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Medicare Health Risk Assessment

In early February, Partnership for Prevention (Partnership) convened a diverse group of 18 experts with medical, research and assessment backgrounds to provide their critical input into the development of a Health Risk Assessment (HRA) that will be included in the annual wellness visit (AWV) authorized for the more than 91 million Medicare beneficiaries under The Affordable Care Act (The ACA). Partnership organized and helped lead the two-day meeting in response to a Federal Register Notice that announced a Public Forum for comments in the development of guidance for the HRA.

The annual wellness visit fosters a culture of prevention within Medicare by developing an annual appointment which generates a personalized prevention plan that identifies interventions to address key risk factors for each beneficiary. The AWV also provides Medicare beneficiaries with an appropriate set of instructions, referrals and medical guidance. The HRA is key to the wellness visit and will allow healthcare practitioners to gather and analyze patient information prior to the office visit, such as family and medical history and behavioral risks. The HRA is intended to serve as a prelude to and a basis for an office visit to avoid the administration of tests and procedures that may not be warranted and to help clinicians identify the highest priority concerns to address during the visit. As a result of using an HRA, healthcare professionals can increase the time he or she devotes to a personalized and comprehensive conversation about the patient’s risk profile and the steps that he or she should take to modify that risk.

Prior to the meeting, Partnership for Prevention, along with Ron Goetzel, PhD, Vice President, Consulting and Applied Research, Thomson Reuters, conducted 13 expert interviews about the development, implementation, and evaluation of HRA. The experts provided guidance based on their own experiences with HRA content, mode of administration, primary care office capacity, patient perspectives, data, certification, and evaluation and quality assurance. The experts included a wide range of perspectives, and represented providers, academic institutions, certifying entities, and product development groups.

The meeting, which consisted of seven expert panel discussions, was a productive one and yielded the following outcomes:
  • Based on the expert interviews and panel discussions as well as background research and public comments, Dr. Goetzel and Partnership will prepare a report for the Centers for Disease Control and Prevention (CDC) that will provide guidance to Medicare on the development of the HRA.
  • Secondly, Partnership is managing the development of an article on HRA guidance to be published in an upcoming issue of The Morbidity and Mortality Weekly Report (MMWR), which is prepared by the CDC. Often called “the voice of CDC,” the MMWR series is the agency’s primary vehicle for scientific publication of timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations. MMWR readership predominately consists of physicians, nurses, public health practitioners, epidemiologists and other scientists, researchers, educators, and laboratorians.
Partnership will continue to be a resource for both CDC and the Centers for Medicare and Medicaid Services (CMS) with regards to HRA and prevention. Partnership will also continue to promote and advocate for prevention with Medicare, including the new AWV.

For additional information about Partnership’s work on the HRA, please contact Jason M.M. Spangler, MD, MPH, FACPM, Chief Medical Officer, Partnership for Prevention, jspangler@prevent.org.

Below is the meeting agenda with links to the panel presentations.
HRA Guidance Public Forum Agenda

Centers for Disease Control and Prevention
Roybal Campus, Global Communication
Center, Bldg 19, Auditorium B-3

Tuesday, February 1, 2011
Facility opens; Check-in
Welcome and Setting the Stage, Day 1: Chesley Richards, MD, MPH, Director, Office of Prevention through Healthcare, Office of the Associate Director for Policy, Centers for Disease Control and Prevention
Director Welcome: Health Risk Assessment: a standardized framework: Thomas R. Frieden MD, MPH, Director, Centers for Disease Control and Prevention
Overview of the new annual Medicare Wellness Visit: Joe Chin, MD, Division of Medical & Surgical Services, Coverage and Analysis Group, Centers for Medicare and Medicaid Services

Review of the HRA impact on health outcomes: Mark Oremus, PhD, Co-Associate Director, McMaster Evidence-based Practice Centre
Overview of the Expert Work Group and Introduction to Panels: Ron Goetzel, PhD, Vice President, Consulting and Applied Research, Thomson Reuters
Panel 1—Content and Design

Don Hall, DrPH, CHES, Founder and Chief Development Architect, Wellsource, Inc.

The Prevention Plan: Ron Loeppke, MD, MPH, Vice-Chairman, U.S. Preventive Medicine

Employer/Purchaser Perspective: Dennis White MS, MBA, Senior Vice President of Value-Based Purchasing, National Business Coalition on Health
Public Comment
Lunch Break
David Anderson, PhD, LP, Senior Vice President and Chief Health Officer, StayWell Health Management

Victor J. Strecher, PhD, Professor, Health Behavior & Health Education, Director, Health Media Research Laboratory, Director, Cancer Prevention and Control, University of Michigan School of Public Health, and Chairman & Founder of HealthMedia, Inc.
Panel 3—Primary Care Office Capacity

Seth Foldy, MD, MPH, Director, Public Health Informatics and Technology Program Office, Centers for Disease Control and Prevention

Primary Care Office Capacity: John H. Wasson, MD, Professor of Community and Family Medicine and Herman O. West Professor of Geriatrics, Department of Community and Family Medicine, Dartmouth Medical School

Primary Care Office Capacity for HRAs: Alex Krist, MD, MPH, Fairfax Family Medicine Residency Faculty, Department of Family Medicine, Virginia Commonwealth University
Public Comment


Wednesday, February 2, 2011
Facility opens; Check-in

Setting the Stage, Day 2: Chesley Richards, MD, MPH, Director, Office of Prevention Through Healthcare, Office of the Associate Director for Policy, Centers for Disease Control and Prevention

Overview of Day One and Introduction to Day Two Panels: Ron Goetzel, PhD, Vice President, Consulting and Applied Research, Thomson Reuters

Panel 4—Consumer/Patient Perspective

The Consumer/Patient Perspective: Jennifer K. Taylor, PhD, Director, Team Leader, Clinical Operations & Evaluation, Corporate & Government Customers, Pfizer Inc

Consumer/Patient Perspective: Brenna Haviland Shebel, CHES, Assistant Director, Institute on Health Care Costs and Solutions, National Business Group on Health

Panel 5—Data

Health Assessment Data--toward meaningful use:  David C. Grossman, MD, MPH, Group Health Pediatrician and Medical Director of Preventive Care, Group Health Cooperative

How to Practice Prospective Health: Basit Chaudhry, MD, PhD, Senior Researcher, Clinical Transformation, Healthcare Analytics, IBM Research
Public Comment

Panel 6—Certification

NCQA and Health Risk Assessments: Sarah Thomas, MS, Vice President, Public Policy and Communications, National Committee for Quality Assurance

Panel 7—Evaluation and Quality Assurance

HRA Guidance, Evaluation and Quality Assurance: Amy Compton-Phillips MD, Associate Executive Director, Quality
The Permanente Federation (Kaiser Permanente)

Evaluation and Quality Assurance Issues for a Senior HRA: Ronald J. Ozminkowski, PhD, Vice President, Healthcare Information and Innovation, Ingenix (UnitedHealth)
Public Comment
4:15–4:30pm Closing