Proposal Presented for the Master Plan for Aging (#80)
Disclaimer
Throughout the MPA process, more than 100 proposals were developed thanks in particular to thousands of hours of work by external stakeholders and members of the public. These proposals and the MPA Council commentary are being submitted to the Governor and shared with policymakers and the public to inform policymaking. These proposals represent a starting point for discussion. Further discussion is necessary between relevant state agencies and stakeholders to both refine these proposals and assess which may be appropriate to adopt and implement.
Summary
Undertake programmatic and educational efforts and consideration of innovative partnerships between community-based and health service providers to provide better awareness and utilization of Annual Wellness Visits with primary care providers to create or update a personalized prevention plan.
Justification
The Medicare Annual Wellness Visit is a yearly appointment with a primary care provider to create a personalized health, prevention, and health monitoring plan, however older adults and physicians lack awareness of the benefit and its usefulness. This benefit improves health care quality and lowers healthcare costs. New York State should explore ways and opportunities to promote this benefit for the improvement of the health, prevention engagement, and reduction in healthcare spending.
Full Proposal
The Annual Wellness Visit (AWV) is a yearly appointment with a primary care provider (PCP) to create or update a personalized prevention plan and it serves as an opportunity to educate the patient on the importance of preventive care, discuss advance directives, track the person’s health over time, and ensure the patient is connected to necessary and desired health and social services. The AWV improves health care quality and lowers health care costs utilizing but not limited to falls prevention screenings, mental health and cancer screenings, necessary immunizations, nutrition and exercise counseling, diabetes control, cognitive health, vision and hearing screenings, and gait and balance testing. New York should explore ways to promote the AWV.
Potential recommendation requirements include:
- Require the dual special needs plan to promote and recommend the AWV within their network of providers.
- Encourage Medicaid managed care plans (that cover older New Yorkers who are ineligible for Medicaid) to promote AWVs for their older and eligible enrollees.
- Encourage MLTC plans to promote AWVs and their benefits through care coordination, to be covered either by Medicare Parts A and B or a Medicare Advantage Plan.
- Utilize the AAA Network to explore partnerships with healthcare systems, plans, and providers for the promotion of the AWV.
- Leverage key partnerships with associations of professionals who administer the AWV to educate physicians, nurse practitioners and physician assistants on the following: what the AWV entails, how it can be billed, how key recommended vaccinations may be billed, questionnaires and standardized tests to make it simpler and reduce the barriers to coverage.
- Include AWV materials on the DOH website and update recommendations annually based on US Preventive Service Guidelines, CDC and the NIH Advisory Committee on Immunization Practices.
- The State could create and adequately fund a division within DOH that focuses on Medicare and Medicaid integration to improve health care quality and health outcomes for the dually eligible.
- Connect the Medicaid patient-centered medical home recipient per-day reimbursement to programs which can provide a patient with necessary and desired health and social services.
- Encourage private health insurance to offer a similar AWV benefit to beneficiaries.
This proposal is focused on primary prevention.
MPA Council Commentary
This proposal is categorized as long-term. To accomplish the proposed components and maintain healthy habits, provide preventative healthcare, reduce hospitalization rates, and lower healthcare costs, the State could assess fiscal impact, necessary resources for development, outreach, coordination, and strategies. This proposal would result in additional State costs and funding allocations would be subject to the annual budget process and the availability of resources.