Health on a Plate with Medically Tailored Meals

Join us as we explore the transformative world of medically tailored meals with Lisa Johnson, a seasoned dietitian and Director of Food Services at Homestyle Direct. Lisa sheds light on how these specialized meals are crafted to meet the nutritional needs of individuals with chronic conditions like COPD, heart disease, and diabetes. She explains that these meals are not just about sustenance but are designed to improve health outcomes and reduce healthcare costs.

We also discuss the pressing issue of food insecurity, which extends beyond mere hunger to include the consistent availability of nutritious food. Lisa shares compelling statistics, revealing that recipients of medically tailored meals are significantly less likely to require emergency or hospital care. This episode provides practical advice on accessing these meals through healthcare providers or private services, ensuring that listeners understand their options.

Tune in to discover how medically tailored meals can enhance quality of life and support those facing food insecurity. Don't miss it!

Please Visit:  homestyledirect.com

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Transcript

Darleen Mahoney [0:41 - 1:10]: And today we are joined by Lisa Johnson with Homestyle Direct. She has been a dietitian for 39 years, working in many areas of the nutrition spectrum, including critical care, nutrition, veterans health, long term care. She is the director of food services, diabetes care, eating disorders, and most recently, medically tailored meals and menu development for Home Style Direct. Thank you so much for joining us today on the podcast, Lisa. 

Lisa Johnson [1:10 - 1:12]: Thanks, Darlene. I'm happy to be here. 

Darleen Mahoney [1:12 - 1:49]: Yes, absolutely. And I know you've joined our podcast in the past and they have all been absolutely delightful. You bring so much information to our listeners. So I'm so glad you were able to join us again today. Thanks. Yeah, absolutely. And we're going to talk about medically tailored meals because it's something that we have found people are super interested in and it's not that complicated, but really understanding what they are and if it's something that's right for our listeners and then how to obtain them, I think are some of the key, key critical points. Am I correct in that? 

Lisa Johnson [1:49 - 1:50]: Okay. Yeah. 

Darleen Mahoney [1:50 - 2:00]: Yeah. Okay. So starting out with super simple, what is the definition of a medically tailored meal? 

Lisa Johnson [2:01 - 3:09]: So the nuts and bolts of a medic medically tailored meal are really about a meal. It can also be a grocery box or they call them food pharmacies, but some type of nutrition that's designed to provide a specific, a specific meal for an individual who usually has some underlying chronic condition. So examples would be, let's say copd, congestive heart failure, heart disease, diabetes. And the other part to this is in general, these meals are set up for people who also have what I would call some type of socioeconomic issue. So maybe they're homebound, maybe they're food insecure, and they don't have money for meals. And so this meal is created to stop the gap for that person, provide nutrition related to a specific disease state. And in our case for Homestyle Direct, actually get food to them in the home. 

Darleen Mahoney [3:09 - 3:24]: Okay, so I do want to cover that really quick again, because I've heard the term food insecure. So for those that don't know what that means, you kind of slightly covered that, but just kind of touch on that again, if you don't mind. 

Lisa Johnson [3:25 - 4:20]: So my definition of food insecurity would be someone who either doesn't have access to food, so let's say they live in what we would maybe call a food desert. Maybe they're out in rural America, they don't have a grocery or they don't have other types of food sources available. It can also Be that they don't have the funds for the meals. So they're on a fixed income. They're not able to buy and provide all of the nutrition that they need. Remote meals can be as few as one a day to as many as three a day, depending on the person's needs. But what we're really talking about is someone who either because of ability, maybe a disability and they can't drive to the grocery to pick up their food or money, doesn't have access to adequate nutrition. 

Darleen Mahoney [4:21 - 4:36]: Okay, yeah, I appreciate that because I've really heard that term for a long period of time and thank. I had a pretty good idea of what it was, but not 100%. So I appreciate the clarification on what that means. So some of our folks listening may have that and they didn't even realize it. 

