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Helen Dandurand (Host): Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Tracey Peachey, primary care provider at Riverside, to talk about Medicare Annual Wellness Visits.

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Host: And we are back with Tracey. Thanks for joining me today.

Tracey Peachey: Thanks for having me, Helen.

Host: Of course. I know you've been on the podcast before, you're a veteran of the podcast. But for anyone who hasn't listened to that episode, just tell us a little bit about yourself.

Tracey Peachey: Of course. I am a nurse practitioner at Kankakee Internal Medicine. I see patients 18 years of age and older. My husband and I live in the community. We have three children. We have five dogs. We love dogs. I always say that. I foster dogs when I can. My favorite thing to do if and when I have free time is read.

Host: Awesome. Awesome. Five dogs. I love that.

Tracey Peachey: Yes.

Host: I only have one, but in my heart, I would have five.

Tracey Peachey: I have two foster dogs. Currently they're bonded brothers. If you would like to adopt...

Host: Oh, I'll have to call my husband up. That's awesome though. Awesome. All right. So today, like I said before, we're going to be talking about Medicare Annual Wellness Visits, And, I guess, just to get started, how do they differ from a traditional physical exam?

Tracey Peachey: So, the Medicare Annual Wellness Visit is a preventative health care appointment. It really focuses on assessing a patient's overall health risks and developing a personalized prevention plan. The traditional physical exam is typically more a hands on physical exam. The Medicare Annual Wellness Visit, though, doesn't necessarily even need to have a physical exam done. It's more a discussion on health maintenance and prevention.

Host: Okay, yeah. And why would you say it's important for the Medicare beneficiaries to schedule this exam, this visit, I guess?

Tracey Peachey: Yeah. Sometimes I think patients come in and they're scheduled for this Medicare annual wellness visit because in the office we're watching for that and when they're due, and they don't even really know what that means or why they're having it. It really allows Medicare beneficiaries to monitor their health consistently. It's a proactive approach to early identification of potential risks. So, the benefit of early identification is always early intervention, which helps individuals maintain health and prevent future disease and disability.

So, I often find patients come in for a problem visit. And yes, I know they need, you know, these three screenings, but they're sick today, so we don't have enough time to discuss it all. And this appointment is really set aside to discuss those prevention measures.

Host: Awesome. That is so, so important, when it comes to your health. Can you walk us through what happens during a Medicare Annual wellness visit?

Tracey Peachey: Yeah. So generally, it's going to feel like a normal visit. A patient will be roomed by a nurse or a tech. They will review the patient's health history and medications and then take vital signs. So, blood pressure, heart rate, height, weight, and then we'll calculate the body mass index. One of the key factors is the patient is asked to complete a questionnaire. It's kind of lengthy and it's very complete, but it's called a health risk assessment. We get a lot of grumbles about this health risk assessment. "Do I have to fill it out every year? Why is it important?" It's very important. We take that information, and that's how we individualize the plan. What are your health risks? Are you a smoker? Do you have enough equipment in your home to do your normal activities of daily living? So, that's why we ask you to fill that out. It is very important.

One of the questions, just for an example, "Is how do you rate your health in the past four weeks?" And the answers that a patient could pick are excellent, good, fair, or poor. So it gives us an idea of how they feel too. So then, the provider will take all of that information, take a look at it, and then we talk about it with the patient. "This is what I see. What do you think? What's important to you?"

Sometimes, if it's appropriate, we'll do cognitive screening for memory loss, depression screening. And then, there's always that time, and I think maybe the focus is education and counseling regarding, you know, diet, exercise, fall prevention, home safety; smoking cessation if that's appropriate, and advanced care planning. So, "Do you have a living will? Do you want to be a DNR?" Some of these things that we just don't talk about on a normal basis. So, that's kind of what that visit looks like. That's really great.

Host: I feel like sometimes that's what I feel like can be missing from health care, is having those conversations. And sometimes you go into your appointment and you don't even know kind of where to start and what to bring up. So, having those guidelines and having a place to consistently have those conversations I think is so important.

Tracey Peachey: It is really important.

Host: That's awesome.

Tracey Peachey: Yeah. And I think sometimes, this is a good one because I don't think patients even realize sometimes they're scheduled for that Medicare Annual Wellness Visit.

Host: Yeah, that's great. And so, how would you say that these visits help in preventing or managing chronic conditions? I know you touched on that that's something they do, but specifically, how would you say that?

Tracey Peachey: Yeah. And I did mention this, and I'm going to say it again and maybe one more time, but the key is early detection to promote that early intervention. There's really different levels of prevention in health care. We don't say them out loud to our patients, but primary, secondary, tertiary, a provider will know that there's different levels.

