What are the recommended components of a routine adult wellness visit for a commercially insured adult between 18 and 64 years old with no significant medical history or health concerns?

Adult Wellness Visit for Commercially Insured Adults (18-64 Years)

For commercially insured adults aged 18-64 with no significant medical history, a comprehensive wellness visit should include cardiovascular risk screening (blood pressure, lipid panel), diabetes screening based on risk factors, age-appropriate cancer screening, lifestyle counseling, and immunization updates. 1

Core Vital Signs and Measurements

• Blood pressure measurement is required at every visit for all adults to screen for hypertension, which is often asymptomatic and requires regular monitoring. 2, 1
• Height, weight, and BMI calculation should be performed to identify overweight/obesity (BMI ≥25 kg/m²), which triggers additional screening requirements. 1, 3

Essential Laboratory Screening

Metabolic and Cardiovascular Assessment

• Complete blood count (CBC) with differential screens for anemia, infection, and blood disorders in all adults. 1
• Comprehensive metabolic panel (CMP) assesses kidney function, liver function, and electrolyte balance. 1
• Lipid profile (total cholesterol, LDL, HDL, triglycerides) should be checked every 6-12 months for cardiovascular risk assessment, with screening recommended for men ≥35 years and women ≥45 years who have cardiovascular risk factors. 2, 1

Diabetes Screening

• Hemoglobin A1C testing is recommended for adults with BMI ≥25 kg/m² who have one or more risk factors (first-degree relative with diabetes, high-risk race/ethnicity, cardiovascular disease history, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, polycystic ovary syndrome, or physical inactivity). 2, 1
• For adults without risk factors, begin screening at age 35 and repeat every 3 years if normal. 2, 1
• Adults with prediabetes (A1C 5.7-6.4%) require yearly retesting. 1

Additional Laboratory Tests

• Urinalysis with albumin-to-creatinine ratio screens for kidney disease and urinary tract infections. 1
• Thyroid-stimulating hormone (TSH) testing is particularly important for women. 1

Age and Gender-Specific Cancer Screening

Women's Health Screening

• Cervical cancer screening (Pap test) should be performed, with approximately 88% of women aged 18-64 with health insurance reporting recent screening. 2
• Mammography and clinical breast examination (CBE) are recommended for women ≥40 years, with 61% of insured women reporting recent mammography. 2

Colorectal Cancer Screening

• Colorectal cancer screening should begin at age 45 using colonoscopy, fecal occult blood testing, or other approved methods. 2, 3

Men's Health Screening

• Prostate cancer screening discussion using shared decision-making should occur for men ≥50 years, with PSA testing and digital rectal examination (DRE) as options. 2, 3

Additional Screening for Men

• One-time abdominal ultrasonography is recommended for men aged 65-75 years who have ever smoked to screen for abdominal aortic aneurysm. 1

Comprehensive Preventive Health Counseling

The joint recommendations from the American Cancer Society, American Diabetes Association, and American Heart Association emphasize core lifestyle modifications that reduce risk across multiple chronic diseases. 2

Required Counseling Topics

• Tobacco cessation counseling for all adults, as tobacco use is a modifiable risk factor for cardiovascular disease and cancer. 2, 1
• Diet and nutrition guidance focusing on a nutritionally balanced diet to maintain healthy weight and reduce chronic disease risk. 2, 1
• Physical activity recommendations to promote regular exercise and reduce sedentary behavior. 2, 1
• Alcohol and substance use screening and counseling for all adults. 1

Mental Health Screening

• Depression and anxiety screening using validated tools should be performed for all adults. 1, 3
• Disordered eating screening when clinically appropriate. 1

Immunization Updates

• Review and update vaccination status according to age-appropriate CDC recommendations. 3
• Annual influenza vaccine should be offered. 3
• Tetanus-diphtheria booster every 10 years. 4

Medication-Specific Monitoring

For patients on chronic medications, targeted laboratory monitoring is essential:

• Vitamin B12 levels for patients taking metformin. 1
• Serum potassium levels for patients on ACE inhibitors, ARBs, or diuretics. 1

Important Clinical Considerations

The Evolution Away from Annual Physical Exams

While traditional annual physical examinations have been challenged by evidence-based reviews showing little empirical value, the unintended consequence is that there are currently no formal recommendations for intervals for periodic preventive health encounters among asymptomatic adults. 2 This creates a gap where essential preventive services like blood pressure screening for asymptomatic hypertension may be missed if patients only seek opportunistic care during illness visits. 2

Screening Intervals

• Rescreening every 3 years is a reasonable approach for adults with normal blood glucose levels. 2
• Blood pressure should be checked at every healthcare encounter. 2
• Lipid screening frequency depends on baseline results and cardiovascular risk factors. 2

Common Pitfalls to Avoid

• Do not rely solely on opportunistic screening during illness visits, as this approach has documented weak accomplishments in achieving adherence with preventive care guidelines. 2
• Do not overlook diabetes screening in overweight/obese patients even if they appear healthy, as screening should be based on BMI and risk factors, not symptoms. 2, 1
• Do not delay colorectal cancer screening beyond age 45, as guidelines have lowered the recommended starting age from 50. 3
• Do not skip mental health screening, as depression and anxiety are common and treatable conditions that significantly impact quality of life. 1