Last week, the United States Preventive Services Taskforce (USPSTF) released its first-ever Draft Research Plan on Preventive Services for Food Insecurity (the “Draft Research Plan”). The Draft Research Plan, available for public comments until March 23, 2022, is an exciting step toward more sustainable coverage of Food is Medicine interventions across the country. This blog post explores the road ahead and the opportunities it may lead to.
What is the USPSTF?
USPSTF is an independent, volunteer panel of national experts that conducts research on preventive healthcare services and issues graded recommendations based on the certainty and efficacy of each intervention. These recommendations are developed in conjunction with the Evidence-based Practice Center (EPC) through a multi-step evaluation process that considers the peer-reviewed evidence on the preventive service in question and weighs the service’s potential benefits against its harms.
Why is USPSTF’s interest in preventive services for food insecurity important?
An “A” or “B” recommendation would open exciting new pathways for coverage of food insecurity interventions across the United States.
Understanding USPSTF Recommendations:
An “A” grade means the USPSTF recommends the service based on its high certainty of substantial net benefit. Examples include pre-exposure prophylaxis (PrEP) for persons at high risk of HIV acquisition, and screening adults for hypertension.
A “B” grade means the USPSTF recommends the service based on its high certainty of moderate net benefit, or moderate certainty of moderate to substantial net benefit. Examples include screening adults for unhealthy alcohol use in primary care settings, and screening asymptomatic pregnant persons for gestational diabetes.
Under the Affordable Care Act, most insured Americans are eligible to receive USPSTF “A” and “B” rated services at no additional charge to them (i.e., without cost-sharing). Nearly all private health plans are required to cover “A” and “B” rated services. States are required to cover all USPSTF “A” and “B” rated services for their Medicaid expansion population without cost-sharing, and have the option of covering these services for their traditional Medicaid populations as well. And, the Secretary of Health and Human Services (HHS) has the option to cover “A” and “B” rated services, without cost-sharing, for Medicare program beneficiaries.
Draft Research Plan Highlights:
The Draft Research Plan proposes systematically reviewing evidence on five key questions:
1. What is the effect of identifying food insecurity in primary care on health outcomes?
2. What is the performance of risk assessment or screening tools to identify food insecurity?
3. What are the harms or unintended consequences of assessment for food insecurity?
4. What is the effect of healthcare-related interventions to address food insecurity on food security, intermediate outcomes (i.e., behavioral, physiologic, and healthcare utilization outcomes), or health outcomes?
a. What are the effects of improvements in food security outcomes on intermediate and health outcomes?
b. What are the effects of improvements in intermediate outcomes on health outcomes?
5. What are the harms or unintended consequences of healthcare-related interventions to address food insecurity?
Also included in the Draft Research Plan is the proposed research approach—identifying the study characteristics and criteria that that will be used to search for studies and determine inclusion—and a series of additional questions that would help contextualize USPSTF’s deliberation and recommendation statement, such as moderators that affect the effectiveness of food insecurity interventions.
How can advocates inform the Draft Research Plan?
While USPSTF opens the process to public comments at several key points, comments on the Draft Research Plan are one of the earliest opportunities for the public to shape an intervention’s final recommendation.
As we describe in our recently-released Food is Medicine Research Action Plan, the volume and rigor of research evaluating food insecurity interventions has increased each year. We encourage advocates—especially those with expertise in Food is Medicine interventions research—to share their reflections.
To read the Draft Research Plan on Preventive Services for Food Insecurity and submit comments, click here.