the service.

CONCLUSIONS

: Historically, this service is known to qualitatively improve participants’ lives. This study begins to quantify the health and cost impact of a community program to support future decision making opportunities.