(126) Medicare Annual Wellness Visits and Incident Alzheimer’s Disease Diagnosis among a Medicare Advantage Population, 2016-2022

Background: Alzheimer’s disease (AD) and Alzheimer’s disease and related dementias (ADRD) are clinically underdiagnosed with patients commonly experiencing a delay to diagnosis. Medicare Annual Wellness Visits (AWV) include cognitive screening that may promote detection/diagnosis of AD/ADRD, however, the impact of AWV on AD/ADRD diagnosis receipt at a population level is unknown.

Objectives: To describe the annual incidence of Alzheimer’s disease (AD) and Alzheimer’s disease and related dementias (ADRD) stratified by receipt of AWV in Medicare Advantage (MA) beneficiaries from 2016 to 2022.

Methods: Using MA insurance claims data from Optum’s de-identified Clinformatics® Data Mart Database, annual cross-sectional cohorts of continuously enrolled patients aged 65 and over were compiled for years 2016-2022. These annual cohorts were stratified into sub-cohorts by receipt of AWV (yes/no) at any time during the year of assessment. Incident AD or ADRD diagnoses (ICD-9-CM and ICD-10-CM) were assessed in these AWV sub-cohorts. As this was a cross-sectional analysis, as a sensitivity analysis, the sequence of AWV and incident AD/ADRD was also explored.

Results: The annual cohorts of MA beneficiaries included from 3,211,268 patients in 2016 to 5,840,178 patients in 2022. Patients were ~58% female with a consistent median age of about 73 years. Race distribution was consistent across the annual cohorts with white, black, Hispanic, and Asian accounting for 70-71%, 9%-11%, 9%-11%, and 4%, respectively. From 2016 to 2022, the proportion of AWV among MA beneficiaries increased steadily each year from 26% (2016) to 42.4% (2022). However, even with the increase in AWV, incident AD and incident ADRD diagnoses among MA beneficiaries decreased steadily from 2016 to 2022 (from 1.3% to 0.6% and from 2.6% to 1.5%, respectively). The proportion of patients with AWV among the incident AD or ADRD subgroups was slightly lower than the overall MA population. Of note, for patients with both AWV and incident AD/ADRD, less than half (40-49%) of patients had AWV before incident AD/ADRD diagnosis, indicating little difference in the sequence of AWV and AD/ADRD diagnosis.

Conclusions: Although the proportion of MA patients receiving AWV increased from 2016 to 2022, the diagnosis of incident AD or ADRD did not increase accordingly. Future research could include whether cognitive testing is being performed as prescribed during the AWV and the impact of these tests on HCP willingness to diagnose patients with AD or ADRD.