Care Transformation Center Blog

Why the Annual Wellness Visit is actually a big EHR opportunity

by John Kontor, MD

In our recent EHR optimization consulting projects, we have frequently been incorporating a component that might be a little bit surprising to veterans of large-scale IT projects: promoting Medicare Annual Wellness Visits.

How, might you ask, is the delivery of an Annual Wellness Visit—a preventive care service—related to health care IT? AWVs, as we call them, are actually a prime target for EHR optimization. They are a service that is good for patients and for the health system’s strategic objectives alike. They are not performed nearly enough. And, much of the "work" of delivering the AWV can be guided by the EHR, including patient reminders, documentation, patient education, and determining eligibility.

A little background, for those not familiar with the AWV: The AWV is not the same as an annual physical exam. Under the Affordable Care Act, Medicare covers AWVs completely, with no copayment and no patient deductible, but only if the services provided in the visit meet specific criteria for information-gathering, assessment, and counseling.

Most health systems deliver far fewer AWVs to their Medicare patients than they could—because meeting the delivery requirements can be daunting, and because documentation can seem onerous. But it’s worth the effort, and here are three reasons why.

Population health risk identification

Accurate risk adjustment is crucial for any health system looking to take on risk-based contracts.

We’re working with a national health system in the East that is pursuing population health management by participating in the Medicare Shared Savings Program. As they’re looking to move even further into risk, they want to gather as much data on their population as possible, which can be achieved in part through the delivery of AWVs.

Not only has the leadership team made capturing AWVs an organizational priority, they’ve even aligned executive incentives to specific AWV metrics.

Fee-for-service revenue

Even for health systems that aren’t setting out to become population health managers, getting more AWVs is a win. It’s one of few strategies that help transition to value-based payment while also reaping benefits under fee-for-service.

Right now, only 14% of Medicare beneficiaries receive an AWV. I’ve seen medical groups increase that to over 70%. And the financial impact of that increase is impressive. For a 100-provider practice, the additional revenue can total as much as $3 million annually.

Patient engagement

Overall outcomes tend to be better when patients are engaged in their health care, and AWVs are, first and foremost, a mechanism for patients to engage with their primary care physicians in their health.

I recently heard a great story from one of our AWV clients in the Midwest. A patient was leaving the doctor’s office after visiting for another purpose, and saw a flyer for AWVs posted on a bulletin. She made an appointment and let the doctor know that she didn’t realize AWVs were available at no out-of-pocket costs. Moreover, she was excited to have that time with her physician and stated she would have been taking advantage of this benefit long before, had she known about it.

Why patient price sensitivity is really an access issue

The bottom line is that patients want time with their physicians to discuss their health. Our clients have professed repeatedly that they see a difference in patient engagement as they capture more AWVs.

So after working with health systems on improving AWV capture specifically, I’m convinced that it’s both achievable and worth the effort. AWV implementation or improvement is not a one-size-fits-all initiative, but it’s also not as difficult as many health system and medical group leaders think.

Get a strong AWV delivery strategy

AWV-MACRA

Find out how organizations are leveraging the AWV framework to better care for their Medicare populations and prepare for successful performance under MACRA.

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