Statistics show that only 16 percent of Americans eligible for a Medicare annual wellness visit have had one. Arlington, Virginia-based Privia Medical Group, a group practice with 1,600 physicians, nearly doubled that national average.

The small number of patients presenting for those wellness visits is "related to the difficulty associated with easily identifying those that are eligible, the large number of FTEs to perform follow-up calls, and the lack of digital capabilities to communicate with the significant number of patients involved," said Keith Fernandez, MD, chief clinical officer at Privia Medical Group.

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"Our ability to double the national average can be attributed to our use of athenahealth services, including athenaOne and athenahealth Population Health, especially the Outreach Manager tool," he added. "These services allow identification of an automated communication with a large number of patients."

The medical group's high adoption rates for its patient portal and online appointment scheduling tools, along with an emphasis on near-immediate access to providers, has helped ensure success, he said.

In one recent nine-week period, the medical group reached 960 MAWV-eligible patients: 31 percent of those who were contacted took action to schedule an appointment within 45 days, and more than 128 provider hours were saved because of the automation, the medical group reported.

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"More important, this led to better financial performance of our Medicare ACO by significantly improving the quality of care we deliver," Fernandez said. "Powerful tools in the hands of a committed, high-performance physician group can – and do – help deliver the best care to patients."

Patient outreach is an important part of population health. Some of the more prominent population health companies, according to KLAS, include IBM Watson Health, Philips Wellcentive and HealthEC, right alongside EHR vendors including Allscripts, athenahealth, Cerner and Epic.

MAWVs can close significant healthcare quality gaps, up to 15 in most cases.

"The quality gaps are most often tests; for example, a test of blood sugar in a diabetic patient, a mammogram that should have occurred in an at-risk woman, a blood pressure test in a hypertensive patient," Fernandez said.

At the time of a wellness visit, these tests are performed or scheduled; if the patient was already scheduled but did not keep an appointment for one of the tests, their importance to wellness is discussed and emphasized to improve the patient's understanding. The "close" indicates that a quality measure has been performed.

"Closing quality gaps are thought to represent better care or improve health outcomes," said Fernandez.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com