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Persistent Disparities in Medicare’s Annual Wellness Visit Utilization

Lind, Kimberly E. PhD, MPH*; Hildreth, Kerry L. MD; Perraillon, Marcelo Coca PhD

doi: 10.1097/MLR.0000000000001229
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Introduction: The Medicare Annual Wellness Visit (AWV) is a preventive care visit introduced in 2011 as part of the Affordable Care Act provided without cost to beneficiaries. The AWV is associated with higher preventive services utilization. Although AWV utilization increased during 2011–2013, utilization was lower among ethnoracial minority beneficiaries who may benefit the most.

Objectives: To determine if AWV utilization disparities have persisted using the most recent data available.

Research Design: The authors analyzed AWV utilization in 2011–2013 and 2015–2016 by beneficiary-reported race and ethnicity, adjusting for potential confounders.

Subjects: Weighted sample of 78,639,501 fee-for-service Medicare beneficiaries aged 66 years and older who participated in the Medicare Current Beneficiary Survey 2011–2013 or 2015–2016.

Measures: AWV utilization was identified using Medicare claims.

Results: AWV utilization increased from 8.1% to 23.0% of all beneficiaries between 2011 and 2016. Compared with non-Hispanic white beneficiaries, utilization was significantly lower among non-Hispanic Black and non-Hispanic other race beneficiaries in both the minimally and fully-adjusted models. Hispanic/Latino beneficiaries had lower utilization in the minimally adjusted model, but not in the fully-adjusted model. In 2016, compared with non-Hispanic white beneficiaries, AWV utilization was 10.2 points lower for non-Hispanic black, 11.6 points lower for Hispanic/Latino, and 8.6 points lower for non-Hispanic other race beneficiaries, and these differences were attenuated after adjusting for all covariates to 6.8 points lower, 9.4 points lower, and 7.2 points lower, respectively.

Conclusions: The AWV has the potential to increase the use of preventive care, improve health, and reduce ethnoracial disparities among Medicare beneficiaries, but realizing these goals will require increasing utilization by minority groups. If ethnoracial minority beneficiaries had used the AWV at the same rate as non-Hispanic white beneficiaries during the study period, then ~1.6 million additional AWVs would have been used.

*Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

Department of Medicine, Division of Geriatric Medicine

Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO

Supported by the Department of Health Systems, Management and Policy at the University of Colorado.

The authors declare no conflicts of interest.

Reprints: Kimberly E. Lind, PhD, MPH, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia. E-mail: klind@email.arizona.edu.

Online date: October 3, 2019

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