20 Aug Ethnic and Racial Disparities in Medicare Annual Wellness Visit Utilization
MedicalResearch.com Interview with:
Kim Lind, PhD, MPH
Centre for Health Systems and Safety Research
Australian Institute of Health Innovation
Macquarie University, NSW
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The Medicare Annual Wellness Visit (AWV) is a preventive care visit that was introduced in 2011 as part of the Patient Protection and Affordable Care Act. Prior to this, the only preventive care exam covered by Medicare was the Welcome to Medicare Visit, which is only available for people in their first year of Medicare enrolment. The AWV is available each year to beneficiaries without co-payment to people who are past their first year of Medicare enrolment. The AWV focuses on prevention and early detection of disease.
Racial disparities in healthcare utilization and health outcomes have been well documented in the US. Prior expansions of Medicare coverage have had varied effects on reducing disparities. For example, in 2001 Medicare began to cover colorectal cancer screening which reduced racial disparities for some minority groups with respect to screening rates and improved early detection.
Expanding coverage of preventive care for people on Medicare may help reduce disparities in health outcomes, but we first needed to know if people were using the Medicare Annual Wellness Visit. Our goal was to assess AWV utilization rates and determine if utilization differed by race or ethnicity. We analyzed a nationally representative database of Medicare beneficiaries (the Medicare Current Beneficiary Survey) that included self-reported race, ethnicity, income and education, linked to Medicare claims.
We found that Medicare Annual Wellness Visit use was low but increased from 2011 to 2013. We also found that people on Medicare who self-identified as belonging to a racial or ethnic minority group had lower AWV utilization rates than non-Hispanic white people. People with lower income or education, and people living in rural areas had lower Medicare Annual Wellness Visit utilization.
MedicalResearch.com: What should readers take away from your report?
Response: The Medicare Annual Wellness Visit, despite being free for people on Medicare, was used by only 15% of eligible people on Medicare by 2013. More effort is needed to engage both people on Medicare and healthcare providers to increase uptake of the Medicare Annual Wellness Visit.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research should examine reasons for low uptake of the Medicare Annual Wellness Visit and evaluate the effectiveness of the AWV on improving disease prevention and health outcomes.
Lind, Kimberly E., PhD, MPH*,†; Hildreth, Kerry, MD‡; Lindrooth, Richard, PhD*; Crane, Lori A., PhD§; Morrato, Elaine, DrPH*; Perraillon, Marcelo Coca, PhD*
Medical Care: September 2018 – Volume 56 – Issue 9 – p 761–766
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