Valuable Insights Gained from the Annual Wellness Visit - Despite Such, We Still See Many Go Uncompleted? Why is That?
Article by Theresa Stanley / Chief Nursing Officer, Guardiant Health
Background on the Annual Wellness Visit
Under the Accountable Care Act (ACA), Medicare instituted the well-intended concept of paying providers to conduct a risk assessment of their patients, including a proactive anticipatory plan of care needs for the year, under what is called the Annual Wellness Visit (AWV). Despite these incentives being in place for over a decade, we continue to see only a minority of Annual Wellness Visits completed, with some reporting that less than 20% of the population who could have benefited from receiving such assessments completed them. Risk assessment and anticipatory planning can have huge benefits in reducing wasted health care costs and avoidable health-related issues by identifying and addressing conditions or risks earlier.
Then Why Do So Many Annual Wellness Visits Never Get Completed?
There are several factors why these AWV — and as such, preventive care recommendations — fail to get addressed in Medicare-aged patients. One such factor is the responsibility that the health system has traditionally placed on the patient to follow up on their own preventive and proactive care needs. Some payers have been able to create consumer incentives for completing these assessments with their doctor through rewards cards and other financial cost incentives allowed by CMS. However, the task of getting into the physician office was still required of patients. While physician offices are getting better at engaging their patients under programs such as accountable care organizations, shared risk programs, and full-risk provider contracts, many independent providers fail to have the systems, processes, and infrastructure or investments to complete these assessments outside of the office environment. Time and attention of staff, along with process, forms, and training are required of an office, and with day-to-day patient care and unexpected office emergencies, it is challenging to be consistent and vigilant. Economics often come into play as practices that have smaller panels of seniors may not have enough volume to justify the time and effort required to contact and collect a risk assessment and review with the patient and physician.
Falling Short of Its Original Intent
While many larger organizations have created workflow and support capabilities to complete these assessments, they often get filed away and never enacted as a guide or a roadmap to care that the patient and provider can use throughout the year. Another issue often seen in seniors is the change in condition or health that can arise, which may alter the plan of care in an assessment at any point in time. As such, these assessments often become obsolete or outdated.
More recently, as a result of the pandemic, many primary care-based offices have reduced staff and nurse skill sets in the office, as providers looked for ways to reduce clinic costs. As such, many of these screening assessments have gone to the wayside, and many find themselves looking to close assessments and care gaps via other means.
With the Medicare/CMS waiver enacted during the COVID pandemic, the ability to conduct an Annual Wellness Visit and engage in preventive and anticipatory care through more virtual and telehealth means could improve engagement and completion in a larger portion of the population outside of the routine sick office visit. More importantly, it would allow for a means to capture and track these plans of care and respond more proactively to care needs of patients without needing in-person office visits, freeing up valuable office-based appointments.
The Opportunity to Improve Care
As was the original intent of these assessments, the ability to act on, track, and monitor care for seniors with high-risk needs is where the greatest opportunity exists to make a significant and positive impact on care. Deploying such management of the population outside of the regular office visit, and under continuous surveillance and intervention, is where more virtual care capability can be highly effective. The ability to deploy real-time engagement and patient CRM capabilities, along with an integrated clinical response, is where more longitudinal virtual care models can leverage the knowledge obtained from an Annual Wellness Visit to address care needs moving forward.
About the Author - Terrie Stanley serves as the Chief Nursing Officer for Guardiant Health and has years of extensive experience in the overall management and care of high-need and high-risk populations, having spent more than 20 years helping to meet the needs of Medicaid and Medicare payer populations through various clinical operations and leadership roles through her career. She received her BS in Nursing and is a Certified Case Manager with clinical ICU nursing background and experience.
About Guardiant - Guardiant is a technology-enabled medical service company using monitoring and digital telehealth capabilities integrated under a single communications platform, providing an engagement and early warning and intervention system for better management of chronic medical conditions. The goal is not to replace traditional “brick-and-mortar” service delivery systems or family care providers, but rather to fill the gap between routine visits to the physician and home where many conditions first start to worsen. Early detection of these warning signs and immediate interventions can reduce unnecessary doctor visits, trips to urgent care clinics, emergency rooms and hospital admissions. Many of these early warning signs can be treated by the Guardiant clinical team from the comfort and security of a patient’s home. As part of our regular early evaluation of patients, Guardiant is able to complete an Annual Wellness Visit on behalf of payers/providers via our proprietary virtual process.
