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Nathan Moore, M.D., medical director of the BJC Medical Group ACO in St. Louis, sees annual wellness visits (AWVs) as a scaffolding for all of the ACO’s improvement efforts. “We’re using this as our point of entry for advanced care planning and for functional status evaluations,” he said.
Moore was speaking during an April 28 panel at the NAACOS spring meeting about how ACOs are using AWVs to improve their quality efforts as well as the accuracy of their coding for risk adjustment and billing purposes. As part of the annual wellness visit, patients have to answer 20 questions about their functional status and social determinants of health, Moore noted. “That data just sits there in the EMR and we don’t do anything with it. But that’s a treasure trove of data that could be used in a variety of other efforts — enrolling patients in remote monitoring for chronic disease management, home-based palliative care. So we’re using the AWV as a platform for all of our other efforts at this point.”