Lisa Johnson [4:36 - 5:49]: Sure. And generally how the medically tailored meal program works is that at some level either let's say you're admitted to the hospital with say congestive heart failure and say the social worker, maybe the physician, the nurse picks up on some of these triggers, you know, not having access to food, not being able to get out and get the food, maybe having monetary issues, they make a referral for that person to a program, either Medicare, Medicaid or some other type of home service program. That person then gets looped into the system, if you will. They generally receive, receive some type of diet, prescription or waiver saying you can have X amount of meals for X amount of time and then they get referred to a company or a meal provider and, or they make the choice of the meal provider that they want and they're set up on a system. Okay. In most cases these meals aren't forever. You know, they are a limit, limited time, duration type program. 

Darleen Mahoney [5:50 - 6:00]: Okay, so, okay, so as far as like stats and studies on food as medicine and how does it improve your health? 

Lisa Johnson [6:02 - 6:14]: So this is an up and coming program in terms of looking at how does food make impacts in people's lives and. 

Darleen Mahoney [6:14 - 6:14]: Right. 

Lisa Johnson [6:14 - 7:44]: And what the cost savings are. The American Heart association has set up a sort of a ten year plan. They became pretty aggressive on this in 2023 and their ten year plan is 2033 where they're hoping to really address and have people in the system to see the benefits of some type of meal program if they either need a special diet and, or they don't have access to food. But in general you can look at things when you look at like Meals on Wheels and you look at some of the stats, a person that's put on a program that provides adequate nutrition and or a disease specific diet, is 58 less likely to go to the emergency room, 49% less likely to require some type of hospitalization and 72% less likely to need to be admitted to a nursing home facility for care. Especially if the main driver of whatever their problem is is nutrition. If there's nothing else wrong with them other than they don't have access to food, having meals delivered to the house fixes that for them. Improves quality of life, improves social communication and interaction with others and definitely improves their nutritional status overall. 

Darleen Mahoney [7:45 - 8:17]: Yeah. Because I think that seniors, especially if they're home, they're alone and they're, I want to say aging in place and they don't have a caregiver that's making sure that they're eating properly. They're more likely to have what I call grab and go food which is packaged and probably not super healthy. Sure. So they're not getting the proper nutrients and probably not eating that much because I think seniors sometimes when they get older and they're staying at home by themselves, they're probably not eating a lot of food. So. 

Lisa Johnson [8:17 - 9:15]: Yeah, I would agree. I mean I even notice it in myself somewhat having been snow bound for the last three or four days. You're less likely to, I mean maybe I make a meal stretch, two meals or you, you, you don't have any fresh veggies so you make something that's easier to make that's shelf stable and may have more salt and fat in it. And so it's really important to be able to get variety out. I like to think of of home delivered meals as having some crunch and munch which we tend to give up if because it's more expensive. It's more expensive to have fresh fruits and veggies, it's more expensive to have breads and some of the cereals and those and grains and so if you can include those in a meal, you provide more variety to the overall diet. 

Darleen Mahoney [9:15 - 9:38]: Yeah. And if you don't have to go in there and make something from scratch, you know, adding the seasonings and doing this and cutting it up and all the things, sometimes you're more likely to, to eat it if you don't have to go in there and prepare, especially if it's just for one. I know that I myself, if I'm just cooking for just myself, I'm not going in there and making a big old meal. It's just not happening. So. 

Lisa Johnson [9:38 - 9:38]: Exactly. 

Darleen Mahoney [9:38 - 10:23]: Yeah, yeah, 100%. So what are some of the risk factors for poor nutrition, I know that we covered them slightly, but some of the more basic ones, I know that, you know, clearly affordability for food, food costs have gone through the roof. I mean, there's no denying that I can run to the store and walk out with a bag and it's 50 bucks. I'm like, 50 bucks of what? What. What's in this bag? You can't even make a meal with what's in this bag sometimes. It's crazy. So it's gotta be really hard for folks that are especially on very limited income. And we know our seniors are definitely on limited income. So what are some of the other factors that. That can come into play? 

