Achieving Large-Scale Quality Improvement in Primary Care Annual Wellness Visits and Hierarchical Condition Coding

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Health Informatics

Background:

• Medicare Annual Wellness Visits (AWV) and Hierarchical Condition Categories (HCC) are critical metrics for Accountable Care Organizations (ACOs), impacting both quality and finances.
• Scaling quality improvement (QI) efforts within existing healthcare systems is essential for enhancing performance in large organizations.

Purpose of the Study:

• To implement and evaluate a multifaceted QI framework, the fractal management system, over three years.
• To improve performance in AWV completion and HCC documentation within a large healthcare system.

Main Methods:

• A pre-post evaluation design was used to assess a health system-wide QI intervention from 2018 to 2020.
• The intervention encompassed project management, coaching, communications, performance feedback, and health informatics.
• The study included 89 primary care practices within an Ohio-based ACO, serving over 72,000 Medicare and Medicare Advantage patients.

Main Results:

• Annual Wellness Visit (AWV) completion rates increased significantly from 23.7% in 2018 to 59.8% in 2020, with over half of practices exceeding the 60% goal.
• Hierarchical Condition Category (HCC) completion tracking improved from 75.9% in 2019 to 79.7% in 2020.
• Performance goals for both AWV and HCC were achieved in 2020, even with COVID-19 related service disruptions.

Conclusions:

• The fractal management system effectively improved AWV and HCC performance in a large ACO.
• The QI approach is adaptable for addressing other healthcare challenges and can be applied to diverse healthcare systems.
• Successful implementation demonstrates the feasibility of scaling QI initiatives within resource-constrained environments.