Can Chef-Made Meals Serve as Medicine? State’s Low-Income Insurance Aims to Find Out

Chef Rudy Ruiz prepares low-sodium meals of beef stroganoff at the Project Angel Food kitchen in Hollywood, July 18, 2018. Photo Credit: Tony Sapien.

On a recent morning northeast of downtown Los Angeles, Nick Cuccia turned his Volkswagen down a small alley. Cuccia, a retired editorial staffer for the Los Angeles Times, parked and unloaded a box from the trunk.

Inside was a week’s worth of chef-made meals for Jorge Marroquin, a 64-year-old retired factory worker who is in frail health. Marroquin is one of a handful of patients participating in a new state initiative that aims to keep low-income patients with congestive heart failure out of the hospital. Called “Food is Medicine,” the Los Angeles pilot program is operated by the local nonprofit Project Angel Food.

Headquartered in Hollywood, Project Angel Food received a $150,000 grant from the Medi-Cal health plan L.A. Care for startup purposes and will receive up to another $250,000 annually from the state to prepare meals for the program, according to Richard Ayoub, its executive director.

The three-year pilot project is being funded by the state of California to the tune of $6 million, with the intent of finding whether what is known as a “medically-tailored diet” can keep those with chronic illnesses out of the hospital.

In California, the overall hospital readmission rate for all patients was 14.5 percent in 2016. But among the Medi-Cal population, it’s 15.7 percent, according to data from the California Health and Human Services data portal. By comparison, the readmission rate for those with private insurance is 10.4 percent. Even before Medi-Cal coverage was dramatically expanded under the Affordable Care Act, readmissions were costing the program $10 billion a year.

Nationwide, 20 percent of patients with congestive heart failure are readmitted after a hospital discharge within 30 days, and half within six months.

The pilot project will focus on patients with congestive heart failure and is expected to serve about 1,000 Medi-Cal enrollees in all, whose hospital readmissions will be closely monitored. Aside from Project Angel Food, other pilot project participants include Project Open Hand in the Bay Area, the Ceres Community Project and Food For Thought in counties north of San Francisco, The Health Trust in Santa Clara County and Mama’s Kitchen in San Diego County.

Medi-Cal enrollees in the program began receiving meals in May, Ayoub said. The enrollees receive the meals free of charge. So far, just four patients are enrolled in the Los Angeles County program, but it aims to eventually serve 60. Patients must fit within a fairly narrow criteria and have been admitted to the hospital for congestive heart failure issues at least twice in the past year, but no more than six times. They also can’t have major food allergies, aortic stenosis or kidney disease. The patients must receive their first meal within a week of their last hospital discharge in order to measure how the meals are impacting their health.

Project Angel Food already prepares meals for low-income people with a variety of health problems, and its kitchen at its Hollywood headquarters cranks out some 1,350 meals daily, a tidy process centered around five Wolf restaurant stoves welded together to maximize efficiency. But with the new Medi-Cal initiative barely off the ground for now, the meals for congestive heart failure patients are more of an artisanal effort.

As a result, chef Rudy Ruiz on a recent morning was preparing just eight servings of beef stroganoff. The ground beef being employed was nowhere within peeking distance of the top of the saucepan.

“The underlying premise is to do no harm,” said Ruiz, 32, a graduate of Le Cordon Bleu in Pasadena who’s been cooking for Project Angel Food full-time at its Hollywood kitchen for the past four years.

The meals pose a gastronomic challenge to Project Angel Food: Prepare 14 lunches and dinners a week for patients that contain two grams or less of salt a day. A single hot dog can contain more than a quarter of that amount.

Although the heart’s primary task is to pump blood, that function ensures that organs, such as the kidneys, work properly and that fluids are properly disposed. With the diminished circulation of congestive heart failure, patients are always at risk of fluid build up, and can even drown in their own bodies. Salt encourages fluid retention.

The beef stroganoff recipe prepared by Ruiz contains salt-free beef bullion. It is flavored with shallots, cider vinegar, pepper and cooking wine. Neufchatel, a light version of cream cheese, replaces sour cream. There are no noodles. The portions themselves are relatively small; about the same size as one of the more petite frozen dinner lines.

Procuring the raw ingredients for the meals has been somewhat of a logistical challenge. “The lean pieces of protein have to be bigger than usual compared to the other (meals we prepare), so we’re buying bigger pieces of meat,” Ayoub said. Some vegetables are off limits. A stalk of celery—a symbol to many of healthy eating—has 32 milligrams of sodium.

Ayoub said the best of the meals is a spaghetti bolognese. It was served at a media event kicking off the program and many attendees went for seconds, he said.

But that and the beef stroganoff dish are nearly a one-off in Southern California, where bacon wrapped hot dogs and miso ramen are among the local delicacies. Another favorite, an In-N-Out double double cheeseburger, contains a gram-and-a-half of salt. That’s without fries.

“In the Latino culture, food is full of salt,” said Cynthia Marroquin, Jorge’s 34-year-old daughter. “Now it’s essentially eating zero salt.”

Already diabetic, Jorge Marroquin suffered a heart attack last fall and now suffers from congestive heart failure. When Cuccia stopped by to deliver the meals, Marroquin was at the doctor and would actually be admitted to the hospital later in the afternoon.

Cynthia Marroquin put the meals in the fridge for him. “We’re so grateful for this service,” she said, adding that her father has regularly visited the hospital emergency room, often in great pain. “My mom is busy, the rent is going up, and we were worried about what we were going to feed him. He was starving. This is a blessing.”

Among the meals delivered for the week were chicken and apple stew, chicken and rosemary, brown rice, egg noodles, stuffed zucchini and green beans.

Although the patients are grateful for the meals, whether they enjoy them or not is another question. According to Cynthia Marroquin, her dad thinks they’re dry. During July 4th, when all the neighbors were grilling, he pined for grilled meat, she said. Salsa is another food he desires, she added.

Jorge Marroquin shares the apartment with Cynthia, who recently moved in with her newborn daughter, and his wife Maria, who has been working multiple jobs since her husband became ill. With limited time to cook meals from scratch, it has been a challenge to keep Jorge on a low-sodium diet, Cynthia Marroquin said.

“We tried to feed him properly, but it was too difficult,” she said. “There needed to be more discipline and more restraint.”

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