Lisa Johnson [10:23 - 11:19]: Ethnicity. So cultural issues with. With a diet safe, you know, typical foods that they like to eat may not be available in the location they are. We refer to food deserts. So lack of availability for food. There's also the term food swamp, which is lots of food is available, but it tends to be highly processed, higher fat, higher sugar foods, geography. So rural versus, say, inner city and what's available. Time, disability, you know, so maybe the person not having any method of travel to get to the grocery store and maybe not being able to walk are all constraints that can affect the person's ability to get food. 

Darleen Mahoney [11:20 - 11:59]: Right. And, you know, you mentioned the poor or the food deserts where it's like unhealthier foods that kind of plays sometimes into the income because we know those unhealthy foods are cheaper. It's much. You can buy chips and some of the processed bagged foods, and you can get bulk on that kind of stuff, less expensive than if you were to buy a bag of apples or oranges or, you know, some of the more nutritious items. I think you can. It seems to go farther if you're buying the. The processed foods is what I'm getting at. 

Lisa Johnson [12:00 - 12:43]: Right. Generally when I'm talking with people and we're. We're cognizant, I guess, of healthcare conditions. You're telling people to roam the outer edges of a grocery store, stay away from the inside. And outer edges of the grocery store tend to be more expensive. Stuff's fresh and it. It requires cooking and whatever. The nice thing about having a meal delivered is that instead of having to buy a bag of apples that you, as one person may not eat before the apples go bad, you say get applesauce or you get apple slices in your meal. And so you have more variety, more choice, and it's all put together for you. 

Darleen Mahoney [12:43 - 12:46]: I like all put together for you? 

Lisa Johnson [12:46 - 12:46]: Yeah. 

Darleen Mahoney [12:47 - 13:02]: I would take that any day of the week. I'm telling you, just cooking is not my thing. So I, you know, I raised my kids. I did it, and I think, okay, they're gone now. I shouldn't have to do it anymore. But, you know, unfortunately, it never ends. 

Lisa Johnson [13:02 - 13:32]: Right. I love to cook, but I guess I just don't see the value in cooking for just myself. If everybody comes home or I'm somewhere where there's more people, I love to do it. But for just me, I agree. It's. It's easier to pop something that's all complete all in one box into the microwave, cook it up, and have it, and then snack on a salad in addition to. To get my fresh fruits and veggies. 

Darleen Mahoney [13:33 - 13:55]: Yeah, absolutely. Absolutely. You know, you're like me. I get the. I sometimes get the bug to do it, but I want to be in the mood to do it. I don't want to do it because I have to do it. I don't want to do it to survive. I want to do it out of joy. And that doesn't strike me very often, so. And I'm not a great cook, so I'll be all excited and I'll make something, and I'm like, well, this doesn't taste amazing. So. 

Lisa Johnson [13:55 - 13:59]: Right. Go to is I love to bake. 

Darleen Mahoney [14:00 - 14:01]: Yes. 

Lisa Johnson [14:01 - 14:17]: And the problem with that is that if you bake a batch of cookies or you bake a loaf of bread, my second go to is carbs and bread and desserts, then you eat it all. And so it's just easier not to do it. 

Darleen Mahoney [14:17 - 14:30]: Yes, 100%. And it's the craziest thing is my kids. Well, my son specifically was never a fan of the dessert, so I would bake them, thinking, I'm going to be a good mom. I'm baking cookies. And then he wouldn't eat them, so I would eat them just to get them out of the house. 

Lisa Johnson [14:30 - 14:32]: Exactly. Yeah. 

