Implementing Medicare Annual Wellness Visits with a Health Risk Assessment in Primary Care

Abstract

Background: Within the primary care setting, there is a deficiency of comprehensive, personalized treatment care plans that identify modifiable risk factors and endorse preventive care. The Medicare annual wellness visit presents an opportunity for patients aged 65 years and older to identify, plan, and optimally manage chronic health conditions and increase preventative care. The health risk assessment, which is part of the annual wellness visit, is intended to identify health behaviors and risk factors that can be discussed with the patient and utilized to collaboratively create a personalized prevention plan that aims to reduce risk factors and related diseases. Local Problem: In a small, single practitioner primary care office, there was a low performance of completion of annual wellness visits with the Medicare population and lack of a consistent method to assess health risks within this population. This practice serves a Medicare population of greater than 300 patients yet only billed a total of 39 annual wellness visits in 2017 and 15 in 2018. The purpose of this quality improvement Doctor of Nursing Practice project was to increase the number of Medicare annual wellness visits, which included the use of a Health risk assessment in a primary care practice, for Medicare patients aged 65 years and older with chronic health conditions. Interventions: The project was implemented over a 14 week period. Mail and telephonic outreach were conducted to all eligible Medicare patients. For beneficiaries with preexisting appointments, annual wellness visits were added to the appointments. Health risk assessments were mailed to the patient after the appointment was scheduled with instructions to complete prior and bring to the scheduled appointment. Health risk assessments were collected when the patient checked in for the scheduled appointment. Results: The percentage of annual wellness visits completed or not completed (among eligible patients) during the pre- intervention and post- intervention was determined by dividing the total number of eligible patients who completed their annual wellness visits by the total number of eligible patients. At the conclusion of the project, there was a 23.7%, or five- fold- increase in the annual wellness visits completed, which is statistically significant. Post- intervention chart audits revealed health risk assessments in 100% of the charts when an annual wellness visit was completed. Conclusions: Annual wellness visits can be integrated successfully in a busy outpatient primary care practice within the time allocated for office visits. Completion of annual wellness visits increased significantly over the project two month implementation timeframe. A tracking tool revealed a higher capture rate when annual wellness visits were scheduled with pre- arranged office visits. Patient and provider participation in the process increased referrals for preventative screenings and vaccinations. The annual wellness visit also has the opportunity to increase practice revenue gained from Medicare reimbursement and increased relative value units.