Disparities in Medicare Annual Wellness Visits After a Systemwide Quality Improvement Initiative: A Serial Cross-sectional Analysis.

Abstract

Medicare Annual Wellness Visits (AWVs) offer potential benefits for older adults. Little is known about recent racial/ethnic disparities in populations with high AWV completion. To calculate racial/ethnic disparities before and after a health system initiative to increase AWV completion, and investigate factors associated with post-initiative AWV completion. Repeated cross-sectional evaluation over 3 years, ending August 2023. Medicare beneficiaries age ≥ 65 in a large Midwestern U.S. health system. Race/ethnicity was categorized as White non-Hispanic, Black/African American non-Hispanic, Latino/Hispanic, Asian non-Hispanic, and Other non-Hispanic. Annual AWV completion during the pre-initiative year (year 0) and two subsequent initiative years. Regression models tested for unadjusted and covariate-adjusted disparities in AWV completion. The health system's overall rate of AWV completion increased from 47.5% in year 0 to 68.9% in year 2. All racial/ethnic groups experienced similar proportional increases in AWV completion, including 21.5% among White, 21.6% among Black, and 22.5% among Latino/Hispanic patients. In unadjusted regression for year 2 (N = 92,634) results, the probability of AWV completion was 15% lower among both Black (relative risk, [RR], 0.85; 95% confidence interval [CI], 0.82-0.89) and Latino/Hispanic (RR, 0.85; 95% CI, 0.82-0.87) patients, compared to Whites. However, the adjusted probability of AWV completion was only 4% lower in Black (RR, 0.96; 95% CI, 0.93-1.00) and 5% lower in Latino/Hispanic (RR, 0.95; 95% CI, 0.91-0.99) patients than in Whites. AWV completion was positively associated with age ≥ 70, using the patient portal for appointment scheduling, and prior year AWV completion, and negatively associated with Medicaid coverage, positive screening for any social need, and dementia. A 2-year health system initiative led to substantially increased AWV completion, but pre-existing disparities persisted. To reduce disparities, future efforts should explicitly focus on enhancing equity and addressing barriers in subgroups with particularly low AWV completion.