Darleen Mahoney [14:32 - 15:39]: Oh, my gracious. Oh, my gracious. All right, so when you're talking about medically tailored meals. So just to clarify, for those listening, medically tailored meals are not something that you go to the grocery store and buy or you. They are really something that is delivered to your home, because you keep mentioning that. So just to clarify, a medically tailored meal is something that you also don't necessarily just go online and go, da, da, da. I have diabetes. I want a medically tailored meal. It's something. How do you access that? So that's kind of something you touched on at the Very beginning. And if it's something that, you know, if you have diabetes and you feel like you don't have access to the right amounts of food or the food that's good for you, you're on a low income or some of these different risk factors that we just touched on qualify for you and you have, you know, some different issues medically, who would that person talk to to see if it's something that they can potentially qualify for or what have you? 

Lisa Johnson [15:39 - 17:31]: So there's essentially, there's two different routes to kind of go about getting this. There's the situation that you're mentioning where the person is, let's say they're an older adult, they're in the system, they're seeing a provider for diabetes, they may be on Medicare or Medicaid. They would contact their provider, their physician, their nurse, their clinic, wherever they're being seen to see if they qualify for medically delivered meals as part of their health care program. Some insurance companies also cover on the private side. But you can also, you could be me with prediabetes and I could go, I, I probably wouldn't go to a service that's generally being funneled into say Medicare or Medicaid, but all kinds of Homestyle direct or not Homestyle Direct, Home Chef, Now Blue Blue Apron. Different food vendor home delivered programs are also creating meals that are specific for different disease states that, that you can private pay for. So you or I could go get meals as well. And if you do a Google Google search on medically tailored meals, you're going to get the gamut. You're going to get programs where you, you can pay for it. On the private side, you can, you can buy meals month to month and, or you may qualify through some type of waiver or insurance program or you can go to a program that's more what I would call general population. But within those meals that they provide, they identify ones that may be lower salt, maybe heart healthy, maybe diabetes friendly, lower carb. 

Darleen Mahoney [17:32 - 17:37]: Okay, but they do have the ones that are available through Medicaid. 

Lisa Johnson [17:37 - 17:38]: Correct. 

Darleen Mahoney [17:38 - 17:40]: Okay. And that would be going to your. 

Lisa Johnson [17:40 - 17:47]: Physician, your physician, your nurse, wherever you're being seen as an entry into the healthcare program. 

Darleen Mahoney [17:48 - 17:55]: Okay, that's very cool. And how long medically tailored meals have not been around for very long. How long have they been around and available? 

Lisa Johnson [17:57 - 18:36]: Well, it depends on how you want to look at that. When I was a student in dietetics, as a dietitian, when you say medically tailored meals, I think about a meal that meets some type of disease problem, maybe an allergy, you know, maybe you're trying to stay away from gluten because of allergic responses. So in this, in a really general way of looking at these diets, any food that's designed to, to address some type of underlying medical condition could be a medically tailored meal, if you will. 

Darleen Mahoney [18:36 - 18:36]: Yes. 

Lisa Johnson [18:37 - 19:01]: Okay, so there's that. But in terms of a movement to address the aging population and the growing need for people who are food insecure actually having food to eat, I would say it's been the last 20 or so years, and it certainly has ramped up in the last five to 10. 

Darleen Mahoney [19:02 - 19:28]: Right. I feel like maybe. Because you're right. Exactly. The medically tailored meals. And I guess that what I was referring to, I think was more the programs created for medically tailored meals and the access that is now available to have them delivered into homes for those that need them. So maybe the word, the program side of it, it's become. 

Lisa Johnson [19:28 - 20:41]: Right, it's probably within the last 20, 25 years that that's really okay, a big deal. And where insurances, Medicare and Medicaid and private insurance have actually carved out portions of their benefits to provide reimbursement for those types of things. And I think it's all being driven by the fact that if I can give you a month's worth, let's say you come into the hospital with congestive heart failure and I can give you a month's worth of sodium, appropriate diets and actual stable food for you to eat for 30 days when you go home, the likelihood that you'll come back with some severe exacerbation of that congestive heart failure within like four to six months goes way down, as opposed to me sending you home. And let's say you don't have ready access to food, let's say you're doing soup, which we know tends to have more sodium in it than some other foods, the likelihood that you might show up in the ER within 30 days is probably pretty high. 

