Medicare Advantage Annual Wellness Visits: A Gateway to Other Services?

A blonde female doctor shows  an older black man a tablet during a medical visit.

This is the fourth in a series of blog posts on Medicare’s annual wellness visit. You can also read a new AARP Public Policy Institute study on the topic.

Medicare’s Annual Wellness Visit is designed to promote the use of preventive care, identify health risks, and plan for future health care needs. The visit includes a health risk assessment (e.g., a questionnaire used to gather information on the patient’s health status and medical history) as well as referral to counseling and programs aimed at reducing identified risk factors, such as obesity, smoking, and depression.

Yet the Annual Wellness Visit’s purpose, and theoretically its benefit, goes beyond the set services included in the visit. One of the goals of this free visit is the opportunity to meet fact-to-face with a primary care clinician. Once a consumer is in the office, he or she might receive appropriate additional preventive services, such as vaccinations and cancer screenings. Or so goes the theory.

Recent AARP Public Policy Institute research examined whether the Annual Wellness Visit is having that intended impact. Our findings, in fact, proved encouraging. Through our study, which focused on Medicare Advantage enrollees, we also gained insight into exactly what services they are getting.

Where the Gateway Leads

The bar graph below illustrates our findings showing how Medicare Advantage enrollees often received additional services on the day of their Annual Wellness Visit. As shown, those services included such additional preventive and screening services as pneumonia vaccinations (23 percent), flu vaccinations (11 percent), and tobacco screening (6 percent). In addition, 5.8 percent of enrollees received depression screening.

At the time of the Annual Wellness Visit, a large share (44.5 percent) of enrollees also received a problem-based “office visit” for a new or existing condition, such as blood tests for diabetes (14.3 percent; A1c) or cholesterol (30.2 percent; lipid panel). These tests could have served as screening tests or been used to monitor the status of new or pre-existing conditions.

Most Common Additional Services Received during Annual Wellness Visits among MA Enrollees, 2015

CPT/HCPCS codes: Office E&M visit = 99201–99205 and 99211–99215; Lipid panel = 80061; Metabolic panel = 80053; Pneumonia vaccine = G0009; Thyroid function test = 84443; Urinalysis = 81001–81003; HbA1c = 83036; ECG = 93000; Influenza vaccine = G0008; Physical examination = 99386, 99387, 99396, and 99397; Vitamin D assay = 82306; Depression screening = G0444; Tobacco screening = 1036F.
Source: OptumLabs Data Warehouse

The Annual Wellness Visit does not include a routine physical. Nevertheless, 9 percent of enrollees who got an Annual Wellness Visit received a physical exam at the time of their visit as well. (Traditional Medicare does not pay for routine physical exams, but many Medicare Advantage plans cover routine physical exams in addition to the Annual Wellness Visit.)

Outcome Intended

Beneficiaries enrolled in Medicare Advantage plans who received Annual Wellness Visits received preventive and screening services substantially more often than enrollees who did not get an Annual Wellness Visit. For instance, those who received Annual Wellness Visits were twice as likely to receive a pneumonia vaccine and 35 percent more likely to receive a flu shot than enrollees who did not get an Annual Wellness Visit. Cancer screening was also more common among those who received an Annual Wellness Visit than those who did not.

Consumers should be aware that although most preventive and screening services are free to enrollees, they may be charged copayments for other services.

Overall, the Annual Wellness Visit appears to be achieving one of its key goals: providing a gateway for beneficial preventive and screening services. The study findings suggest that Annual Wellness Visits appear to boost people’s use of many services shown to help reduce disease and improve health. The Annual Wellness Visit seems to be doing its job.

Keith Lind

Keith Lind is a senior strategic policy adviser at the AARP Public Policy Institute. His areas of expertise include Medicare and chronic care.

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