The Effect of Medicare's Annual Wellness Visit on Preventive Care

The U.S. health care system is transforming from a focus on treatment to increasing emphasis on wellness and preventive care. Such change is necessary to curb the rising health care cost and improve population health. As the nation’s largest public health insurance program, Medicare serves approximately 50 million Americans, 85% of them being elderly. According to the Center for Disease Control and Prevention (CDC), however, fewer than half of people age 65 and older are up-to-date with recommended age-specific preventive services.

Recognizing the need for enhanced preventive care, Medicare started covering a one-time “welcome-to-Medicare” visit for newly enrolled beneficiaries since 2005. Starting in 2011, Medicare also began covering an annual wellness visit. In this study, we examine the effect of undergoing annual wellness visit on six core clinical preventive care services as recommended by CDC, including screening mammography, pap smear test, bone mass measurement, colorectal cancer screening, prostate cancer screening, and seasonal influenza virus vaccine.

We use the difference-in-difference analysis with propensity score matching to evaluate the change in the biennial rate of the six preventive services (with sex-specific denominators where appropriate) on a 5% sample of Medicare fee-for-service beneficiaries aged 65 and older in 2009, who were alive, residing in 50 U.S. states and the District of Columbia, with continuous part A and B coverage and no HMO enrollment between 2009 and 2013.

The treatment group includes beneficiaries who received the annual wellness visit in 2011 without any type of prior or subsequent wellness visit. The control group includes those who have never had an annual wellness visit or welcome-to-Medicare visit between 2009 and 2013. The study period is 2009-2012 for the control group, or 24 months prior to and following the wellness visit for the treatment group.

Both groups are one-to-one matched on a propensity score of receiving wellness visit, calculated through a Probit model on patient age groups, sex, race, state, urban classification, Charlson comorbidity score, receipt of Medicaid subsidy, and the total number of hospitals at the country level. The difference-in-difference analysis is then performed on the matched sample, adjusting for the above covariates and clustering on patient ID.

Preliminary results indicate that in terms of the biennial rate, receiving annual wellness visit in 2011 was associated with a small but significant increase colon cancer screening, pap smear test, and bone mass measurement; a small but significant decrease in influenza virus vaccine; and no change in screening mammography or prostate cancer screening. When restricting the study sample to those under 73 as of 2011, the statistical significance remains the same and the effect becomes bigger.

Healthy People 2020 has targeted at increasing the proportion of older adults who receive a core set of preventive services by 10 percent. Annual wellness visit represents an important opportunity for achieving that goal. Our study indicates that although the percentage of people undergoing the wellness visit is still low (3%), we begin to see improvement in area of underutilized services such as colorectal cancer screening and bone mass measurement.