by Jill Clendening
When it was determined in June 2019 that a majority of the 19,000 individuals eligible to receive a no-cost annual wellness visit (AWV) as part of their Medicare coverage had not yet scheduled one, a large, multidisciplinary task force was assembled at Vanderbilt University Medical Center to contact these patients and schedule their visits before year’s end.
At the year-end deadline, 74% of patients who are part of the Connected Care of Middle Tennessee Accountable Care Organization (ACO) or who are members of the Humana Medicare Advantage plan had completed either a wellness or return office visit with Vanderbilt Health providers.
“When patients were identified who had not yet received their annual wellness visit, we mobilized quickly to reach out to these patients and have them seen,” said Victor Legner, MD, Medical Patient Care Center executive medical director and Connected Care of Middle Tennessee ACO board member.
“These visits are a vital component of providing comprehensive, preventive care for older individuals, and conversations that happen during these visits are important as we work to keep these individuals healthy and enjoying their best lives.”
Vanderbilt Medical Group, the clinical practice group of VUMC, is a participant in the Connected Care of Middle Tennessee ACO, along with NorthCrest Physician Services and Williamson Medical Group. Launched in January 2018, Connected Care of Middle Tennessee is a network of physicians, hospitals and other health care providers tasked with delivering coordinated, high-quality care to their assigned Medicare patients. An ACO’s primary goal is to ensure patients receive the right care at the right time, while avoiding duplicated services.
Medicare began offering the AWV benefit in 2011 under the Affordable Care Act (ACA) as a way to proactively address risks and improve the health of older adults.
These visits are free to Medicare recipients who have had Part B coverage for at least 12 months, and the Centers for Medicare and Medicaid Services (CMS) reimburses medical practices for AWVs.
It wasn’t a surprise that patients assigned to the Connected Care of Middle Tennessee ACO had not yet scheduled their AWVs. In a study published in 2018 in the journal Health Affairs, it was reported that less than one-fifth of all eligible Medicare patients actually receive their AWV. But the fact that these patients were missing a core component of their preventive care drove VUMC leaders to tackle the issue with just months remaining in 2019.
In addition, the ACO is part of the Medicare Shared Savings Program (MSSP), which means the ACO performs against measurable benchmarks related to the health status of the ACO’s assigned patient population.
If patients eligible for an AWV are either not seen or their health conditions are not precisely documented during a visit, the health status of the population might not be accurately reported to Medicare.
That means the financial benchmark set for the ACO, which is based on this information, could be inaccurate which can then negatively impact the ACO’s funding, said Office of Population Health Manager Jeremey Whitaker.
During an AWV, a medical provider develops a personalized preventive care plan, reviews and updates the patient’s medical history, reconciles their medications and identifies other providers involved in their care. These visits are lengthier than an acute care or illness-focused office visit — often lasting an hour — allowing providers to develop a comprehensive care plan.
“All the workflows for this project, the enormous task of contacting and getting these patients in for clinical visits, had to be created in a compressed timeline, including implementing new coding processes; creating changes in eStar (VUMC’s electronic medical record); training our clinical teams and our scheduling staff in Care Connections; and making changes in the technology around how that scheduling works,” said Catherine McCarver, associate operating officer for the Medicine Patient Care Center. “Every piece of this project had an element of innovation, complexity and novelty.”
Another key component of the effort was clinician education. Legner and other leaders of the Medicine PCC traveled to adult primary care clinics — 17 sites in Davidson and Williamson counties — to explain the critical push to schedule and complete AWVs for patients by Dec. 31, 2019.
In addition, specialty clinics that provide oncology, endocrinology and cardiology care for patients who don’t have a VUMC primary care provider but who still needed to receive an AWV were engaged to provide AWVs for those patients.
To better educate the public, VUMC’s Office of Strategic Marketing created patient education materials distributed through social media and on-hold messaging about the importance of wellness visits. And VUMC’s nursing staff played a key role by closely reviewing patient medical records to check for important medical screenings that should be scheduled during AWVs and creating a “best practice advisory” to alert clinicians to topics that should be covered during a patient’s visit.
“The most amazing part of this experience is that everyone we reached out to for assistance with this came through with novel ideas and full enthusiasm to make this work,” said Legner. “The culture here at Vanderbilt is one where if there’s an issue, no matter how insurmountable it might seem, you have a lot of brilliant minds working together, really looking for the best solution so our patients have the best care experience. As long as we keep our focus on our patients and how we can work together to improve their care, we’ll have support throughout the organization.”
Project leads included Legner; McCarver; Roshanda Johnson, Medicine PCC assistant administrator; Jeremey Whitaker, Office of Population Health manager; and Phil Cook, Medicine PCC senior program manager. Groups who contributed significant effort to this project include the Office of Population Health; Vanderbilt Health Affiliated Network (VHAN); HealthIT; Enterprise Analytics; the Office of Healthcare Compliance; Vanderbilt Health OnCall; Vanderbilt Quality, Safety and Risk Prevention; the Medicine PCC; Nurse Faculty Clinics; Strategic Marketing; Care Connections; VMG Coding; and eStar Learning.