Primary prevention focuses on preventing a disease before it ever occurs. So, examples of that are immunizations and health education. Secondary prevention is think about the detecting disease early, so screening, mammograms, colonoscopy. If we catch a grade 1 breast cancer or colorectal cancer, it's much more manageable and treatable than stage 4. So, it's that, idea that we catch it early so that we can prevent comorbidities and just death and disease down along the line.

The final area, and I think sometimes patients don't know, and it's important to know, but we call it tertiary prevention, but it's after a patient has a disease. So, they've been diagnosed with hypertension or diabetes. It's the measures we take to keep those well controlled so that they don't get sicker, right? So, if they have high blood pressure. And in our diabetic, we want to keep those as best controlled so that their vision stays good, their kidneys function well. And those are just things like taking medications consistently, adhering to diet and exercise and things like that. So, that's kind of it in a short gist there.

Host: Yeah. No, I think that's awesome, like the three levels and like kind of understanding more about that. That's something that I think most people wouldn't even think about. You know, just think of prevention as prevention, but it's interesting to hear it from a provider. Yeah. we're going to take a quick break to talk about primary care at Riverside.

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And we are back, and hopping back into the Medicare Annual Wellness Visit topic. Are there specific topics, or concerns that patients should bring to this visit when they're talking with you?

Tracey Peachey: I think patients should bring up any concerns regarding their overall health. So, that might include questions about preventative screenings, potential health risk based on their family history, lifestyle habits like diet and exercise, mental health concerns, medication management, and changes in daily functioning.

So, these patients who are having this done, this isn't for everyone, but typically are 65 and older. So, "Are you more forgetful? Are you having trouble getting your groceries on your own? And how can we intervene and make that better for you?" So, any kind of concerns like that are very important.

Host: Great. And I'm not sure if screenings even happen at this, but I was going to ask, what kind of screenings or assessments are typically included in the visit? I guess the assessment would include that sheet that they fill out, but are there screenings included?

Tracey Peachey: There are.. So, that health risk assessment that we talked about, that patient questionnaire, that's really big one. The visit is somewhat guided on the patient's answers to that because it might point out that they need help in one area or the other, we need to focus our attention there.

But also, you know, we're screening for high blood pressure when we check a blood pressure. The cognitive screening, sometimes will give us separate memory tests if that's an issue for the patient. We screen for depression. We screen for fall risk. This is more of a caveat for us. But on occasion, those visits will include a vision exam. And home safety. So, those are things done during the visit that the patient might not even realize are being done, but that are kind of incorporated. But that would be during the actual visit.

And then, the other screenings and things are things we might order outside of like you're due for a mammogram, colonoscopy, bone density, whatever that might be. And those would be things that we would order and the patient would do and we would follow up with them.

Host: That's great. And when patients are leaving this visit, you know, is there something they can expect to take away as far as like a personalized prevention plan? Like, how does that work?

Tracey Peachey: In my experience, and maybe every provider's a little different in that, but typically that is something we just talk about at the visit, and sum up for them at the end. Anything we order for them would be summarized on the after-visit summary as far as testing or additional screenings we order. And then, any immunizations that we want them to do, we would either do in the office if appropriate or we would write those down for them to do at their local pharmacy. So, it's not really a form. It's more of a discussion. A lot is covered in these visits. So, I'm always, you know, very insistent that if they get home and they're like, "What did she say and what am I supposed to do?" that they definitely call me or send me a myChart message because that's what we're there for.

Host: Yeah, that's awesome. Well, what would you tell someone who hasn't scheduled their Medicare Annual Wellness Visit yet?

Tracey Peachey: It's a new year. Schedule a visit, right? It's never too late to improve your health. The Medicare Annual Wellness Visit, it's dedicated to health promotion and disease prevention. Medicare finds it so important to patients' overall health and their outcomes that there's no cost. It's a free visit. And according to CDC, chronic diseases account for the most illness, disability, and death in the United States. They're the leading cause drivers of healthcare costs, too. We spend trillions of dollars in the United States every year on chronic disease management. But so many of these conditions are preventable, really. So, early detection is key to early intervention and positive patient outcomes. So, we will see you soon for your Medicare Annual Wellness Visit.

Host: That's perfect. Thank you so much for being here today.

Tracey Peachey: Thank you for having me.

Host: Yeah, of course. I think that's all really, really good information. It's basic, but something that I've always kind of wondered a little bit about and so those details that you shared I think are really, really important for people to hear. So, thanks, listeners, for tuning in to the Well Within Reach podcast brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org.