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03.20.2019

From the Aledade Frontlines: The Case for Annual Wellness Visits

by Katherine Tangen Fellow, Office of Chief Medical Officer and Emily Maxson, M.D., Chief Medical Officer

Our healthcare system has evolved to pay for sickness rather than health. Prevention and proactive chronic disease management are reimbursed modestly in primary care, while the majority of costs are accrued in emergency rooms and hospitals after patients have already fallen very ill.

To contest the current ‘wait until you’re sick’ model, Medicare created the Annual Wellness Visit, or AWV, which emphasizes upstream care and enables a more intimate understanding of the patient’s personal circumstances and risk factors.

Rather than focusing on a particular complaint or physical exam, the patient and provider dedicate the AWV to a variety of conversational topics including screenings for depression, cognition, and falls-risk, reviewing medications, optimizing the care team, and understanding end of life wishes. At the end of the visit, the patient receives a personalized care plan with an emphasis on preventive services that will maximize their health outcomes.

Despite this unique opportunity to enhance the patient-provider relationship and prevent future adverse health events, adoption of AWVs has been slow, with only 16 percent of Medicare beneficiaries receiving the service in 20141. In an effort to help the health care community understand the potential impact of these visits—and the need to do more of them—Aledade released a study that quantifies the effects of AWVs on both cost and quality among Medicare beneficiaries in Aledade’s Delaware and Primary Care Accountable Care Organizations (ACOs). The study found that AWVs were associated with both improved performance on clinical quality measures and an annual cost savings of approximately $418 per beneficiary.

We are immensely proud of our Delaware and Primary Care ACO partner practices, and encouraged by the practices who have followed in their footsteps, optimizing their workflows to enable these high-quality visits.

“For me, an Annual Wellness Visit provides the perfect opportunity to step back momentarily from chronic disease management and problem-focused interactions with my patients so that we can engage instead in critically important conversations about prevention and safety.” said Dr. Mathew Weimer, a physician at Valley Health Systems and participant in the Aledade West Virginia ACO.

“While I have always woven these discussions into office visits, I rarely had the chance to focus on these matters clearly, comprehensively, and in a single visit with Medicare patients before I started doing Annual Wellness Visits,” continued Dr. Weimer.

As our population ages, it will be crucial to not only bend the cost curve and improve the quality of care, but to recognize the importance of building a trusting relationship between patients and providers. Solidifying this relationship through AWVs paves the way for patients to be vulnerable and express their healthcare needs—ultimately enabling clinicians to deliver high-value care.

We are hopeful that the experience of our two ACOs, and broader community of physicians, serves as a call to action for primary care practitioners to more rapidly adopt the use of AWVs and encourages policymakers to expand funding for preventive care interventions among the Medicare population.

Footnotes

1. Ganguli, I., Souza, J., McWilliams, JM., Mehrotra A. Trends in Use of the US Medicare Annual Wellness Visit, 2011-2014. JAMA. 2017;317(21):2233–2235.