Integrating 4Ms Assessment through Medicare Annual Wellness Visits: Comparison of Quality Improvement Strategies in Primary Care Clinics

The Medicare Annual Wellness Visit (AWV), which includes comprehensive preventative assessments and screenings, is associated with improved preventative services, including vaccination and cancer screenings. However, the AWV alone does not promote whole-person care. Integrating the AWV within an Age-Friendly Health System (AFHS) contextualizes AWV services within a comprehensive geriatric care framework that integrates the "4Ms" (mentation, medication, mobility, and what matters). This study describes and evaluates quality improvement initiatives to improve the completion of AWV within two different AFHS-recognized health systems (an academic university clinic and a Federally Qualified Health Center). The results from this evaluation present opportunities that other health systems can consider for leveraging electronic health records (EHRs) and enabling services to complete AWVs within a 4Ms framework. The implementation results also suggest an adaptation of the 4Ms assessment schedule for patients with complex chronic conditions who may suffer from multiple comorbidities and cognitive impairment.