As we enter the fall, healthcare marketers should be starting their push for Medicare enrollees to schedule an Annual Wellness Visit.
Unlike an appointment for a specific ailment, the Annual Wellness Visit is a longer-than-usual appointment, centered on a conversation between patient and provider. Self-reported issues, such as feelings of depression or cognition difficulty, coupled with direct observations by the provider, allow for better monitoring of concerns, as well as a more complete clinical record.
This matters to health plans with Medicare Advantage enrollees, as well as provider groups who care for them, because better documentation means a more accurate risk-score assigned to the individual enrollee. Patients with multiple conditions often require more extensive monitoring than healthier patients. In recognition of that additional effort, the federal government applies a risk-score adjustment to the fixed monthly payment (capitation) paid to the Medicare Advantage plan. This is intended to encourage care management interventions that can improve the patient’s health.
Medicare Advantage plans, in turn, often offer bonuses to medical groups and providers that have a high percentage of completed Annual Wellness Visits among eligible patients. If your organization has a large number of Medicare patients, you’ll generally find that at least one-third of them are enrolled through a Medicare Advantage plan. The incentive revenue to your organization from the health plan for completed Annual Wellness Visits can be significant.
Although the risk-adjustment model of payment applies only to Medicare Advantage plans, the Annual Wellness Visit itself is a covered benefit for all Medicare patients.
There are three challenges when promoting Annual Wellness Visits:
- Encouraging a person to see their provider when they are feeling fine. In general, people go to the doctor when they have a specific medical complaint. In contrast, the Annual Wellness Visit is not a visit for diagnosis and treatment, but for a conversation that leads to improved care on subsequent visits. Annual Wellness Visits can be performed by a physician, nurse practitioner, registered dietician, or other medical professionals under a doctor’s supervision.
- Ensuring the patient knows to ask for an Annual Wellness Visit rather a different type of visit when making the appointment. This matters, because Annual Wellness Visits are longer than other types of appointments, so the number of available scheduling slots may be fewer. Annual Wellness Visits also have no co-pays from the patient, but the patient will be asked for a co-pay if the appointment is incorrectly classified.
- Communicating urgency to make the appointment before end-of-year. Although a patient can take advantage of this annual benefit on a rolling 12-month calendar, the provider has to log the appointment by close-of-business on December 31 for it to impact upcoming risk-adjusted payments. (Thus, any incentives offered by the plan to your organization also will have a 12/31 cut-off.)
Despite these challenges, promotion of Annual Wellness Visits can benefit patients, plans, and providers, alike.