Hospital utilization and expenditures among a nationally representative sample of Medicare fee-for-service beneficiaries 2 years after receipt of an Annual Wellness Visit.

Abstract

Medicare's Annual Wellness Visit (AWV) provides an opportunity to link beneficiaries to cancer screenings and immunizations, however, research has not examined its effectiveness. The aim of this study was to examine the effect of receiving an AWV on outcomes while accounting for the healthy user effect. This study used 2013-2017 Medicare claims data to compare hospital utilization and total expenditures among a 5% random sample of Medicare fee-for-service (FFS) beneficiaries with and without AWV use in 2014 (228,053 AWV users were propensity-score matched to 228,053 nonusers). Linear fixed effects regression models examined differences in study outcomes 12 and 24 months after AWV use, controlling for baseline differences in sociodemographics, health status, utilization, and accountable care organization attribution. The proportion of Medicare FFS beneficiaries that used the AWV increased from 13% in 2013 to 24% in 2017. Users of the AWV had a marginally significant reduction in Medicare spending 12 months (-$122, 95% CI -$256, $11, p = 0.073) and significant reductions (-$162, 95% CI, -$310, -$14, p = 0.032) 24 months after the visit, relative to non-users. However it remains unclear what is driving these savings as there was no change in hospital-related utilization and results may still be biased due to inherent differences between users and non-users. The AWV provides an opportunity for providers to focus on prevention and geriatric needs not covered in typical office visits. Practices adopting AWVs have noted increased revenue, more stable patient populations, and stronger provider-patient relationships. While utilization remains low, it is steadily increasing over time.