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Unleash the Power of AWVs —Transform Outcomes, Cut Costs, and Maximize Your Organization’s Financial Success

Why Annual Wellness Visits (AWVs) still matter. Organizations need to start with AWVs to drive better care, lower spend, and maximize revenue performance.

The Annual Wellness Visit (AWV) remains one of the most underused yet strategically essential tools in a health plan’s arsenal. AWVs directly impact risk scores, identify patients who need complex care management, enhance Stars performance, and member participation in their care. Studies show that organizations with high AWV completion rates consistently outperform those with lower rates across preventive care and member satisfaction measures.

Despite its value, the completion rates of AWV remain low. The number of non-utilizers and utilizers without a current AWV is high. National rates are between 25% and 35%, leaving plenty of room for growth. Access challenges and provider capacity are consistent key barriers to increasing rates.

Organizations cannot improve what they can’t see; visibility drives better population health. Without the information provided by the AWVs, organizations are operating in the dark. Organizations need systems, platforms, and tools that provide visibility, guide assessment, and support actionable responses.

For payers, AWVs enhance risk score accuracy by prompting timely and complete documentation of chronic conditions. It serves as the foundation for building care plans.

For providers, it offers opportunities to close care gaps, deliver preventative services, identify SDOH risks, and, in many cases, earn additional incentive payments.

For members, AWVs are a zero-cost benefit and a gateway to improving or managing their health journey. When coupled with incentives, the completion of AWVs increases engagement and connectedness to their health care provider and plan.

 

Timing is Everything
The earlier an AWV is completed in the year, the greater the benefits; even at mid-year, it’s not too late. Summer represents a window before providers shift their focus to flu season, annual employee physicals, holidays, and a compressed timeline for execution.

Summer Actions
• Prioritizing high-risk and Q1/Q2 enrollees for outreach and scheduling.
• Use the team – maximize clinical capacity by using nurse practitioners, physician assistants, and registered nurses.
• Deploy mobile and home-based AWV collection to reach members who may be unresponsive or have challenges visiting their provider.
• Coordinate AWVs with routine visits to optimize billing opportunities and care delivery.
• Leverage financial incentives to activate disengaged members and reward proactive provider participation.

 

From Doctor’s Office to Community: CBOs as Powerful Partners in Member Engagement

  • Help reach and educate diverse cultural groups, explaining the AWV and encouraging participation. This can be especially helpful for low-literacy or those populations with Limited English Proficiency (LEP).
  • Assist with scheduling and additional services, such as transportation.
  • Host on-site mobile AWV clinics in community/senior centers or housing complexes – meet the members where they are. Expand the scope or the reach of community events.
  • Support expanded screening efforts that capture SDOH and other unmet social needs.

 

Existing levers—policy, technology, and outreach—to increase AWV completion

  • CMS extended telehealth flexibilities through the end of 2025, allowing virtual AWVs with audio-visual capabilities.
  • Some payers reimburse SDOH risk assessment during the AWVs, with no out-of-pocket costs for the patient.
  • Team-based delivery models are gaining popularity, supported by CMS Innovation Center pilots and AMA’s STEPS Forward program.
  • Health plans are working with retail clinics and Community Health Workers (CHWs) during flu season and experiencing significant increases in completion year-over-year.
  • Use of SMS reminders and other push notifications to boost AWV scheduling.

 

Key Takeaways

  • AWVs enhance outcomes, lower the total cost of care, and optimize financial success.
  • Plans and providers require integrated tools that provide insight, facilitate evaluation, and enable timely interventions.
  • Starting early helps organizations avoid the pressure of end-of-year catch-up efforts. Action now can prevent a last-minute scramble at year-end.
  • AWVs lay the groundwork for personalized care planning, population health management, and accurate risk scoring.
  • Harness the collective power of care teams, community partners, digital tools, and platforms to maximize impact.
  • For almost all patients, AWVs are always covered and at no cost to the patient.

 

How we can help!

1. Position AWVs as a Catalyst for Risk Adjustment and Quality Metrics

  • Improve HCC coding integrity and financial alignment through risk-adjusted reimbursement
  • Implement data-informed strategies to boost Star performance metrics.

2. Enable Smarter Operations Through Integrated Technology Solutions

  • Boost timeliness and clarity of essential data to drive more efficient Care Management operations
  • Fast-track EMR and third-party system interoperability to support real-time workflows.

3. Leverage Data-Driven Insights to Prioritize Outreach and Close Care Gaps

  • Identify and prioritize high-risk groups such as Dual Eligibles and populations flagged for SDOH-related vulnerabilities
  • Optimize workforce deployment to improve resource allocation and workflow efficiency

4. Prioritize key AWV elements that impact risk scores and Star Ratings, including medication reviews, fall risk assessments, and depression screenings.

Contact us at info@copehealthsolutions.com to learn more today.

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