Quality Effort at University Hospitals Boosts Annual Wellness Visits for Medicare Patients

UH Clinical Update | October 2022

A multifaceted quality improvement effort at University Hospitals has boosted the number of Medicare patients receiving Annual Wellness Visits by almost three times their previous level – a significant accomplishment achieved in just four years and in the height of the COVID-19 pandemic. That’s according to an article published by UH in the Journal of General Internal Medicine and more recent data from the UH Primary Care Institute. These results were part of the calculus from the American Hospital Association in recently awarding UH its Quest for Quality award.

What the data shows: In 2018, UH primary care practices reported 23.7 percent Annual Wellness Visit completion for their Medicare patients. By 2020, that number was nearly 60 percent. For 2021, with a new goal of 65 percent, the team hit 69 percent visit completion. Three quarters through 2022, AWV completion was at 60 percent - putting UH on track to hit 80 percent this year.

Why it matters: Some studies show that Medicare patients who receive an Annual Wellness Visit receive more preventive services than other patients and have lower Medicare expenditures. But UH family medicine physician Todd Zeiger, MD, Quality Medical Director for the UH Primary Care Institute and lead author of the recent article, says these visits are also important because they’re dedicated, protected time a primary care physician has to talk about prevention and screening – topics that have clear implications for patients’ health and well-being.

“This is a great opportunity to talk about cancer screening, vaccinations, falls risk, social support, advanced directives -- and all those things that are important for the prevention side,” he says. “Our American health system, even though we spend the most money, our longevity pales compared to other countries where there's healthier habits and screenings and things done. The key with these Annual Wellness Visits is attending to prevention and screening and being proactive rather than reactive, which can lead to better patient outcomes.”

How They Did It

The UH team achieved these Annual Wellness Visit results with a four-part plan:

• Declare goals. The UH team now declares an annual goal for Annual Wellness Visit completion for its Medicare patients.
• Create an infrastructure to enable success. Dedicated personnel in the UH Accountable Care Organization provide support to primary care practices in areas such as project management, coaching, communications, feedback on performance and health informatics.
• Engage clinicians and encourage them to provide peer learning activities. For example, one UH clinically active primary care physician received the support to conduct 30- to 45-minute education sessions with peer physicians on how to create workflows for Annual Wellness Visits.
• Report results transparently and ensure shared accountability. User-friendly dashboards for providers and monthly and quarterly scorecards allow providers to gauge their progress and leaders to identify providers needing more support.

Of these elements, Dr. Zeiger says the peer-to-peer education likely has the greatest impact. He credits UH internal medicine physician Sona Kirpekar, MD, Quality Medical Director with the UH Primary Care Institute, with much of the group’s success.

“She knows Annual Wellness Visits like the back of her hand,” he says. “As a working internal medicine primary care doctor, she can relate. When people bring up barriers, she said, ‘I know exactly what you're talking about and here's how you work around that barrier,’ especially for those who are struggling. Since it is peer to peer, it is received so much better.”

Another important factor behind the group’s success has been shared accountability for improving the numbers. Dr. Zeiger says the group counts on the competitive nature of doctors dating back to their days as pre-med students. They have found, for example, that primary care physicians like being personally identified in weekly emails for their efforts to complete more Annual Wellness Visits. Individual physicians not hitting targets are not singled out, but those at target or above are identified and celebrated, which helps motivate others.

The main lesson from the whole experience, Dr. Zeiger says, is that quality improvement projects like this and others are doable.

“We just went into this with the intent that it can be done,” he says. “And we are doing it.”