What are the recommended assessments and interventions for a patient during a Medicare visit?

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Last updated: June 17, 2025View editorial policy

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From the Guidelines

During a Medicare visit, a comprehensive assessment and personalized intervention plan are crucial to promote preventive care, identify health issues early, and improve overall quality of life. The assessment should include a thorough health history, physical examination, medication review, functional status assessment, cognitive screening, depression screening, fall risk evaluation, and preventive services based on age and risk factors 1. It is essential to involve patients and their family members or carers in the assessment process, clarify and resolve misconceptions, and explore patient’s contacts with other healthcare professionals and any related changes in management 1. Interventions should address identified health issues, update vaccinations, manage chronic conditions, and develop a personalized care plan, with a focus on medication management, minimizing polypharmacy, and addressing potential drug interactions. Preventive services may include cancer screenings, cardiovascular risk assessment, and bone density testing for osteoporosis risk. The Annual Wellness Visit should include a health risk assessment, personalized prevention plan, and advance care planning discussions. Key recommendations for interaction assessment include evaluating diseases, health problems, clinical and functional status, pharmacological and nonpharmacological treatment, and considering the patient’s psychosocial context 1. By prioritizing these assessments and interventions, healthcare providers can improve health outcomes, reduce morbidity and mortality, and enhance the quality of life for Medicare beneficiaries. Some studies suggest that strategies and techniques should be used to support patients’ self-management efforts, including providing education on problem-solving skills for all aspects of disease management 1. However, the most recent and highest quality study emphasizes the importance of a comprehensive assessment and personalized intervention plan in improving health outcomes 1. Therefore, a comprehensive and patient-centered approach is essential during a Medicare visit to ensure optimal health outcomes and quality of life. This approach should include regular follow-up visits to assess the patient’s condition, update the care plan, and address any new health issues that may arise. By following this approach, healthcare providers can provide high-quality care that meets the unique needs of each Medicare beneficiary.

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From the Research

Recommended Assessments

  • A health risk assessment is a crucial component of the Medicare Annual Wellness Visit, as stated in 2.
  • The assessment should include a review of the patient's Health Risk Assessment (HRA) information, patient observation, and unstructured queries during the visit, as recommended by 3.
  • Structured cognitive assessment tools should also be used for both patients and informants to detect cognitive impairment, as suggested by 3.

Interventions

  • A customized wellness or personal prevention plan should be developed based on the results of the health risk assessment, as mentioned in 2.
  • General health checks, including the Medicare Annual Wellness Visit, have been associated with increased detection of chronic diseases, such as depression and hypertension, as well as moderate improvements in controlling risk factors, as reported in 4.
  • Pneumococcal vaccination is recommended for adults at very high risk or with established cardiovascular disease, and has been shown to decrease all-cause mortality by 22%, as found in 5.
  • The use of specific tools and assessments during the Medicare Annual Wellness Visit can vary widely, and primary care providers have expressed interest in using more structured and objective methods, as noted in 6.

Additional Considerations

  • General health checks, including the Medicare Annual Wellness Visit, may not be associated with decreased mortality or cardiovascular events, but can lead to improved patient-reported outcomes and increased uptake of preventive services, as discussed in 4.
  • The Alzheimer's Association has developed an algorithm for assessing cognition during the Medicare Annual Wellness Visit, which includes review of patient HRA information, patient observation, and use of structured cognitive assessment tools, as described in 3.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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