Blog

July 10, 2025
Unlocking the power of the Annual Wellness Visit
When the Annual Wellness Visit (AWV) was introduced as part of the Affordable Care Act in 2011, the goal was clear: shift healthcare for seniors from reactive to proactive. It was designed as a no-cost, prevention-focused visit for Medicare beneficiaries, one that could help detect early signs of chronic illness, close care gaps and lay the foundation for personalized, long-term care planning.
Fifteen years later, the AWV remains one of the most powerful benefits within Medicare. Despite its value, awareness is low, and misconceptions are high. Operational friction and acute demands make it easy to deprioritize. That’s not just a missed opportunity: it’s a systemic failure in how we think about and deliver preventive care.
The AWV is not a physical exam. This distinct, prevention-focused encounter helps providers establish or update a personalized prevention plan tailored to a beneficiary’s health risks and goals. It’s a structured opportunity to provide whole-person care, coordinate necessary screenings and empower patients to take a more active role in managing their health. And it’s 100% covered by Medicare.
The AWV still hasn’t reached its full potential. In 2022 (the most recent dataset analyzed by CMS), 60% of all Medicare beneficiaries received an AWV. Among those with Original Medicare, the utilization rate was about 40%. This is an improvement from just 16% overall in 2011, but growth has plateaued, and uptake still lags far behind the benefit’s potential.
Why the AWV matters
When done right, the AWV doesn’t just check boxes — it can close critical care gaps, strengthen patient relationships, improve quality scores and lower long-term costs. The AWV also serves as a gateway to identifying undiagnosed conditions and optimizing care plans.
- Closes care gaps that might otherwise stay open
The AWV helps providers systematically screen for cancer, depression, cognitive decline and other high-priority conditions. These visits offer the structure and time needed to detect issues before they escalate. - Moves the needle on quality metrics
AWVs support better HEDIS and Star ratings, which directly impact pay-for performance incentives. As CMS continues to raise quality thresholds, some health plans have lost millions due to sliding Star scores. - Builds patient engagement in a way other visits can’t
The AWV provides rare, dedicated time to educate patients, build trust and plan for aging-related concerns. With the average primary care visit lasting just 18 minutes, the AWV’s preventive focus stands out as a meaningful point of interaction and engagement. - Lowers long-term costs
Screenings for colorectal cancer, breast cancer and diabetes can all be coordinated during an AWV, streamlining preventive care and cutting long-term costs. According to one study, an AWV was associated with significantly reduced spending on hospital acute care and outpatient services. Patients who received an AWV experienced a 5.7% reduction in adjusted total healthcare costs over the ensuing 11 months, with the greatest effect seen for patients in the highest hierarchical condition category risk quartile. - Powers better risk adjustment
Risk adjustment discourages health plans from covering only healthy patients and ensures appropriate funding based on health status. AWVs provide an opportunity for PCPs to review and document chronic conditions and capturing accurate risk adjustment data, which
Helps ensure appropriate care management resources, especially for patients with chronic and complex conditions.
What’s standing in the way?
Misunderstanding. Miscommunication. Provider workload. Those three factors account for the majority of missed AWVs. Many patients simply don’t understand what the AWV is or why it matters. Some confuse it with a standard annual physical, while others don’t realize that it focuses on prevention. Providers who lack the time and resources to deliver AWVs miss the opportunity to focus on preventive and holistic care.
Admittedly, the process can be cumbersome. The documentation required is extensive and in many EMRs, eligibility isn’t clearly flagged. The result? Providers may avoid offering the AWV altogether, especially when acute issues dominate their schedules.
On top of that, many practices lack outreach support. AWVs are rarely promoted directly to patients and scheduling them often falls through the cracks. Meanwhile, providers don’t always feel incentivized — especially in fee-for-service models — to prioritize prevention when they’re focused on volume. Telehealth has offered some hope: more providers are experimenting with virtual AWVs. But even then, the tools to make these visits smooth, compliant and clinically meaningful are still evolving.
The Enhanced AWV: from checklists to catalysts
AWVs can be used as a springboard to participate in health-plan-sponsored programs designed to capture accurate clinical documentation and close risk and quality care gaps. This expanded scope ensures appropriate care and reimbursement while enhancing performance under value-based care arrangements. Vatica, the pioneer of this approach, has dubbed it an “Enhanced Annual Wellness Visit” or EAWV.
The EAWV transforms the standard visit into a clinical jackpot — a high-touch, data driven encounter that improves patient care while enabling accurate documentation for risk adjustment. Prior to the visit, Vatica’s solution (a unique combination of clinical resources and technology) compiles a list of the patient’s conditions and open care gaps gathered from the patient’s medical records and claims data. After the visit, Vatica’s quality team ensures accurate coding of conditions supported by appropriate documentation.
The AWV is one of Medicare’s most forward-thinking offerings. With support, the AWV can be a strategic cornerstone of value-based care. It engages patients, improves outcomes, enhances quality scores and can ensure proper risk adjustment coding. But it requires enablement.
Vatica Health leads the industry in delivering EAWVs that are clinically meaningful, financially impactful and operationally seamless. Together, we can help ensure appropriate care and reimbursement while enhancing clinical performance.
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