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Annual Wellness Visit | Value-Based Care

Implementing Value-Based Care With Annual Wellness Visits (AWV)

June 8th, 2022 | 6 min. read

ThoroughCare

ThoroughCare

Content Team

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Implementing value-based care can help providers improve patient health and reduce care costs, but it has introduced new, overwhelming challenges to physician practices. 

For example, private insurers and Medicare now use alternative payment models, such as the Merit-based Incentive Payment System (MIPS), to promote value-based care. 

In this or similar arrangements, providers find that they could miss reimbursement opportunities or be penalized if they fail to meet or exceed specific performance metrics. These metrics can include patient engagement, health outcomes and readmission rates, and clinical efficiency. 

This shift in reimbursements has made the healthcare industry apprehensive about an overall transition to value-based care. A lack of specificity about how to actually implement this new model has made the matter more difficult. 

Care coordination offers a broad strategy to address the referenced metrics and transition to value-based care. But specific care management programs can offer a more exact method to pursue change.

Annual Wellness Visits (AWV) is one example. Overseen by Medicare, this program places emphasis on yearly health assessments. Through an AWV, a patient can be introduced to new preventive care services and gain greater insight into their well-being. 

At ThoroughCare, we’ve provided digital care coordination solutions to more than 600 clinics and physician practices. We’ve helped many of these groups establish AWV programs to improve patient engagement, enable better health, and maximize clinical efficiency.

In this article, we’ll review what an AWV is, and cover two core areas where the program can help your practice implement and transition to value-based care.

What is an Annual Wellness Visit (AWV)?

As the name suggests, an AWV is a yearly assessment of one’s current health. It is entirely free for anyone covered by Medicare Part B.  A doctor uses the time to discuss health history, identify potential issues and answer an individual’s questions. 

The overall goal is to establish a record of a person’s physical and mental well-being for the purpose of preventive health planning. But an AWV should not be confused with a routine physical examination. 

The AWV is more about recognizing possible gaps in a patient’s healthcare and planning the next steps. It should include:

  • A review of your medical and family history.
  • Developing or updating a list of current providers and prescriptions.
  • Height, weight, blood pressure, and other routine measurements.
  • Detection of cognitive impairment.
  • Personalized health advice.
  • A screening schedule (or checklist) for appropriate preventive services. 

By participating, a patient will receive a personalized risk prevention plan, targeted for specific diseases or disabilities relevant to their situation. AWVs are offered in three different ways

Providers can be reimbursed for offering this service. Rates vary depending on the type of AWV provided. National average rates are $117 to $174 per annual assessment. Additionally, an AWV is an opportunity to introduce Advance Care Planning (ACP). This service can add an average of $85 to your billing claim.  

2 Ways That AWV Enables Value-Based Care Success

Wellness assessments can help your practice address specific performance areas that are relevant to value-based care. Below, we’ll review two of these, so you have a better sense of how exactly an AWV program can help you implement and transition to this new care model. 

1. Improve Patient Satisfaction and Engagement

Value-based care emphasizes creating a satisfying patient experience. It aims to provide a more transparent, valuable exchange in a world where most everyone finds their healthcare complicated and costly.

Patient engagement is important to value-based care because it can influence health outcomes. With an AWV, your patients have the opportunity to identify health risks and connect with helpful resources. Only 8% of adults 35 or older receive all recommended preventive care services, according to the Centers for Disease Control and Prevention (CDC). An AWV can help bridge this gap. 

For instance, a health risk assessment (HRA) is a core component of a wellness visit. 

It helps you collect your patient’s information, such as medical history and lifestyle details. Using this information, you can steer your patient’s attention to relevant resources that can address specific risks. These could be care management programs, such as Chronic Care Management (CCM) or Behavioral Health Integration (BHI). Both can help you further engage patients on a month-to-month basis by targeting specific chronic diseases or mental health conditions. 

Additionally, an AWV is an opportunity for your patient to pause and take notice of their present physical or mental state. The assessment can bring overall health or specific conditions front of mind for the patient, which could encourage more active engagement in treatments or making lifestyle changes. 

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2. Maximize Clinical Efficiency

With AWVs, you have the opportunity to learn more about your patients. 

The outcome of the annual assessment is often the creation of a customized patient-centered care plan. This document can help you further personalize the patient’s experience as you interact with them over time. This can reduce the need to repeat conversations with the patient, as well as promote better coordination between providers and specialists.

Software solutions can further streamline the AWV process. 

Automation can help you complete an assessment, saving you time with paperwork and ensuring proper billing codes are utilized. This can allow you to place more focus on the actual patient and make the most of your time with them. 

Finally, AWV reimbursements can help your practice establish a new source of revenue. This can help expand capacity in other areas of your practice or support the adoption of new technology to further increase efficiency. 

Implement Value-Based Care With AWV

Value-based care revolves around general quality performance metrics, such as patient engagement and clinical efficiency. But it presents you and other providers with a challenge, in that you’re asked to meet these expectations without a clear-cut way to do so.

Missing the mark could mean that your practice fails to maximize reimbursement opportunities or is penalized. 

Annual wellness visits can help your practice meet some of the performance metrics underlying value-based care. The program can also help your practice adapt to reimbursement challenges, and drive revenue. 

But what exactly are the reimbursement rates for AWV? 

Medicare supports several CPT codes for this program, but it’s important to know which of them best applies to the type of AWV you provide. Learn more about billing requirements and reimbursement rates for AWV to understand the program’s revenue potential.

Digital software solutions are available to help your practice embrace integrated, coordinated care through an AWV program. At ThoroughCare, we’ve designed our care coordination software for easy clinical use with an intuitive interface that allows you and your team to engage patients through multiple care management programs. 

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