Optimizing Fall Prevention in Annual Wellness Visits

Introduction

Falling down is a significant problem affecting older adults, with far-reaching consequences for both individuals and healthcare systems. It is the leading cause of trauma-related deaths and injuries, contributing to a significant burden on healthcare resources. Approximately one-fourth of adults over the age of 65 experience a fall each year [1], highlighting the urgent need for effective fall prevention strategies. Not only do falls pose a risk to the well-being and independence of older adults, but they also have substantial financial implications. In fact, falling is ranked as the fifth most expensive health condition in terms of healthcare spending [2] and medicare is estimated to be spending more than $29 billion annually on falls [3].

Recognizing the gravity of this issue, healthcare policies and guidelines have incorporated fall prevention measures within the framework of Annual Wellness Visits (AWVs) and Welcome to Medicare visits. These visits require fall risk screening and the development of personalized fall prevention plans for patients. Furthermore, the Centers for Medicare and Medicaid Services (CMS) have associated quality measures with fall risk screening and reduction, underscoring the importance of addressing fall prevention in healthcare settings.

While the integration of fall prevention initiatives into AWVs and Medicare visits is a step in the right direction, there is growing concern that these efforts may be reduced to mere checkbox exercises, failing to adequately address the complexity and severity of the fall prevention challenge. This white paper aims to explore the significance of fall prevention in the context of AWVs, examine the limitations of current practices, and propose strategies to enhance the effectiveness of fall prevention interventions. By doing so, we hope to foster a more comprehensive and proactive approach to fall prevention, ultimately improving the health outcomes and quality of life for older adults.

Purpose of the Annual Wellness Visit (AWV)

The AWV serves multiple purposes, ranging from reimbursement revenue to driving cost savings and initiating preventive care, particularly in the context of value-based care (VBC). While the AWV is a reimbursable service, its significance extends far beyond financial considerations. In the realm of VBC, the AWV has proven to be an effective launch pad for preventive healthcare, as exemplified by organizations like Aledade, which have achieved an impressive AWV rate of approximately 70%. This emphasis on the AWV has enabled Aledade to engage patients early on, identify risks, and implement interventions to mitigate those risks, resulting in improved health outcomes and cost savings.

One of the primary purposes of the AWV is to facilitate proactive and preventive care for Medicare patients. By conducting a comprehensive assessment of the patient's health and risk factors, the AWV enables healthcare providers to identify potential health issues at an early stage. This early detection allows for timely interventions and the development of personalized prevention plans. Through the AWV, healthcare providers can engage patients in discussions about their medical history, current medications, lifestyle, and vaccinations, helping to establish a roadmap for preventive healthcare tailored to each individual.

In the realm of VBC, the AWV holds particular significance. Value-based care models emphasize delivering high-quality care while containing costs. The AWV, with its focus on prevention and early detection, aligns well with this objective. By initiating preventive care through the AWV, healthcare providers can address health issues before they escalate, potentially reducing the need for costly interventions and hospitalizations later on. The AWV serves as a gateway to comprehensive preventive services, fostering a proactive approach to healthcare that can lead to improved health outcomes and cost savings.

Missed Opportunity for Fall Prevention with Current Clinical Practices

Despite the recognized importance of fall prevention in AWVs, current clinical practices often fall short in adequately addressing this critical issue. One significant issue lies in the effectiveness of fall risk screening tools currently employed in clinical settings. Surprisingly, research indicates that a substantial proportion of patients at risk of falling, as many as 69% to 85%, are not identified using these tools. This suggests that a significant number of individuals who could benefit from fall prevention interventions are slipping through the cracks due to the limitations of existing screening methods.

One commonly used tool for fall risk assessment is asking about fall history. However, relying solely on patient self-reporting poses its own challenges. Studies indicate that less than half of patients actually disclose their fall history to their physicians [4]. This underreporting can stem from various factors, such as fear of loss of independence, embarrassment, forgetfulness or considering falls as an inevitable consequence of aging. Relying on fall history as a screening tool may lead to a substantial number of individuals with unidentified fall risks, resulting in missed opportunities for appropriate interventions.

