Primary Care



General Medicine and Pediatrics

Emergency Department Hyper-utilizers


General Medicine and Pediatrics

Grand-Aides function as a part of a primary care team, e.g. a "Patient Centered Medical Home" to help care for adults and children. The goals are to keep people requiring primary care healthy and reduce unnecessary visits to the Emergency Department and clinic. Grand-Aides leverage the supervisor with 5 Grand-Aides per supervisor and 100-250 patients per Grand-Aide depending on the degree of illness.


  • Meet the patient / family in the clinic
  • Make one or more visits to the home to begin a relationship
  • When a member of one of these families calls, the Grand-Aide asks a series of questions in a "protocol" (or questionnaire) for one or more of 20 conditions (e.g. cold, fever)
  • Receive instructions from the supervisor, that may involve a home visit by the Grand-Aide
  • Grand-Aides also make home visits to teach
    • Primary prevention – and efficiency (e.g. reduce "no-shows")


  • Payment mechanisms are discussed in detail in the Health Affairs article.
    • In fee-for-service
      • The code 98966 (“Reporting of clinical telephone calls managed by ‘qualified non-physician health care professionals,’ [e.g., registered nurses])” may be used by the supervisor in states and plans permitting the use of this code
        • Could share savings with level of reimbursement for 98966
    • In a capitated or bundled payment system, the savings accrue to the payer for the reduced number of visits
      • Could share savings

    • This spreadsheet includes fees for Grand-Aides USA
  • A spreadsheet with calculated savings using a program’s own data is available from Grand-Aides USA.

Emergency Department Hyper-utilizers
Adults and teens with as many as 300 visits per year. Approximately 45% have mental illness / substance abuse. Programs use frequent visits and a combination of primary care, chronic disease, mental illness, and social work curricula.


Family Medicine program using frequent visits and other methods to improve adherence in secondary prevention to improve outcomes in patients with:

  • Obesity
  • Hypertension
    • Sustained control in BP
  • Diabetes
    • Sustained control of A1c and Lipids