Medicare Annual Wellness Visits (AWV) are frequently viewed by primary care providers as a tedious visit in which patients see little value. With consistent access to care issues and a shortage of primary care providers, these visits are easy to push to the side and focus on other visits. The problem is, these visits can impact attribution and they are also a key metric in value-based care plans as well as Accountable Care Organization (ACO) requirements to receive incentive payments. So how can a practice balance the need to maintain attribution and satisfy insurance requirements while still providing crucial hands-on care to patients? The answer may be more simple than hiring more providers or limiting new patients. Nurse-led Annual Wellness Visit programs have been proven to effectively meet the AWV requirements while increasing access to the provider for other visits.

The Extreme and Uncontrollable Circumstances (EUC) adjustment from CMS, also known as Covid protection, has now expired, which means that the overall star ratings for health plans will not be adjusted to account for Covid. There was an overall decline in year over year star ratings over the last two years, with the national average star rating declining from 4.37 in calendar year 2021 to 4.15 in 2022, a decline of 0.22.

Staffing, access, and burnout are like four-letter words in most healthcare settings these days. There aren’t enough people to perform the tasks needed to keep patients flowing through the system or enough providers entering the industry to keep up with the demand resulting in limited access for patients in need of care.

The Institute of Medicine defines primary care as “the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams that are accountable for addressing the majority of an individual's health and wellness needs across settings and through sustained relationships with patients, families, and communities”. To align insurance carriers, healthcare providers, and patients’ perception of quality healthcare, the first step is to build relationships among the three entities through more collaborative communication.

Merriam-Webster defines quality as the “degree of excellence”. So how do we define the degree of excellence in healthcare? What does quality healthcare look like? This answer can vary depending upon who is asked the question.

Over the past 40 years, we've seen a large shift in primary care and the United States healthcare system. Unfortunately, the changes have resulted in a very broken system, and we now more than ever see the need to correct the flaws.

The National Committee for Quality Assurance (NCQA) has developed a list of metrics and measures they consider pertinent to the assessment of quality in the delivery of healthcare based on access, availability, effectiveness, and outcomes