Annual Wellness Visits (AWVs) Drive Additional 2X+ in Referral Revenue

The following is a guest article by Mike Linnert, Chief Executive Officer & Founder at SymphonyRM.

Most healthcare systems don’t think about the annual wellness visit (AWV) as a way to drive the holy grail in healthcare: better health outcomes and increased revenues. I’m going to make the argument here that they should.

Less than 1 in 4 Medicare and Medicare Advantage (MA) recipients currently receive an AWV

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 appointments. 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, and build patient satisfaction.

While AWVs may generate revenue through fee for service reimbursement, the real value for provider organizations is the ability to identify patients with comorbidities, get them the care they need and code to the highest levels of severity to ensure revenue is available to treat and manage risk.

Identifying and 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.

Health systems that prioritize AWV-specific patient engagement and education can drive significant downstream referrals

Looking at the data across AWV-focused patient engagement campaigns on SymphonyRM’s platform for the past two years, we were able to extrapolate the full revenue-generating power these annual visits can deliver. Not only do these visits close critical CMS care gaps, they generate significant downstream revenue.

  • Of those patients who completed an AWV, more than 60% received referrals for follow-up appointments.
  • Thirty percent (30%) of those [who received referrals] averaged three or more referrals each.
  • The top three referral types from AWVs included mammography, gastroenterology and cardiology, which indicates that AWVs have significant impact on care gap closure and Quality of Care to also deliver value to Primary Care.

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.

Four Best Practices for AWV 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.

Leverage data

Within the EHR, provider organizations have the ability to identify the patients who fall into a number of categories, including age. Start by focusing a campaign on those patients who are 64 and will be aging into eligibility for an IPPE on their 65th birthday. Once that is underway, design a campaign for those patients who are 65+ and eligible for initial and subsequent AWVs.

Customize the message

Most Medicare and Medicare Advantage recipients are either unaware of – or apathetic to – the AWV benefit. Therefore, 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. Are they driving click-throughs? AWV appointments? If the results are below expectations, revisit the criteria to ensure the right patients are targeted, the messaging is specific and the call to action is clear. Continue to monitor, measure and optimize.

Set goals

Since AWVs are yearly, healthcare organizations see the greatest results when the campaigns run annually as well. Some organizations have launched these campaigns in the New Year when people are thinking about healthy goals and improving behaviors. Others have aligned their launch to Medicare Open Enrollment to ensure patients get the maximum benefits from their coverage. Most importantly, 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. With those goals established, find ways to tweak and improve the campaign to meet, and maybe even exceed, your goal.   

AWVs can be a significant driver of additional revenue for organizations. They are also a critical tool for helping senior citizens live longer and healthier lives. In order to take advantage of that opportunity, systems need to educate and engage patients on the value those visits deliver. Armed with the right data and plan to execute, AWVs can be turned from a “break-even” line item to one that consistently delivers value for both the health system and patient.

About Mike Linnert

Michael Linnert, Founder and CEO of SymphonyRM is on a mission to help healthcare organizations – from practice groups to health systems – leverage their audience data to improve patient engagement, health outcomes and exceed business goals. At SymphonyRM, he’s guiding those organizations successfully through the consumerization journey to meet their patients where they are. Find and connect with him on LinkedIn to talk patient engagement, Next Best Actions, and the role marketing plays in healthcare.

   

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