Why Healthcare Organizations Need to Focus More on Annual Wellness Visits to Generate Better Revenue

Moving away from the ideology of treating diseases to actually preventing them has gained a lot of traction in the last few decades. The shift has certainly been dynamic and has opened floodgates for discussions around its implementation and success. Many organizations are focusing on revamping their operational strategies, enhancing patient-provider collaboration, and leveraging robust technologies to make this transition smooth.

Preventive care, in its purest essence, is all about improving population health by gaining timely visibility into patient’s health issues and thus reducing the need for medical interventions. One of the most critical aspects of preventive care in a value-based scenario is Medicare Annual Wellness Visits (AWVs), an ideal way of initiating preventive care.

AWVs are yearly health round-ups conducted by PCPs to create a customized preventive care plan based on routine measurements such as weight, blood pressure, among others. AWVs often require patients to complete a questionnaire related to health risks, behavioral patterns, physical activities, et al. and include discussions related to their medical history and ongoing treatments. Not only is it an effective way to assess the needs of patients, but also to reduce the risk of any unforeseen medical condition.

The state of AWVs in the US and its importance in ensuring improved care quality

Assessing probable risks beforehand is easily the finest way of dealing with health issues. In spite of that, the state of AWVs is an area of concern and needs immediate attention of virtually all healthcare organizations. According to a study based on Medicare data, only 23.1% practices provided AWVs to at least a quarter of their population. Many estimates put the amount that could be saved by streamlining AWVs in billions of dollars.

Encouraging AWVs can have two broad implications. First, it can obviously power preventive care initiatives, and second, it can also act as a starting point for follow-up care if the patient is in need of it. It is essential to understand that providers cannot come up with follow-up care strategies if they do not have the required insights. Identification of a health issue helps in ensuring fewer complications in the treatment procedure and could possibly reduce potentially avoidable admissions. Indirectly, organizations can gain immensely in a value-based payment system by optimizing admissions.

Since AWVs address multiple aspects and gaps in care, each service is implicitly mentioned while filing for reimbursements. These additional services come with unique CPT codes and are, in fact, billed separately. Putting it in a financial perspective, practices with higher AWV rates have a higher primary care revenue. Also, AWVs bring patients who are relatively healthier, thus improving operational stability.

Building the right environment for improving AWVs

While developing a strategy for improving AWVs, organizations should begin with consulting their care teams. It is important to listen to their viewpoint and whether or not they are comfortable with the idea of devoting more time in seeing “well off” patients. This exercise is essential since care teams at times may have doubts about AWVs being an additional workload for them. It’s about enlighting every care provider about the significance of AWVs and then defining roles of each one of them.

Further, organizations should build strategies for increasing AWVs based on their infrastructural capabilities and staffing level to ensure that they have ample bandwidth, resources, and even sitting area to accommodate patients without any chaos at the time of visit. Unless an organization has a clear idea about the number of check-ups they can perform on a daily basis, implementing the process can take a toll on care teams and even affect other operations.

Involving patients in the process

No matter how good the strategies for improving AWVs are, their successful implication depends on the level of patient engagement. Beginning with communicating patients the benefits of such visits to establishing a well-ordered flow of patients across the facility, ensuring patient involvement at every step is highly recommended. And improving patients’ decisiveness, conviction, and contentment is a time-taking but indispensable process.

Engaging patients for higher AWVs is not merely about telling them that their appointment is pending. Instead, it is about providers taking up the responsibility upon themselves to assist patients at every step. Like any other care episode, AWV too should have some definite purpose. One way of looking at AWVs is taking them as an opportunity to help patients in realizing their health goalsㅡ being able to run for a mile, quit smoking, whatever good they think for themselvesㅡ and then counseling them in that direction using both the medical wisdom and personal knowledge.

Patients should have an exact idea about each step involved in an AWV episode. They should know whom to meet first after entering the premises of the facility, the doubts they need to resolve regarding their health, and even the type of questions they would be asked or should ask a provider. For a process as important as an annual wellness visit, any kind of ambiguity can cost patients dearly.

These visits are even more crucial for recently discharged or patients with comorbidities. After-discharge communication and telemedicine support can substantially enhance the effect of AWVs in such cases. Clubbed with a targeted approach, such check-up visits can drastically reduce the chances of further complications.

Leveraging technology beyond just data analytics

Data analytics-driven approach is indeed fundamental for catering to the needs of the entire patient population. However, organizations need to further equip themselves with solutions built on top of their data platform or warehouse for ensuring a trouble-free AWV process. For instance, analytics can deliver key insights to the providers about the number of patients who did not come for their check-ups in the last one year, but expecting care teams to manually call each one of those patients would not be the best way to close gaps. Automating the process would be instrumental in efficiently touching a significant number of lives.

Another vital facet of the use of technology is how seamlessly organizations impart evidence-based care and triage their population based on accurate insights. Imagine how elegantly providers can enhance the efficacy of the process if they exactly know what to expect every time they see a patientㅡ their history, their current health issues, prominent SDOH affecting their health, among all other information sources.

The road ahead

AWVs are indeed on the rise across the states, albeit at a slow pace. In a recent poll, many respondents were not even aware of the concept of AWVs, but they wanted to enroll for it when they were told what it meant. From an organization’s perspective, these visits can boost its revenue while optimizing population health and enabling the process of timely referrals. AWVs can be the cornerstone for the much-needed shift from curing to preventing. EDs, urgent care facilities, inpatient facilitiesㅡ the desired “optimization” healthcare leaders talk about may well begin with ensuring AWVs for all.

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This blog has originally been authored by Abhinav Shashank.