An incredible analysis from Wakely Consulting, one of the foremost actuarial firms in the Medicare world. Wakey finds that annual wellness visits (AWVs) can demonstrably help control costs among Medicare beneficiaries. As the firm notes, AWVs are meant to identify disease states and conditions as well as create a care plan to act as a long-term preventive action plan.
Wakely looked at a sample of traditional fee-for-service (FFS) Medicare program claims from 2018 – 2023. Beneficiaries who met the criteria for the institutional, end-stage renal disease (ESRD), or new enrollee risk score models were excluded. As well, only Medicare beneficiaries in the community with full calendar year data were included. The final sample comprised 733,532 beneficiaries with data for each year. Wakley also took into consideration social determinant and disease state impacts.
Wakely broke out the sample into the following:
- Not Engaged with AWVs: Having 0–1 AWVs from 2018–2023. (45%)
- Somewhat Engaged with AWVs: Having 2–3 AWVs from 2018–2023 (25%)
- Engaged with AWVs: Having 4–6 AWVs from 2018–2023 (30%)
Wakley found that AWVs are considerably underutilized. About 45% of beneficiaries had just one or no such visits during the study period. It did find that the percentage of people with an AWV increased from 33% in 2018 to 40% in 2023, but persistency of utilization of such visits dropped considerably over the study period as well.
Dual eligibles had problems with AWV engagement. Wakley found that 62% had no engagement, with 21% somewhat engaged and 17% fully engaged. Those with no chronic conditions only had 24% full engagement. Engagement patterns are roughly consistent for those who have 1 or more conditions. Non-engagement is high from age 60 to 69. Engagement increases at age 70 and is roughly consistent for age groups from that age on. Engagement is low for those with the lowest incomes and moves higher as income rises.
Wakely also found how such visits can reduce costs and improve outcomes. Medicare beneficiaries who had 4 to 6 visits during the study period had lower inpatient and emergency department spending, and a lower annual total cost of care trend compared to those who had not engaged in such visits. Those who received an AWV had an average $885 reduction in total costs per beneficiary per year compared to years without an AWV. Wakely found a statistically significant association between AWVs and care costs. The $885 is almost 6% of Medicare Parts A and B spending in 2024.
Other studies find something very similar. Uncontrolled disease states account for a huge share of spending on healthcare and this is particularly true in Medicare. A recent study in the Journal of the American Medical Association found that disease states are poorly managed in America. Forty-three percent of patients with diabetes and heart disease are not treated at all with evidence-based treatments and only 20% are treated adequately based on evidence. So, attacking the disease state problem is key.
Wakely recommends that providers should consider implementation strategies that can increase member engagement for wellness visits. This is a great recommendation, too, for Medicare Advantage (MA) plans, which are struggling with costs right now.
AWVs have been around for years, but engagement with beneficiaries appears to be a major challenge. The Trump administration has recently announced efforts to engage beneficiaries with technology in an effort to control costs and better manage disease states and conditions. The pilot models are known by the acronyms ACCESS and ELEVATE. Program descriptions can be found below with the Wakely study.
Links:
Wakely analysis: https://www.wakely.com/blog/annual-wellness-visits-and-the-economics-of-prevention-insights-from-a-longitudinal-study-of-medicare-enrollees/
ACCESS: https://www.cms.gov/priorities/innovation/innovation-models/access
ELEVATE: https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate
#wellness #prevention #medicare #medicareadvantage
— Marc S. Ryan
