CMO message from Amy Scanlan, MD
The benefits of Annual Wellness Visits.
I’ve heard it said that patients don’t have plans, but they need plans.
Most of our days in clinic are spent in reactive mode. Patients come in with a problem they need solved—chest pain, belly pain, an upset stomach, a rash, a fever…you get the general idea. The minute we enter the exam room, we are alert to the problem the patient has identified (usually the chief complaint) and looking for clues that might help us solve it. Most of our time is spent reacting to what is directly in front of us, and then we move on to the next room.
The Annual Wellness Visit (AWV) is not that. Introduced in 2010, it is specifically designed by Medicare to allow space for prevention, rather than just reacting to the here and now. It is specifically designed to help providers and patients develop a personalized care plan for the next 12 months—answering the question, “How can I help this person stay healthy?” Done well, it can be a cornerstone of primary care.
AWVs are NOT annual physicals, despite what many patients think. We all are aware of data questioning the value of the “annual physical,” but AWVs are supported by data showing lower adjusted total health care costs and improvements in preventative screenings in the 12 months following (footnote). They are meant to be visits that assess the patient’s current health risks, focus on screening and prevention, and offer an opportunity to discuss goals of care. These visits help build stronger relationships between primary care teams and patients. They are meant to give space to plan.
For patients, AWVs provide dedicated time to share important health information often overlooked in problem-centered visits. For providers, they can be an opportunity to accurately code and document the complexity of the patient’s chronic conditions. These visits can help identify patients who would benefit from care management programs and available community resources. They also offer an opportunity to educate patients about managing their chronic conditions and to discuss their end-of-life wishes.
AWVs have other benefits for providers. Medicare purposely attached a higher RVU rate to these visits, recognizing their value. A study in Health Affairs showed that practices that focused on providing AWV services to their patients saw increased revenue and more stability in their patient population (footnote). Many payers offer incentive dollars, rewarding providers for completion of AWVs. These visits offer a structure that provides the perfect opportunity to reap the rewards of value-based programs.
To quote Benjamin Franklin, “By failing to plan, we are planning to fail.” And we can’t fail our patients.
Patients don’t have plans. They need plans. AWVs are a way to plan.
Spotlight: UCHealth Primary Care – Grandview
UCHealth Primary Care – Grandview is a 10-provider clinic in Colorado Springs that struggled to increase their AWV rate. In 2023, they decided to take on the challenge.
The team at Grandview started using an “AWV due” column in EPIC to show which of the patients who were already on the provider’s schedule were due for an AWV. The providers then reviewed their schedule daily to determine whether those AWVs were appropriate to add on to the already scheduled visit, communicating their decision to the front desk and MA staff. If the AWV was to be added on, the front desk staff member would ask the patient if they would like to do their AWV as part of their scheduled visit. If the patient was agreeable, they would be given the Medicare questionnaire to complete while waiting. If the patient decided not to add the AWV on, the front desk staff member would then schedule a dedicated AWV in the future. The front desk would let the MA know of the patient’s decision so the MA could follow the appropriate AWV protocols during the rooming process. Providers then conducted the appointment and completed their documentation using the Problem-based Charting functionality in EPIC.
Grandview started 2023 with a 45% completion rate on their Medicare Annual Wellness Visits and ended the year at 66%.They also spread the word about the success they were seeing to other clinics, and clinics who implemented this same process showed similar results, improving 8% to 15% each over the last 6 months of 2023.
We are grateful to all our physicians on National Doctor’s Day celebrated this year on March 30.
Reflections: Articles and podcasts from outside experts.
- Monday Medical: Strong patient, primary care provider bond leads to better health, SteamboatToday.com (steamboatpilot.com)
- How to Make Healthcare work for patients with Rushika Fernandopulle
“Turn on the Lights” podcast. - How Accountability for Outcomes Works in the Real World, with Kenny Cole, MD
Relentless Healthcare Value podcast.