Longitudinal analysis of Annual Wellness Visit use among Medicare enrollees: Provider, enrollee, and clinic factors.

Abstract

Background: The utilization of Annual Wellness Visits (AWVs), preventive healthcare visits covered by Medicare Part B, has grown steadily since their inception in 2011. However, longitudinal patterns and variations in use across enrollees, providers, and clinics remain poorly understood.

Objective: This study aimed to analyze AWV usage trends from 2018 to 2022 among a sizable cohort of Medicare beneficiaries, employing electronic health record (EHR) data. The goal was to assess AWV frequency and explore variations across enrollees, providers, and clinics.

Design: This retrospective observational study utilized EHR data from Medicare beneficiaries aged 66 and above, receiving continuous primary care from 2018 to 2022 (N = 24,549). Enrollees were classified into three categories based on their AWV utilization over a 5-year period: low users (0-1 AWVs), moderate users (2-3 AWVs), and regular users (4-5 AWVs). AWV usage patterns were examined across individual demographics and provider/clinic characteristics using multilevel regression models.

Key results: Over the 2018-2022 period, 58.6% were regular AWV users, 27.7% were moderate users, and 13.7% were low users. Differences in primary care providers and clinics accounted for 56.4% (95% CI, 45.3%-66.9%) of the variation between low and regular users. Among enrollees who visited the same providers and clinics, individuals were less likely to be regular users of AWVs if they were 85 and older, Hispanic, from socioeconomically disadvantaged areas, or had multiple comorbidities.

Conclusions: The majority of Medicare beneficiaries in the study engaged with AWVs, with 86% having two or more over the 5-year period. These findings underscore the broad acceptance of AWVs among beneficiaries but also show that clinic and provider factors influence usage, especially among older, minoritized, and socioeconomically disadvantaged populations. Interventions at the provider and clinic levels are necessary to further improve AWV uptake, particularly for vulnerable groups.