July 27, 2016

Good morning MaineHealth ACO Participants,
Wellness is "the quality or state of being in good health, especially as an actively sought goal."
Summertime, especially in Maine and New Hampshire, is all about seeking our inner wellness.  The allure of long, warm, sunny days draws us toward our pursuit of health.  After months of biting winds, mounds of snow and slippery slopes, the outdoors suddenly becomes a hospitable, welcoming place again, and we make our plans for the summer. For many of us, summer means vacation - a much-needed break from our routine that allows us to relax and rejuvenate with friends and family.  For others, it is a time to make new goals in order to recharge the batteries.

For each of us, these wellness goals will be different.  For my teenage son, his wellness goal this summer was to "be outside and make money."  For his parents, our wellness goal for him was to "be outside and away from electronics."  As it turns out, our son pursued a job working on a 100 acre farm in New Hampshire, and the experience has been incomparable:  learning to bale hay, driving a large John Deere tractor, mucking the sheep fold, weeding the garden, and selling the end product at the farmer's market on the weekend.  For my younger son, the pursuit of summer wellness was All Stars Little League baseball---a state of youthful comradery, competition and striving for victory.

What is the pursuit of wellness and what does it mean in our own practices as we care for our patients?  Thirty years ago, I probably would not have equated summer with "wellness."  Not because summer was any less invigorating, but because the whole idea of "wellness as a state of being" was seldom considered.  "Wellness" as it's understood today only really emerged in 1982 when a handful of academics held the first national wellness conference. Shortly afterward, the University of California began publishing the monthly Berkeley Wellness Letter. Today, the concept of wellness is so thoroughly embraced by society, and healthcare, that Medicare has established an " Annual Wellness Visit" for its beneficiaries.

Linking the Maine/New Hampshire summer to the Medicare Annual Wellness Visit may seem like a stretch for some, but thoughts of both have occupied my mind recently. Consider our many older patients who can't revel in summer like we do---working on a farm to earn pocket money or chasing All Star dreams, or dangling one's legs off the dock while reading a book.  They can't make it to the lake or the beach anymore to escape the heat.  And even on a bright, sunny day the stress of living on a fixed income continues unabated.  A Medicare Annual Wellness Visit (AWV) could very well uncover for them their goals (and barriers) in the pursuit of wellness and allow our health care teams to partner with the patient in attainment of their goals such as a visit to their grandchildren, a stroll along the beach, a trip to the farmer's market, or a hike up the White Mountains.

As care teams, you have probably heard about the "AWV" but may or may not know what to do.  A central component of the AWV is the Health Risk Assessment (HRA). Essentially a questionnaire that's filled out before or during the visit and then reviewed by both the provider and patient, the Health Risk Assessment can reveal social, economic and behavioral factors that can be addressed by a referral to resources and services in the community. Is the patient exercising? Is she eating nutritious food? Does she have support from friends and family? Is her stress level contributing to anxiety or depression? Does she have transportation? All these questions, and more, can be addressed and answered during an Annual Wellness Visit. 

At the ACO, our Contracting and Performance Improvement teams  have partnered with MaineHealth to develop resources to assist you in navigating Annual Wellness Visits for both Medicare- and Medicare Advantage-covered patients.  We are ready and willing to assist you with logistics of AWVs so the patient can have a dedicated amount of time to focus on their wellness goals, and the care team will be supported in its efforts.  And our care coordination experts are at the ready to build bridges and find the pathways for our patients' dreams of wellness.  If you'd like more information about incentive opportunities associated with Annual Wellness Visits, how to identify eligible patients and close gaps in care, or connect patients with resources, please reach out to us at ContactMHACO@mmc.org.

While you may think I have put a pretty good spin on a process that feels cumbersome and annoying, I have worked to understand the reasoning behind the wellness push so the ACO can help you, too.  For my sons, the memories of farm life's earthy rewards or a ball game's perfect strike-out will carry them into the winter months with a sense of health and well-being.  For all of our patients, we hope the time we spend with them addressing their hopes for wellness and well-being carries them into the long winter months, as well. I encourage you to understand how the Annual Wellness Visit can help you and your patients get there.

Bale hay, play ball and stay well!
Yours in health,

Elizabeth Johnson, MD, MS
President & Chief Executive Officer
MaineHealth Accountable Care Organization
EHJohnson@mmc.org |  (207) 482-7050