With a growing number of providers and insurers participating in value-based care models, prevention and health maintenance are crucial to their success. To support this, Medicare and health plans encourage their members to schedule annual wellness visits (AWVs) with their primary care providers. These visits are typically done at little or no cost to the patient and focus on promoting preventive care and early intervention. 

However, disorganized problem lists and missing diagnoses that inform Hierarchical Condition Category (HCC) codes can prevent physicians from gaining a complete understanding of their patients’ health profile. This lack of information hinders the effectiveness of AWVs, impacts risk adjustment factor (RAF) scores, and complicates value-based care initiatives. It can also lead to poor care outcomes and lower capitation payments or shared savings for both providers and payers. 

While payers may request data recapture at a later time, this data is rarely as accurate as the notes captured at the point of care. Furthermore, this can add to the burden placed on our healthcare providers, who are already stressed with data entry tasks. To address these challenges, payers and providers must implement the following strategies to optimize AWVs, improve data quality, and ensure success in value-based care programs. 

An organized medical problem list for improved decision-making 

A well-structured problem list reduces the cognitive burden on providers during AWVs, allowing them to focus on patient care. Tools like IMO Core simplify this process by organizing problem lists into clinical categories, providing problem-oriented filtering, and displaying contextual summaries of patient issues connected to medications and lab results. IMO Health also provides tools that assist in the reduction of clutter due to outdated or redundant problems on the list. This approach ensures providers have access to accurate and up-to-date data, facilitating better clinical decision-making and enhancing value-based care initiatives. 

Terminology that facilitates clinical documentation without the stress of billing codes 

Accurate clinical documentation is critical for value-based care and risk adjustment. IMO Health solutions provide comprehensive clinical terminology that includes synonyms, acronyms, misspellings, and local vernacular mapped to all appropriate billing codes, such as ICD-10, CPT®, and CMS-HCCs. IMO Health also provides complex clinical terms not captured by the standard billing and administrative code sets.  This allows providers to document patient conditions comprehensively without concern for billing codes, thus streamlining workflows, enhancing data quality, and enabling accurate coding for care and reimbursement. 

Finding unaddressed care gaps and HCCs 

IMO Discovery for Problems can help close care gaps by analyzing patient data from previous encounters and unstructured clinical notes not documented on the problem list. IMO Health can present to clinicians suggested diagnoses that may be appropriate additions to the patient problem list in the electronic health record (EHR). This will support value-based care by identifying unaddressed chronic problems from previous encounters that the provider can review with the patient during the AWV. 

Additionally, IMO Health partners with payer organizations to integrate member’s care gap data into problem lists. This ensures clinicians are notified of unaddressed HCCs during AWVs, enabling them to identify data-backed, actionable interventions before the visit. This process improves clinical care, streamlines documentation workflows, and enhances data quality for more accurate RAF scores, which benefits patients, providers, and payers. 

By closing care gaps with tools, providers can deliver better care while maximizing reimbursement. These strategies not only ease the burden on providers but ensure payers benefit from improved quality metrics and financial performance, fostering a collaborative approach to value-based care success. 

To see how you can implement IMO Health solutions to make the most of your AWV visits, schedule a demo here.