Darleen Mahoney [20:42 - 20:45]: Exactly. So it really actually saves them money at the end of the day. 

Lisa Johnson [20:45 - 20:46]: Exactly, exactly. 

Darleen Mahoney [20:46 - 20:46]: Yeah. 

Lisa Johnson [20:46 - 20:47]: Exactly. 

Darleen Mahoney [20:47 - 20:59]: Yeah. And it keeps you healthy. It would be nice if we started out with medically tailored meals at like the age of two, and then we might avoid altogether some of our physical issues. 

Lisa Johnson [21:00 - 21:47]: Exactly. I think that. And again, it's back to access. So a growing part of medically tailored meals is actually addressing high risk pregnancy and moms who may not have access to the appropriate types of foods during the pregnancy and post pregnancy and or have diabetes. I mean, type 2 diabetes is a significant complication in high risk pregnancy. And so we have members that are joining because of that. You know, that we're trying to get food to them throughout the pregnancy to make sure that they're adequately nourished and we minimize any disease complications. 

Darleen Mahoney [21:48 - 22:36]: Yeah, yeah. Oh my gracious. So the cost savings for insurance companies increases the health benefits for people that are having medical issues. So those are some of the clear benefits. So if that's the case, what if someone has some of these issues, the diabetes. Is there a option or a possibility for the long term ability to receive meals as. I don't know, excuse me, almost want to say, like, almost as a lifestyle where you say I have diabetes, I want to continue with some of these meals just to kind of continue to keep my diabetes in check. Is that, is that an option? 

Lisa Johnson [22:36 - 24:01]: It is a, it can be a part of their, whatever their insurance program is and, or I mean, as a private pay person, you could buy, buy them forever. But on an insurance program it's all about the qualifying event. You know, do you, do you have a disability? Are you food insecure and you don't have money? Do you not have access to food and do you have some type of underlying disease condition? And if you meet whatever the trigger points are for that particular insurance program that you're on, the meals can continue. They may need to be recertified periodically. Most of our programs, I think it's probably between three to six months that they need to have some type of recertification. Oftentimes it's just a recheck with a dietitian. So you get the person referred. And as a part of the rollout of the meal program to them, they actually spend 30 to 60 minutes with a dietitian kind of getting a diet history, kind of figuring out where they are at in terms of access to food, what things do they eat in addition to their meals? And then you set up the meal program for them and then you may check back with them in 60 days to see is it making a difference? 

Darleen Mahoney [24:02 - 24:04]: Oh, there you go. Is it making a difference? 

Lisa Johnson [24:04 - 24:49]: Right, yeah. You know, and I think in terms of like funding and whether this is really valuable, a check back at some point to see are there hemoglobin A1Cs going down, are their blood sugars better managed, did they have a healthy baby, is their blood pressure better, is their cholesterol down? All of those things that you can look at to target and say this made a difference in this person's life are helpful and Certainly probably welcomed by insurance to say we're spending, let's say, $10ameal for this person and we're saving thousands of dollars by keeping them out of the hospital. 

Darleen Mahoney [24:50 - 24:59]: Exactly. I feel like, especially with diabetes specifically, that that would be very beneficial for any insurance company to kind of look at that over. 

Lisa Johnson [25:00 - 25:01]: Yes. 

Darleen Mahoney [25:01 - 25:09]: Yeah. Especially as seniors grow older, diabetes can definitely be something that can be very problematic. 

Lisa Johnson [25:09 - 25:10]: Exactly, exactly. 

