Optimizing Medicare Annual Wellness Visits Through Quality Improvement: Leveraging Process, Continuity, and Combined Visits.

Abstract

Purpose: To determine if combining Medicare annual wellness visits (AWVs) and problem-based visits with continuity clinicians could improve patient and clinician engagement and increase the percentage of AWVs completed and capture of quality measures.

Methods: A family medicine department utilized the quality improvement process to increase their percentage of AWVs by increasing the number of combined (ie, AWV and problem-based) visits through clinician education and targeted scheduling. De-identified data with the number of AWVs, eligible members, and clinicians were obtained from institutional data. Significant findings for trends, shifts, and data outside the normal limits were identified through Taylor's change point analysis. Differences in tests ordered pre- and post-implementation were analyzed with Wilcoxon rank sum analysis.

Results: Monthly AWV rates increased from 8.4% to 50.8% over 9 months. No-show rates were lower (11.9%) for combined visits than for AWV-only visits (19.6%; P = .008). Patients had lower no-show rates for AWV with their continuity clinicians (12.5%) compared to appointments with other clinicians (25.4%; P <.001). Compared to the 9 months preceding the study period, quality metrics increased for multiple screenings: breast cancer (P <.001), cervical cancer (P = .009), colorectal cancer (P <.001), depression (P <.001), falls (P = .039), function (P = .003), hepatitis C (P <.001), HIV (P = .006), lung cancer (P = .002), pain (P = .006), and osteoporosis (P <.001),. Hemoglobin A_1c and urine microalbumin testing, and pneumococcal vaccine administration also increased (P <.001). Influenza vaccinations did not significantly increase (P = .913).

Conclusion: Combined visits with continuity clinicians led to significant AWV completion rates and decreased no-show rates leading to improved quality measures.