The Medicare Annual Wellness Visit (AWV) is a powerful tool for delivering proactive care in the value-based care environment. Created in 2011 by the Centers for Medicare & Medicaid Services (CMS), the service is a free benefit for Medicare beneficiaries that can go a long way towards putting patients on the best possible path to wellness each year.
Starting the year off with Annual Visits helps get physicians, staff and patients on the same page, ultimately improving care coordination and outcomes. The visit is a chance for providers to address the overall wellness of patients by reviewing health history, reconciling medications, identifying any immunizations or screenings that might be needed and recommending potential treatments.
There are many reasons to make Annual Wellness Visits a priority in your practice. Here are a just a few:
Unlike yearly physical exams, the focus of the AWV is on preventative services. The purpose is to review the patient’s wellness and develop a personalized prevention plan to reduce future health problems.
This sort of proactive healthcare planning helps identify potential problems that may have been overlooked and aids in early detection of disease. Early detection is key to successful intervention and mitigating disease progression, helping patients live a longer, healthier life overall while avoiding costly care.
CMS designed the AWV to encourage and support individuals in taking an active role in managing their health and improving their well-being and quality of life.
The relatively well patient is more likely to be receptive to discussing preventative care measures, such as lab work or screenings, than when they are sick or at an appointment to address a specific issue. According to CMS, "The Annual Wellness Visit is best furnished to a beneficiary when their health status is stable and they are open to discussing preventive and screening services available in Medicare."
Providers can establish trust and get to know their patients during a AWV, before urgent issues arise. With the level of communication that the annual wellness visit necessitates, patients work closely with providers, often achieving better rates of compliance and treatment adherence because they have a clearer understanding of health goals.
With HCC risk-adjustment, risk scores reset each year, so each qualifying diagnosis must be reported annually. The more chronic conditions a patient has, the more care that may be required, so annual reporting is crucial to quality of care and proper funding.
A comprehensive update of HCCs and, consequently, the RAF score, establish the financial allotment provided by CMS towards the annual care of each patient. If all conditions are not reported, funds for that patient could be put into a negative balance, creating difficulties for the provider, payer, and patient.
For the Medicare Advantage population, the AWV is the ideal time to fulfill the yearly reporting requirement and document how all HCC conditions are monitored, evaluated, and/or treated.
Conditions can be diagnosed and evaluated that might not otherwise be captured during an urgent visit when the focus is on addressing a specific problem.
The data collected during the ACV also enables risk stratification, which is a technique for segmenting patients into distinct groups of similar complexity and care needs for better care coordination and population health initiatives.
A more comprehensive grasp on patient health statuses across a given population as a whole gives organization the opportunity to strategically align staffing and operations accordingly. Patent outreach plans and education programs can be designed around the most prevalent diseases among each patient population and interventions can be targeted more specially to each patient’s needs.
Incorporating a systematic approach to increasing the utilization of the Medicare Annual Wellness Visit is well worth the investment – when executed as intended, these visits are a powerful tool for delivering preventative care - which benefits patients, providers and plans alike.
Payers in value-based contracts are expected to move beyond their traditional role as insurance purveyors and assume the broader responsibility of improving outcomes and care coordination. Claims data is not a sufficient foundation for successfully fulfilling this role. By leveraging the valuable insights and real-time availability that clinical data offers, plans can carry out the level of proactive outreach and crises prevention that value-based care management demands.
AI is no replacement for human judgement but it can go a long way towards simplifying and streamlining data management and analysis. AI-enabled chart review helps providers and plans that coordinate care for complex populations work smarter, not harder, by shifting the focus from volume of charts targeted to precision targeting of charts.
The Centers for Medicare & Medicaid Services (CMS) initiated the Hierarchical Condition Category (HCC) model in 2004 to adjust payments to Medicare Advantage Organizations (MAOs). The model has been more prevalent in recent years as HCCs are becoming more widely recognized as one of value-based programs' most important components. This heightened visibility is due in large part to the growth and success of Medicare Advantage.