Medicare annual wellness visits: Their importance in the preventive care landscape

In the last decade, the transition from volume- to value-based health care delivery ushers in a trend of preventive care. As a result of the Affordable Health Care Act, Medicare covers a preventative health benefit, known as an Annual Wellness Visit (AWV). From 2011 to 2015, the percentage of Medicare Advantage enrollees who participated in AWVs jumped from 6.2 to 25.2%. Preventive care is becoming more engrained in the U.S healthcare system. This post will review what an AWV is and where it fits into the preventive care landscape.

What Exactly is an AWV?

Upon enrolling in Medicare B, which covers outpatient services, a beneficiary is eligible for a free Medicare annual wellness visit (AWV). The AWV emerged with the Affordable Care Act, when many private insurers began offering coverage for an annual physical examination.

The AWV is not the same as an annual physical, a service that Medicare does not cover. Unlike a comprehensive examination, it zooms in on elements of a beneficiary’s health that indicate the need for focused care in the future. According to CMS, AWVs “develop or update a personalized prevention plan, and perform a health risk assessment.”

CMS provides a list of what an AWV covers: a patient-completed health pre-screening questionnaire, followed by measurement of basic stats like vision, weight and blood pressure. A provider also assesses a patient’s current prescriptions, cognitive function, any recent health problems among relatives of the patient’s age or older, and ability to manage the daily routine, such as cleaning, mobility, transportation and personal care for self and others. The beneficiary and provider then develop a longer-term plan for annual follow-up.

Why is it Important?

Although a recent analysis found “differential improvements in rates of evidence-based screening and declines in emergency department visits,” AWVs are vital for enrollees because they emphasize preventative care and establish better relationships with care providers. Many seniors do not have common conversations on their health. An AWV provides a chance to develop a plan towards maintaining one’s health.

Preventive care and increased communication between aging patient populations and health care providers can identify issues and ameliorate those that could arise in the near future. This benefits patients and theoretically benefits all parties who contribute to a patient’s care.

What the future holds

Reports have suggested that socioeconomic factors impact whether a beneficiary seeks out and receives an AWV and that these factors should be considered as the intent and anticipated outcomes of the visit continue to evolve.

Additionally, in 2017, A report that appeared in JAMA shared data about the program’s impact. The authors reported that 15.6% of eligible beneficiaries in the study had undergone an AWV. JAMA’s statistic represents a missed opportunity for enrollees as the practice is currently being underutilized.

However, with advances in broadband and insurance compliance, providers are now able to conduct AWVs through telemedicine. As a result of the COVID-19 pandemic, doctors are already starting to conduct AWV’s virtually. Virtual AWVs help drive enrollee involvement by compensating for socioeconomic factors such as travel expenses, which will increase overall participation from underserved groups.

How will Medicare AWVs and other facets of value-based care models continue to impact the delivery and reception of innovations in pharmaceutical and device-related therapies?

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