Annual Wellness Visits That Close Gaps, Not Just Check Boxes
Medicare patients are entitled to an annual wellness visit every year. Most don’t complete one. When they do, the visit is often a documentation exercise that misses the chance to close care gaps, update risk scores, and activate patients on their biggest health priorities.
AWV completion rates remain low across most organizations. Patients don’t schedule them. Reminders go ignored. And when visits do happen, the health risk assessment and care plan often become rote paperwork that doesn’t lead to any follow through action.
Your staff already struggles to keep up with acute visits and ongoing chronic care. Adding proactive AWV outreach, scheduling, pre visit preparation, and post visit follow up stretches an already thin workforce. The reimbursement opportunity is clear. The operational capacity to capture it isn’t.
Root Cause
The Missed AWV Isn’t Just Missed Revenue. It’s a Missed Activation Opportunity.
The annual wellness visit is the single best touchpoint for comprehensive health assessment. It’s where you catch the new diabetes diagnosis, identify the cancer screening that’s three years overdue, update the medication list that hasn’t been reconciled in 18 months, and capture the ICD-10 codes that your risk adjustment scores depend on.
When AWVs don’t happen, or when they happen without activation intent, your entire quality and risk adjustment infrastructure suffers. Care gaps stay open. Risk scores stay stale. And patients miss the preventive interventions that could have changed their trajectory for years.
Our Approach
Our Approach
We handle AWV outreach, scheduling, and follow up as part of our integrated care management approach.
Proactive patient outreach
We identify eligible patients and conduct outreach to schedule their annual wellness visit. Not a reminder letter. A conversation with a trained specialist who can address hesitation, answer questions, and book the appointment.
Every visit becomes an activation touchpoint
AWVs conducted through our programs don’t end with documentation. They connect to quality gap closure, care plan updates, and follow through scheduling for any services identified during the visit.
Integrated with CCM and other care management models
For patients enrolled in CCM, PCM, or RPM, the AWV becomes another activation touchpoint in an ongoing relationship, not an isolated annual event.