Blacks, Medicaid users see fewer annual wellness visits

In 2011, as outlined in the Affordable Care Act (ACA), Medicare began offering wellness visits at no cost to fee-for-service beneficiaries. The goal of the annual checkup was to introduce preventative care and address specific risks such as depression and risk of falling.

In a new report in February’s issue of Health Affairs, researchers examined national Medicare data from 2008 to 2015, finding 51.2 percent of practices provided no wellness visits, while 23.1 percent provided them for at least a quarter of those eligible. Those who adopted the practice had more stable patients who were slightly healthier.

The team—led by Ishani Ganguli, MD, an instructor at Harvard Medical School and Brigham and Women’s Hospital in Boston—also found lower utilization rates among underserved populations, including racial minorities and those also enrolled in Medicaid.

“Practices caring for a larger fraction of disadvantaged or high-risk populations may offer fewer annual wellness visits, because they have limited resources or their patients have more pressing needs,” Ganguli and colleagues wrote. “Meanwhile, practices with a greater focus on providing primary care or those with more Medicare beneficiaries per doctor may have greater incentives to overcome the challenges of adoption.”

Researchers used a random 20 percent sample of fee-for-service Medicare patients. Limiting the analysis to 4.4 million beneficiaries whp were assigned to a practice, the team found 24.8 percent received an annual wellness visit in 2015. These visits were overwhelmingly at an assigned practice (90.6 percent) and from an attributed primary care provider (79.7 percent).

The researchers found interesting conclusions from the data, including:

• Gaining popularity: Annual wellness visits among eligible beneficiaries grew from 7.5 percent in 2011 to 15.6 percent in 2014.
• Country vs. city: Lower rates of visits were found in rural practices, with 8.1 percent utilization vs. 24.4 percent in metropolitan practices.
• Managing risks: Practices with patients with high medical risk (18.2 percent) were less likely to perform wellness checks than those serving those with low risk (23 percent).
• Medicaid reduces visits: Higher Medicaid enrollment practices had a visit rate of 17 percent, compared to 26.5 percent with lower enrollment.

“Medicare introduced the annual wellness visit in 2011 to promote preventive care and mitigate health risks in aging adults,” Ganguli et al. wrote. “While it is not yet clear if the visits improve patient outcomes, these goals cannot be achieved unless practices are able and motivated to provide these visits in the first place.”

In addition to improved outcomes for patients, researchers also found that wellness visits may make financial sense, with improved revenue for providers who offered them.

Adoption of the annual wellness visit may benefit practices financially, yet half of them are missing out on these benefits—particularly practices that disproportionately care for medically and socially complex patients.”