Grand-Aides USA Summary

GRAND-AIDES

Award-winning answer to value-based care and population health:

One patient at a time

• At a recent meeting in the Silicon Valley, Arnold Milstein founder of Leapfrog, introduced Grand-Aides as one of the few innovations that improves outcomes in patients and communities and saves money as well.

• Grand-Aides (www.Grand-Aides.com) relies on people and technology to improve population health. At the individual level, this is done through improved adherence with medications as well as all other parts of the medical regimen, recognition of danger signs including prevention of opioid abuse, leading to cost reduction through reduction in unnecessary hospital admissions, readmissions, length of stay and visits to the Emergency Department. Grand-Aides address Social Determinants of Health initially by understanding issues in each family and then working to improve conditions, helping not only the families but also their communities.  

• Grand-Aides have the characteristics of a “good grandparent” regardless of their age, almost becoming a member of the family.  Grand-Aides are Certified Nurse Aides. Each 45-minute home visit is supervised by a nurse on video for 5-10 minutes; that nurse then communicates with the patient's care team with electronic records as well as emails / calls as directed for that patient. The first week (can be after hospital discharge or initiation in the clinic) the Grand-Aides visit 3 times. In the COVID era, these “home” visits may be by telemedicine and Grand-Aides will test the hypothesis that in-person visits will be more effective. By the end of 30 days, most patients and families are empowered in self-care concentrating on the caregiver. The Grand-Aides make "telemedicine" visits (again nurse supervised) in further follow-up but with the ability to make a home visit, and put the patient on video within hours of a concerning call. 

• Grand-Aides have the best published results in reducing hospital readmissions, unnecessary admissions, and emergency room visits. The recent paper in the American Journal of Cardiology showed 82% reduction in 30-day readmissions to 2.8%, similar data for Emergency Dept reduction both, also at 6 months (please see graph below), with >$560,000 savings per Grand-Aides per year in this article. 

• Grand-Aides are effective in different types of patients  varying from  settings as different as the Cleveland Clinic and the Methodist Hospital in Houston to a randomized trial at Temple in low-income Philadelphia. In a Medicare / Medicaid "dual-eligible", a study of 10 states, Grand-Aides were superior in reducing readmissions, ED visits and improving medication adherence, potentially saving 6% of all Medicaid expense.

• Patients can be identified in the clinic rather than only on discharge.  A study on diabetic patients demonstrated  >90% medication adherence at 1 year with >75% reduction in hypertension. 

• The table also shows outstanding results in patients being discharged from Skilled Nursing (SNF) and Rehabilitation facilities.   Grand-Aides is working with a large group to reduce referrals to SNF’s partnering with home health agencies. 

• In children, as published in Health Affairs, Grand-Aides and their supervisors averted 62 percent of drop-in visits at the Houston clinic and would have eliminated 74 percent of emergency department visits.  

• Behavioral Health.  1. Grand-Aides started a behavioral health program with over 8,000 patients with depression, bipolar disorder or schizophrenia. 2. The University of Virginia is initiating a program to reduce the number of patients who "Hyper-utilize" the emergency center, with 10 or more visits per year.  At UVA as well as nationally, over 50% of these patients carry a behavioral diagnosis. 3. Grand-Aides and a major national information company are working to create a program in prevention of opioid abuse. 

• Patients with COVID-19 have a special program with added targeted visits for the first 10 days as this is the time with most likely readmission to the hospital.  

• Grand-Aides is in various stages in 61 programs in the US including ACO’s, commercial insurers, health plans, third party administrators,  employers, and hospitals (as well as Medicare Advantage, Medicaid, and the VA, training veterans to be Grand-Aides for veterans. 

• There are 2 models: one where the personnel are employed by Grand-Aides and the other as a consultant to train the client’s personnel.

• The Grand-Aides financial model is to bundle services and generate savings. The savings are based upon a 50% reduction in readmissions in high-risk patients generating significant ROI. As financial incentives are directed in the same direction, Grand-Aides savings for groups “at risk” for patient expense are highly appropriate.