Annual Wellness Visits (AWVs) Generate Downstream Revenue

Engagement campaigns run on Actium Health’s platform drove 2X+ in referral revenue while helping close care gaps.

Case Study Highlights

  • Drove 2X+ in referral revenue
  • Closed critical care gaps and enabled patients to proactively manage their health
  • Engaged and influenced patients to schedule annual wellness visits

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Poor Utilization of AWV Benefits in Medicare and MA Patients

Nearly half (45%) of all Medicare beneficiaries have four or more chronic conditions, making the prevention, management and treatment of those conditions critical to both health outcomes and healthcare spending. Unfortunately, many Medicare and Medicare Advantage (MA) recipients are not aware that they are eligible for an initial preventive physical exam (IPPE) in their 65th year and an annual wellness visit (AWV) every year thereafter. 

For patients, these visits can be incredibly valuable, as they may uncover or identify areas of concern or risk that need further study or treatment. Early detection of disease not only enables prompt treatment that can prevent disease progression, but costly health outcomes. And yet, only 25.2% of Medicare and MA recipients receive an annual wellness visit.

For provider organizations, these visits represent an opportunity for downstream revenue from referrals generated during these wellness visits. 

With Primary Care being the entry point for specialty care, getting this higher risk population established with Primary Care through the AWV helps provider organizations:

  • • Deliver growth
  • • Build loyalty
  • • Improve quality
  • • Build patient satisfaction
annual wellness benefits in medicare and medicare advantage patients

Only 25%

of Medicare and Medicare Advantage recipients receive an AWV

Engaging Medicare and MA Patients

For many organizations, identifying and engaging that group of patients is often seen as an obstacle to prioritizing and collecting revenue from AWVs. The slots allocated for those annual visits sit unfilled because administrators believe the effort to fill those appointments outweighs the reimbursement value.

The Primary Care Provider serves as the entry point for the annual wellness visit, but the specialty providers benefit from the referral revenue. This creates a challenge to operationalize the process because Primary Care needs to realize value as well.

best practices for annual wellness visit engagement campaigns

Four Best Practices for Annual Wellness Visit Engagement Campaigns

Not every patient engagement campaign is created equal, nor will they deliver the same results. For example, campaigns that cast too broad a net or fail to customize outreach run the risk of high attrition, and therefore less-than-optimal results.

Here are four best practices for AWV engagement campaigns:

Leverage Data
Within the EHR, identify patients who are 64 and will be aging into eligibility for an IPPE on their 65th birthday. Design a campaign for those patients who are 65+ and eligible for initial and subsequent AWVs.
Customize The Message
A campaign should not just be designed around making it easy for an individual to complete their AWV; education should be a core pillar in order to demonstrate the benefit and value of preventive vs. episodic care.
Measure The Results
Every campaign should deliver real-time data that demonstrates how well the messages are performing. If the results are below expectations, revisit the criteria to ensure the right patients are targeted and that messaging is specific and clear for the call to action.
Set Goals
Once the AWVs have been launched, they gain the most traction when the campaign is “Always-On”. As the campaigns continue throughout the year, set goals and track progress. Find ways to tweak and improve the campaign to meet and exceed your goals.

Conservatively averaging values for reimbursement for more than half of the AWV patients, a health system may generate more than $800 in additional revenue per patient.

Driving Downstream Referrals

Looking at the data across the AWV-focused patient engagement campaigns on the Actium platform for the past 2 years, we were able to extrapolate the full revenue generating power these annual visits can deliver. 

For the campaigns, the results demonstrated the power of driving AWVs. Not only do these visits close critical CMS care gaps, but they generate significant downstream revenue. 

Conservatively averaging values for reimbursement for more than half of the AWV patients, a health system may generate more than $800 in additional revenue per patient. And with 44 million Americans currently enrolled in the Medicare program, healthcare systems are sitting on a mostly untapped opportunity to drive revenue, close care gaps and improve health outcomes.







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