Darleen Mahoney [25:10 - 25:19]: If not taken care of. So when you're talking about meals, is this like one meal a week, one meal a day, three meals a day? What does that typically look like? 

Lisa Johnson [25:20 - 25:48]: So I would say the most infrequent would probably be one meal a day. So seven meals a week. The average is probably two meals a day. And there are, there are people who qualify for three meals a day. They have no access to food. They're so food insecure that they receive a meal for every, you know, they get breakfast, lunch, and dinner, essentially. 

Darleen Mahoney [25:49 - 25:50]: Wow, that's pretty cool. 

Lisa Johnson [25:50 - 25:52]: Yeah, yeah, yeah, yeah. 

Darleen Mahoney [25:52 - 25:59]: That's really nice. So what. So give me just a few, if you don't mind, a few examples of what, like, a breakfast might look like. 

Lisa Johnson [25:59 - 26:15]: Like, so a breakfast. In the, let's say, 55 and older group, most people like to have eggs. And these days, everyone likes to have eggs. And eggs are really expensive. So they are now. 

Darleen Mahoney [26:15 - 26:16]: Yes. 

Lisa Johnson [26:16 - 27:20]: Yeah. So our, our breakfast meals are really popular. They're behind like Mac and cheese and, and the cheeseburger. I think our breakfast meals are probably the most popular. So one example would be a scramble with like turkey, ham, spinach, a little bit of cheese. So that egg scramble, a corn tortilla maybe. Currently we're serving it with a, what I call fiesta hash. So it's a sweet potato with kind of a black bean, kind of a, I guess, Mexican flavor type side and say strawberries, diced strawberries. Or you could do something fun like a whole grain morning berry scone with like an egg bite. So little individual kind of crustless mini quiches with egg and cheese, maybe a low fat chickenleaf sausage and some type of maybe diced mango on the side. 

Darleen Mahoney [27:21 - 27:24]: Every time I talk to you on a podcast, you make me hungry. 

Lisa Johnson [27:26 - 27:28]: It's breakfast time. 

Darleen Mahoney [27:28 - 27:57]: I was going to say, I haven't had anything to eat yet this morning and I'm going, yeah, I'm going to have to go scramble some eggs. I think so. Yeah, I love that. So it is. It's a hearty. That's a hearty breakfast to an extent. It's not like, oh, here's your piece of Toast and have a great morning. So that's a nice breakfast. That sounds delicious and it has to be delicious. So it's not that you're getting something that's not taste that tastes well or tastes good. 

Lisa Johnson [27:57 - 27:58]: Right. 

Darleen Mahoney [28:00 - 28:10]: So yeah, so it has to be delicious as well. So that's one of the goals that I know Homestyle direct that that you target when you're preparing some of these meals. Correct. 

Lisa Johnson [28:10 - 28:54]: Right. So there's a balance between taste and finding things that are are tasty and flavorful. Also remembering that it's going to be frozen. And so thinking about re therming and how food reheats and will the flavors still be there upon reheating. But the other piece to this is especially when you're talking about Medicaid and reimbursement for meals. So if the person is is trying to get a meal service that is essentially free for them as a qualifying thing, there are nutritional standards that have to be followed. 

Darleen Mahoney [28:55 - 28:55]: Right. 

Lisa Johnson [28:55 - 30:02]: So most of what drives how we do our business is based on the Older Americans act for, for food reimbursement from the federal government and the requirements there that it meet the dietary guidelines for Americans for the age group that you're serving that have x, has a certain amount of calories, has a variety of nutrients, both micro and macronutrients, and all kinds of things like iron and fiber and those types of things. So in general, these meals are coming in either the meal itself or the meal with say, a supplement. So maybe a snack with it. In our case, we serve something called power oats, which is a serving of oatmeal. These meals are coming in at like 650 calories. So even for the person that gets one meal a day, that's pretty significant if you're an older adult. And they may split the meal and eat it over over two different sittings. But that's a significant source of calories. 

