Cracking the Code on Annual Wellness Visits

In 2011, the Centers for Medicare and Medicaid Services established a new benefit for Medicare beneficiaries—the Annual Wellness Visit. But despite its decade of existence, this valuable healthcare tool remains underappreciated and underutilized—by patients and providers alike. In 2018, only 19% of Medicare beneficiaries had an Annual Wellness Visit. Many more made these appointments, only to cancel them.

CMS may be focused on preventive care, but getting their beneficiaries to do the same, it turns out, has been a challenge. But it’s one that’s worth solving. A study published in 2019 found that an AWV is associated with a nearly 6% reduction in healthcare spending.

Part of the problem is word association. “Annual Wellness Visit,” to many, simply sounds like an updated term for the old-fashioned “annual physical.” But it’s so much more than that. According to CMS, the goal of the AWV is health promotion, disease detection and fostering the coordination of the various screening and preventive services that already are covered under Medicare Part B.

Through its seven required elements, the visit is intended to set the stage for preventive care for the entire year.

Required Elements of the Annual Wellness Visit

  1. Administer a Health Risk Assessment (HRA).
  2. Establish a list of current providers and suppliers.
  3. Establish the beneficiary’s medical/family history.
  4. Review the beneficiary’s potential risk factors for depression.
  5. Review the beneficiary’s functional ability and level of safety.
  6. Assess height, weight, BMI, blood pressure and other routine measures appropriate to medical history.
  7. Furnish a personalized preventative plan of care, which must include a written screening schedule, a list of risk factors and conditions with interventions, and personalized health advice and referrals to programs, as appropriate.

There’s no ‘I’ in ‘AWV’

If it sounds tedious and time-consuming, you’re not wrong. But, in 2016, CMS clarified what was clear to us in the beginning—that AWVs should be a team effort and practices will get the most out of the AWV when they use a team-based approach.

Physicians, of course, are eligible to provide the AWV, but so can physician assistants, nurse practitioners, clinical nurse specialists, as well as health educators, dietitians and other licensed medical professionals who work under the “direct supervision” of the provider.

Because of the team-based approach, AWVs can be a natural extension of a practice’s care coordination program—and it’s a two-way street. Care coordinators can fulfill many of the required elements of the AWV, including building and helping implement the personalized preventative plan of care. Likewise, if a patient is already receiving chronic care management or participates in another care coordination program, they are likely familiar with the team-based approach and may be more open to receiving an AWV.

On Feb. 18, Faith Jones, HealthTechS3 director of care coordination and lean consulting, will be hosting the webinar Happy Anniversary to the Annual Wellness Visit. In addition to covering AWV basics, she’ll focus on how to utilize a team-based approach and how to create meaningful preventative plans of care. Don’t miss out—reserve your spot today.