This reactive protocol also requires a fall to have occurred before any intervention can be considered, leading to suboptimal care and a massive missed opportunity.

Furthermore, the consequence of using low-predictive capability tools for fall risk screening is that these tests become mere checkboxes during AWVs, lacking the ability to effectively identify and address fall risks. By solely relying on reactive care, where fall prevention is treated as an afterthought rather than a proactive preventive measure, the healthcare system misses the opportunity to reduce fall-related injuries and their associated costs. Without comprehensive and accurate fall risk screening, the healthcare system remains in a reactive mode, providing care primarily after falls have occurred, which can result in higher healthcare costs and compromised patient outcomes.

Enhancing Fall Risk Screening in AWV for Value-Based Care: The Role of ZIBRIO

To address the limitations of current fall risk screening tools and maximize the effectiveness of fall prevention interventions in the context of VBC, integrating new technologies that address the current gap in accurate, predictive tools offers a promising opportunity to significantly improve the accuracy and efficiency of fall risk assessment during AWVs.

Research has shown that ZIBRIO's scientifically validated fall risk screening tool outperforms traditional methods by 2-5 times in terms of predictive capability [5]. By leveraging advanced balance assessment technology, ZIBRIO provides a comprehensive evaluation of an individual's fall risk, considering the patient’s intrinsic capability to control their postural stability, rather than self-report or limited functional tests. This innovative approach enables a more accurate identification of patients at risk of falling, empowering clinicians with valuable insights for targeted preventive interventions.

The integration of ZIBRIO into AWVs brings numerous benefits for both clinicians and patients. By utilizing a more accurate fall risk screening tool, clinicians can make well-informed decisions and develop personalized fall prevention plans tailored to each patient's specific needs. This enhanced risk stratification allows for more efficient allocation of healthcare resources, optimizing care delivery and driving better health outcomes for patients

For patients, the use of ZIBRIO as a fall risk screening tool during AWVs translates into better identification and subsequent prevention of falls. The simple, objective measures is reported to help cut through patient denial. 

“[getting patients to realize they’re at risk for falling] – it’s half the battle!”

— Primary Care Physician

A 74% reduction in falls has been observed in studies using ZIBRIO's technology [6], likely a result of patient awareness driving changes in behavior. By incorporating ZIBRIO into AWVs, patients benefit from a proactive empowering approach to fall prevention, promoting their safety, well-being, and independence.

The ZIBRIO tool includes clinician support software that streamlines the patient care plan, highlighting appropriate interventions based on patient score and factors from their health record.

After comparing the ZIBRIO system against their prior method of screening patients (a gait test), a primary care physician reported: “Patients have come to expect this higher quality of care from us. We can’t take it away now.”

Conclusion

In conclusion, the AWV holds great potential as a platform for effective  fall prevention in the context of healthcare. Falling is a significant problem for older adults, ranking as the leading cause of trauma-related deaths and injuries, reducing quality of life, negatively impacting all other health issues, and incurring substantial healthcare costs. While the AWV requires fall risk screening and personalized prevention plans, current clinical practices often fall short, missing opportunities for effective fall prevention. By solely relying on inadequate screening tools and reactive care, the healthcare system fails to address fall risks proactively, leading to compromised patient outcomes and increased costs. However, there are opportunities for improvement. Integrating innovative tools like ZIBRIO, which outperforms traditional methods and has shown remarkable reductions in falls, can significantly enhance fall risk assessment during AWVs. By adopting proactive and personalized fall prevention strategies, healthcare providers can better identify and mitigate fall risks, leading to improved patient care, reduced healthcare costs, and ultimately, a higher quality of life for older adults. Embracing a comprehensive approach to fall prevention in AWVs is not merely checking the box; it is a crucial step towards ensuring the well-being and safety of older adults in our healthcare system.

Related article: How Ageism is Preventing Seniors From Getting Effective Fall Prevention Care

Sources

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