Practices Caring For The Underserved Are Less Likely To Adopt Medicare’s Annual Wellness Visit

Abstract

In 2011 Medicare introduced the annual wellness visit to help address the health risks of aging adults. The visit also offers primary care practices an opportunity to generate revenue, and may allow practices in accountable care organizations to attract healthier patients while stabilizing patient-practitioner assignments. However, uptake of the visit has been uneven. Using national Medicare data for the period 2008-15, we assessed practices' ability and motivation to adopt the visit. In 2015, 51.2 percent of practices provided no annual wellness visits (nonadopters), while 23.1 percent provided visits to at least a quarter of their eligible beneficiaries (adopters). Adopters replaced problem-based visits with annual wellness visits and saw increases in primary care revenue. Compared to nonadopters, adopters had more stable patient assignment and a slightly healthier patient mix. At the same time, visit rates were lower among practices caring for underserved populations (for example, racial minorities and those dually enrolled in Medicaid), potentially worsening disparities. Policy makers should consider ways to encourage uptake of the visit or other mechanisms to promote preventive care in underserved populations and the practices that serve them.

Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial

“…Focusing on a general cognitive screening instrument like the MoCA has advantages in terms of clinical implementation, but there are numerous barriers to routine objective measurement of cognitive function. Although the Medicare Annual Wellness Visits provide an appealing context for ascertaining function, they are underused and may not adequately detect impairment with respect to cognition . In addition, there are a number of recent concerns with the MoCA specifically related to monetization …”

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“…For instance, the use of one new service, the annual wellness visit (AWV) for Medicare beneficiaries, has been low (Jensen et al 2015), especially among underserved populations (Ganguli et al 2018). Whereas practice characteristics are one factor contributing to variation in AWV provision and use (Ganguli et al 2018), our study suggests how social factors may diminish uptake of preventive services among minority communities: barriers to uptake may include healthcare-seeking norms tied to cultural beliefs, health literacy, and home-country experiences. Among IMPACT's South Asian immigrant communities, walk-in visits for episodic, symptom-atic treatment were the norm, contrary to the regular visits essential for disease management and preventive care.…”

“…The impact of this strategy on use of preventive services has been mixed (Chait and Glied 2018). For instance, the use of one new service, the annual wellness visit (AWV) for Medicare beneficiaries, has been low (Jensen et al 2015), especially among underserved populations (Ganguli et al 2018). Whereas practice characteristics are one factor contributing to variation in AWV provision and use (Ganguli et al 2018), our study suggests how social factors may diminish uptake of preventive services among minority communities: barriers to uptake may include healthcare-seeking norms tied to cultural beliefs, health literacy, and home-country experiences.…”

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“…36 Furthermore, another study found that healthcare practices with medically and socially complex patients provide less AWVs, whereas accountable Care Organizations and practices with higher rates of electronic health record incentive program participation provided more AWVs in 2015. 19 Yet, future studies are needed to determine whether the increase in AWVs since their introduction is explained by diffusion of recommendations from practice guidelines and policy to implementation in the healthcare practices and/or by incentives programs aimed at managed care beneficiaries.…”

“…[10][11][12][13][14][15][16][17] At the same time, primary care physician practices and geographical regions where AWVs are more frequently adopted do not deliver a higher amount of healthcare services overall. 18 Despite a gradual increase in utilization of AWVs after their introduction in 2011, [17][18][19][20][21] less than a quarter of Medicare beneficiaries received an AWV in 2015. 19 Previous studies have identified underutilization of AWVs among older adults who are unmarried, members of a race/ethnic minority group, or living in rural or less affluent areas.…”