Medicare’s annual wellness visit was introduced in 2011 to promote evidence-based preventive care and identify risk factors and undiagnosed conditions in aging adults. The annual wellness visit (AWV) is a yearly visit with a primary care provider (PCP) to create or update a personalized prevention plan. The AWV is a fully covered benefit to increase preventive care among beneficiaries. This service may help prevent illnesses based on current health conditions and other patient risk factors. The AWV is not a periodic health examination in the traditional sense, as the required physical exam component is limited to the measurement of blood pressure and body mass index (BMI).
A physical exam helps your doctor figure out what the problem is and what needs to be done, but a wellness exam helps your doctor understand what’s working for you and how to best support your continued health and well-being. It also is a time when providers review existing health problems of patients and determine what health issues may become a concern in the future and how to prevent them.
As health care continues the shift towards value-based care, it is crucial for providers to find innovative treatments. An AWV plan is one way to improve health care outcomes and reduce costs. Here are some reasons why an annual wellness visit is important for patients and providers.
Benefit for Provider: A Revenue Source for Our Practices
The proportion of Medicare fee-for-service beneficiaries that used the AWV increased from 13% in 2013 to 24% in 2017. Users of the AWV had a marginally significant reduction in Medicare spending 12 months (−$122, 95% CI −$256, $11, p = 0.073) and significant reductions (−$162, 95% CI, −$310, −$14, p = 0.032) 24 months after the visit, relative to non-users. This is especially important in value-based cost savings contracts and shared savings programs. Practices adopting AWVs have noted increased revenue, more stable patient populations, and stronger provider-patient relationships. While utilization remains low, it is steadily increasing over time.
Benefit for Provider: Proper HCC Coding/Quality Metrics
The Health Risk Assessment (HRA), a part of the AWV, identifies high-risk factors for each individual completing the HRA and calculates an overall Wellness Score. The Centers for Medicare & Medicaid Services (CMS) uses the CMS-HCC (Hierarchical Condition Category) risk methodology. Given that patients with higher HCC scores and, therefore, a greater number of medical complications, have significantly higher costs, it may be useful for the clinical care team to review all of the diagnoses for all patients to identify those patients having medical conditions that may create significant costs. The AWV HRA is a perfect time to collect the ICD-9 codes necessary for CMS-HCC risk adjusting methodology.
There are many advantages for a physician to provide an efficient and cost-effective AWV HRA and CMS-HCC risk adjustment. There is significant reimbursement to deliver the AWV, provide the indicated preventive services, and identify and provide diagnostic tests to identify early chronic disease. Providers can receive incentive payment by providing the ICD-9/HCC codes to the plans. Higher risk scores can also be leveraged for increased reimbursement to care for sicker patients.
AWV also presents a value-added opportunity for practices because it can easily satisfy 11 of the required quality measures established by CMS. In addition, it achieves 25 Healthcare Effectiveness Data and Information Set (HEDIS) clinical quality and medication adherence measures identified by The National Committee for Quality Assurance (NCQA).
Benefit for Provider: Reveal Vital Health Information
Annual wellness exams are intended as a way for providers to get important health information from patients and determine appropriate health plans through health risk assessment. A health risk assessment, including demographic data, behavioral and psychosocial risks, activities of daily living (ADLs), and instrumental activities of daily living (IADLs), should be obtained during the first AWV and updated during all subsequent AWVs. The patient’s medical and family histories should be collected and documented during the initial AWV and updated at all subsequent AWVs. CMS also includes screening for all risk factors for depression as a component of the initial AWV. Evaluation of the patient’s functional ability and falls risk, using direct observation or screening questions, is also a key component of the initial AWV. This plan is similar to but separate from the one-time welcome to Medicare preventive visit. It also provides an opportunity to educate older adults through screening and prevention and to empower them to take an active role in their own care.
Benefit for Patient: Personalized Prevention Plan for Each Patient
One of the main components of the Medicare annual wellness visit is creation of a personalized prevention plan. After counseling the patient about a personalized prevention plan and screening schedule, the health care provider should then provide personalized health advice and referrals to programs for lifestyle interventions to decrease health risks and promote self-efficacy in ADLs, prevention of falls, weight loss, tobacco cessation, nutrition, and physical activity. The personalized prevention plan should be updated at each subsequent AWV. A patient satisfaction study found that the majority of patients reported the AWV met their expectations (88%), they would recommend this visit to friends and family (86%), and they would make the visit again within 6 years (88%). Also 62% of patients reported receiving new recommendations during their visit, 32% of patients reported the provider discovered new information about their medications, and 80% of patients plan on making changes or following at least some of the suggestions made by the health care provider.
Benefit for Patient: Increased Patient Satisfaction
The findings of a study have shown that patients who participated in the AWV had a positive experience and were satisfied with the visit and their health care providers. A possible reason of high satisfaction rates may be due to longer visits patients have with their provider, which allows time for developing preventive health care plans and clarifying health recommendations. One patient who is a part of Netrin Health’s network reports: “This visit allows my doctor to see the big picture of my health and make sure I am on the right track without costing me a dime.”
The Role of Accountable Care Organizations (ACOs) in Annual Wellness Visits
AWV will be attractive to ACOs and other potential health care partners who are looking for ways to increase quality and lower costs.
Netrin Health care managers ensure Medicare patients schedule and complete their annual wellness visit with their primary care physician. Our data analytics provides us up-to-date lists so that your patients do not miss a visit, and we help optimize your practice workflow and revenue based on your individual needs. Netrin Health care managers also are looking for ways to increase quality and lower costs as they broaden their geographic coverage and negotiate better contracts with value-based payers.
This rapid move toward value-based care delivery reimbursement will force practices to find ways to appropriately manage complex patients. Providing value-based healthcare starts with the annual wellness visit, which focuses on preventive care, screenings, and quality measures. Importantly, annual wellness visit is what Medicare uses to attribute a patient to a provider. Implementing the AWV will allow practices to establish baseline patient data, attain quality metrics and demonstrate the ability to successfully manage complex populations.
To learn more about how Netrin Health can help you succeed in value-based care, contact us today.
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Snyder, A. June 13, 2013. Seven Reasons Why the Medicare Annual Wellness Visit is Good for Physicians and Patients. Physicians Practice.
Simpson V., Edwards N., Kovich M., May 2021, Enhancing Annual Wellness Visit Outcomes: Patient Perceptions and Provider Practices. The Journal for Nurse Practitioners, Science Direct.