Medicare’s Annual Wellness Visit (AWV) was introduced in 2011 to encourage the utilization of preventive services, but many clinicians and patients still do not participate in the visit. We qualitatively and quantitatively assessed motivations and clinical and financial value of AWVs from a primary care perspective using interviews and Medicare claims from 2012 to 2019. Primary care providers with the highest acuity patients had AWV utilization rates 11.2 percentage points lower than providers with the lowest acuity patients; utilization rates were 3.8 percentage points lower in rural counties. Adoption was motivated by patient needs and financial incentives. AWVs closed gaps in preventive care, strengthened patient–provider relationships, facilitated advance care planning, and provided an opportunity to improve quality metrics. Overall, the AWV has the potential to increase the use of high-value preventive services although not all clinics have an economic incentive to adopt the visit, which may explain some of the variability in utilization rates.
AbboE. D.ZhangQ.ZelderM.HuangE. S. (2008). The increasing number of clinical items addressed during the time of adult primary care visits. Journal of General Internal Medicine, 23(12), 2058.
2.
BeckmanA. L.BecerraA. Z.MarcusA.DuBardC. A.LynchK.MaxsonE.MostashariF.KingJ. (2019). Medicare annual wellness visit association with healthcare quality and costs. American Journal of Managed Care, 25(3), e76–e82.
3.
BeranM.CraftC. (2015). Medicare annual wellness visits. Understanding the patient and physician perspective. Minnesota Medicine, 98(3), 38–41.
4.
CamachoF.YaoN.AndersonR. (2017). The effectiveness of medicare wellness visits in accessing preventive screening. Journal of Primary Care & Community Health, 8(4), 247–255.
ChenR. C.HaynesK.DuS.BarronJ.KatzA. J. (2021). Association of cancer screening deficit in the United States with the COVID-19 pandemic. JAMA Oncology, 7(6), 878–884.
9.
CodoriA.-M.PetersenG. M.MighorettiD. L.BoydP. (2001). Health beliefs and endoscopic screening for colorectal cancer: Potential for cancer prevention. Preventive Medicine, 33(2), 128–136.
10.
ColburnJ. L.NothelleS. (2018). The medicare annual wellness visit. Clinics in Geriatric Medicine, 34(1), 1–10.
11.
CorbinJ.StraussA. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed.). SAGE.
12.
CreswellJ. W.ClarkV. L. P. (2017). Designing and conducting mixed methods research. SAGE.
13.
CreswellJ. W.KlassenA. C.Plano ClarkV. L.SmithK. C. (2011). Best practices for mixed methods research in the health sciences. Bethesda (Maryland): National Institutes of Health, 2013, 541–545.
14.
DamschroderL. J.AronD. C.KeithR. E.KirshS. R.AlexanderJ. A.LoweryJ. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50. https://doi.org/10.1186/1748-5908-4-50
15.
FisherM. P.HamerM. K. (2020). Qualitative methods in health policy and systems research: A framework for study planning. Qualitative Health Research, 30(12), 1899–1912.
16.
GanguliI.SouzaJ.McWilliamsJ. M.MehrotraA. (2017). Trends in use of the US medicare annual wellness visit, 2011-2014. Journal of the American Medical Association, 317(21), 2233–2235.
17.
GanguliI.SouzaJ.McWilliamsJ. M.MehrotraA. (2018). Practices caring for the underserved are less likely to adopt medicare’s annual wellness visit. Health Affairs (Millwood), 37(2), 283–291.
18.
GanguliI.SouzaJ.McWilliamsJ. M.MehrotraA. (2019). Association of medicare’s annual wellness visit with cancer screening, referrals, utilization, and spending. Health Affairs (Millwood), 38(11), 1927–1935.
19.
GreenhalghT.RobertG.MacfarlaneF.BateP.KyriakidouO. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581–629.
20.
HsiehH.-F.ShannonS. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.
21.
HuJ.JensenG. A.NerenzD.TarrafW. (2015). Medicare’s annual wellness visit in a large health care organization: Who is using it?Annals of Internal Medicine, 163(7), 567–568.
22.
