Abstract
Medicare Annual Wellness Visits, Telehealth Adoption, and Diagnosis of Dementia in Fee-For-Service and Medicare Advantage Plans
Zhang Zhang, PhD, Postdoctoral Fellow, Johns Hopkins University Bloomberg School of Public Health
The prevailing care delivery environment is not well aligned with the needs of persons living with ADRD, and just half of the individuals who are affected receive a diagnosis. The Annual Wellness Visit (AWV), introduced in 2011, offers some promise to improve ADRD diagnosis rates as it mandates direct observation of cognition and creation of a personalized prevention plan. Use of the AWV has been increasing and AWV use is associated with early detection of dementia, especially among the high-risk population of undiagnosed ADRD, but AWV use is disproportionately low. There is a critical need to improve ADRD diagnosis rates. The long-term goal served by this pilot is to explore how policy and technology may allow AWVs to meet this critical need.
Specific Aims:
Aim 1: To examine the impact of Medicare coverage type (TM-FFS vs. MA) on AWV use and ADRD diagnosis. We hypothesize that MA is associated with higher AWV uptake and AWV-related ADRD diagnosis rates because MA plans have managed care tools that can improve uptake of screening services for older adults with risk factors for ADRD and financial incentives to do so because of their risk-adjusted payments.
Aim 2: To evaluate the impact of service modality (in-person vs. telehealth) on AWV use and ADRD diagnosis. We hypothesize that telehealth adoption is associated with higher AWV use and AWV-related ADRD diagnosis rates because of its potential to improve access to AWVs and streamline complex screening tasks, such as cognitive assessment, which could, in turn, increase AWV uptake, leading to earlier diagnosis.
This pilot study will be a critical step in identifying pathways -- including payment models (Medicare coverage type by FFS vs. MA) and novel modalities of care delivery (telehealth vs. in-person) -- to increase ADRD diagnosis rates via AWV.