Darleen Mahoney [30:02 - 30:15]: Yeah, absolutely. Yeah. For three meals at 650 per meal. For three meals that for some seniors that can be. Because they can sometimes get to the point where they're just not big eaters. 

Lisa Johnson [30:15 - 30:55]: No, they aren't. The dietary guidelines for 55 and over for that age group average like 2100 between male and female, which is a lot. When you're talking about numbers, it sounds like a lot. I think one of the benefits of getting a meal service is that it doesn't probably visually because it's a tray, you know, it's a size tray and everything's in the tray. It probably isn't as Visually daunting. As if you had a big dinner plate and you're putting all your food on your dinner plate and somebody tells you you need to eat all this. 

Darleen Mahoney [30:55 - 31:15]: Yeah, yeah, I know I've talked about that in the past that, you know, in this country we do the big dinner plates and think that's normal sized food. Where if you really just made your plate smaller and filled it up, that's probably actually the amount of food you should be eating. I think we fill up a dinner plate and it's just a lot of food. 

Lisa Johnson [31:15 - 31:15]: Right. 

Darleen Mahoney [31:15 - 31:16]: Yeah, yeah. 

Lisa Johnson [31:17 - 31:51]: The 9 inch, the, the 8 to 9 inch plate is probably, you know, just think about if you went to a buffet somewhere and all of the plates were salad plates, you obviously would eat less each sitting. And I would argue that if you allow your digestive system to respond to what you're eating, you would stop sooner. Yeah. You know, people will say, well, if it's a smaller plate, I'm just going to go back, you know, three times. Well, after the first plate, you may be full and never go back, so. 

Darleen Mahoney [31:52 - 31:57]: Exactly. I absolutely agree with you because I've experienced that. I think you should always put smaller plates at the buffet. 

Lisa Johnson [31:58 - 31:58]: Yeah. 

Darleen Mahoney [31:58 - 32:03]: And some people do, and they're smart with that because they're probably saving money versus putting the big plates at the buffet, so. 

Lisa Johnson [32:03 - 32:04]: Exactly. 

Darleen Mahoney [32:04 - 32:16]: Yeah, exactly. So before we finish out this podcast, is there anything that we didn't talk about that you think it's important for our listeners to hear? When it comes to medically tailored meals. 

Lisa Johnson [32:20 - 33:09]: One of the big advantages of the push for medically tailored meals is to move people from, I guess what you could call food sufficiency. So when we're trying to address things like hunger or availability, just having something to eat meets that need. But that may not always be the best thing. As we move into medically tailored meals and provide food service for people, we move them to a state where they're actually getting a healthy meal. They're getting a meal that meets a nutritional need. And we elevate them to food sustainability, food equity, in that we're providing them what they really need. 

Darleen Mahoney [33:10 - 34:44]: Yeah, no, absolutely agree. So I do want to just mention once again before we sign off, that Lisa is with Homestyle Direct. Homestyle Direct does provide these meals directly into homes. And I'm going to provide the website, which is correct, homestyledirect.com that link will be available in the description no matter what app that you're utilizing, so you can go and check it out. And it does have a link and I'll include that as well if you are buying direct as a consumer. So I'll put that in there so you can check it out and you can actually look at the menu on there as well to see if there's some delicious meals that you would like to have come direct to your home. So I'll include that. But they do a wonderful job over there and they have some really nutritious meals that might fit exactly what you're looking for for whatever medical issues that you might have as well. So definitely check that out. So thank you so much for joining us today, Lisa. I really appreciate it. I love doing podcasts with you. You always bring such great information when you do and like, like I said, you always make me hungry when we're on together. So thank you again for joining us. If you enjoyed this podcast, please feel free to listen to more of our podcasts. We are actually going into our fifth season. We have almost 100 podcasts available for you to listen to anywhere you enjoy podcasts such as Spotify, Apple Podcasts, good pods and more. Thank you for listening.