JensenG. A.SalloumR. G.HuJ.FerdowsN. B.TarrafW. (2015). A slow start: Use of preventive services among seniors following the affordable care act’s enhancement of medicare benefits in the US. Preventive Medicine, 76, 37–42.
23.
JiangM.HughesD. R.WangW. (2018). The effect of medicare’s annual wellness visit on preventive care for the elderly. Preventive Medicine, 116, 126–133.
24.
KirkM. A.KelleyC.YankeyN.BirkenS. A.AbadieB.DamschroderL. (2015). A systematic review of the use of the consolidated framework for implementation research. Implementation Science, 11(1), 1–13.
25.
KlabundeC. N.SchenckA. P.DavisW. W. (2006). Barriers to colorectal cancer screening among medicare consumers. American Journal of Preventive Medicine, 30(4), 313–319.
26.
LafataJ. E.CooperG.DivineG.Oja-TebbeN.FlockeS. A. (2014). Patient–physician colorectal cancer screening discussion content and patients’ use of colorectal cancer screening. Patient Education and Counseling, 94(1), 76–82.
27.
LesserL. I.BazemoreA. W. (2009). Improving the delivery of preventive services to medicare beneficiaries. Journal of the American Medical Association, 302(24), 2699–2700.
28.
LindK. E.HildrethK.LindroothR.CraneL. A.MorratoE.PerraillonM. C. (2018). Ethnoracial disparities in medicare annual wellness visit utilization: Evidence from a nationally representative database. Medical Care, 56(9), 761–766.
29.
LindK. E.HildrethK.LindroothR.MorratoE.CraneL. A.PerraillonM. C. (2021). The effect of direct cognitive assessment in the Medicare annual wellness visit on dementia diagnosis rates. Health Services Research, 56(2), 193–203.
30.
LissendenB.YaoN. A. (2017). Affordable care act changes to Medicare led to increased diagnoses of early-stage colorectal cancer among seniors. Health Affairs (Millwood), 36(1), 101–107.
MorganK. M.MarcotteL. M.ZhouL.LiaoJ. M. (2021). Annual wellness visits in the era of value-based care: National trends in use, 2011–2018. Journal of General Internal Medicine, 36(9), 2894–2896.
33.
O’MalleyA. S.RichE. C.MaccaroneA.DesRochesC. M.ReidR. J. (2015). Disentangling the linkage of primary care features to patient outcomes: A review of current literature, data sources, and measurement needs. Journal of General Internal Medicine, 30(3), 576–585.
34.
PalmerM. K.JacobsonM.EnguidanosS. (2021). Advance care planning for medicare beneficiaries increased substantially, but prevalence remained low: Study examines medicare outpatient advance care planning claims and prevalence. Health Affairs (Millwood), 40(4), 613–621.
35.
PellandK.MorphisB.HarrisD.GardnerR. (2019). Assessment of first-year use of Medicare’s advance care planning billing codes. JAMA Internal Medicine, 179(6), 827–829.
36.
ShentonA. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 63–75.
37.
SimpsonV. L.EdwardsN.BerlinK. (2018). Annual medicare wellness visit: Advanced nurse practitioner perceptions and practices. The Journal for Nurse Practitioners, 14(2), e45–e48.
38.
SimpsonV. L.KovichM. (2019). Outcomes of primary care-based medicare annual wellness visits with older adults: A scoping review. Geriatric Nursing, 40(6), 590–596.
39.
SolinskyP.Rochester-EyeguokanC.BrandtN.PincusK. J. (2021). A multicenter focus group analysis of medicare beneficiaries perception of annual wellness visits. The Journal for Healthcare Quality (JHQ), 43(3), e33–e42.
40.
ToseefM. U.JensenG. A.TarrafW. (2020). Effects of the affordable care act’s enhancement of medicare benefits on preventive services utilization among older adults in the US. Preventive Medicine, 138, 106148.
41.
ZitoC.DerricksJ. P. (2016). How medicare preventive services can bolster the hospital-physician enterprise: Medicare preventive services offer hospital-owned physician practices an opportunity to increase revenue. Healthcare Financial Management, 70(12), 56–63.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
