Annual wellness visits for Medicare Advantage members
Per the American Academy of Family Practitioners (AAFP), “90 percent of patients who had received an AWV said they did so at the recommendation of their physician.” AWVs are a yearly exam (usually with a physician) to develop or update a personalized prevention plan and assess health status and any social, psychological, and behavioral health risks. An AWV can be a useful tool for improving quality of care, providing proactive care management, facilitating care coordination, and positively impacting up to 20 Medicare Advantage Star measure ratings for health plans.
There is often confusion between an AWV and an annual routine physical (ARP). The ARP is more comprehensive than an AWV. It consists of a physical exam by a physician and includes bloodwork, screenings, and other tests. The AWV involves checking standard measurements such as blood pressure, height, and weight. AWVs are free for Medicare Advantage members and, in many instances, can be conducted remotely via telehealth.
Note: CMS does allow both visit types to occur on the same date/time and providers can submit one claim encompassing each type.
There are many provider benefits for completing an AWV, including:
- Opportunity to develop a complete medical history for members
- Strengthened relationship with member
- Ability to provide proactive care to member
- Increased performance on quality metrics
- An ongoing, sustainable revenue stream for practice
- Vehicle for providers to obtain caregiver demographics
There are also many member benefits for completing an AWV, including:
- No copay
- Strengthened relationship with healthcare providers
- Annual comprehensive preventive evaluation
- Reduced risk of chronic conditions
- Keeps members out of the hospital
- Prevents accidents at home
In the ever-increasing emphasis on value-based care that focuses on shared savings, it is urgent for providers to complete an AWV for each of their assigned members. Doing so keeps members healthy, reduces healthcare costs, and can increase practice revenues.
March 2022 Anthem Provider News - Ohio