Assuming the 2010 health law survives its Supreme Court challenge, about 32 million more people are expected to be eligible for coverage in 2014 through the law’s Medicaid expansion or new health insurance exchanges. If the law is struck down, the number of uninsured will continue to increase. With experts warning of physician shortages and rising health expenditures, how can all those people get medical care without costs going through the roof?
Dr. Arthur Garson Jr. has a plan.
Garson, previously the dean of the University of Virginia School of Medicine and now director of the university’s Center for Health Policy, is the grandfather of a program called grand-aides, which trains individuals to provide care and transmit medical advice under the supervision of nursing personnel. After an extensive training program, grand-aides conduct telephone consultations or make home visits to patients who might otherwise be seen in emergency departments and clinics for conditions usually associated with primary care, such as a high fever, the common cold or vomiting.
Pilot testing of the grand-aides program in two pediatric Medicaid settings show promising results, according a study published in the May issue of the journal Health Affairs. Garson is the lead author of the study.
The program was created on the idea that “grandparents have been doing simple primary care for centuries,” Garson said in the study. But the concept was later broadened to define grand-aides as “typically local community members who are wise and nurturing, have cared for others, and generate respect and trust in patients.”
At an urban federally qualified health center in Houston, grand-aides and their supervisors averted 62 percent of drop-in visits. The authors also analyzed records of 402 patients younger than age 19 who were treated at a Harrisonburg, Va., hospital emergency department whose demographics were similar to those of patients treated at the Houston health center. The analysis showed that the grand-aides program could have eliminated 74 percent of those visits to the Virginia hospital’s emergency department.
According to the study, care from a grand-aide is less expensive than medical care delivered at a clinic or an emergency room. The cost of a patient to see a grand-aide is $16.88, far less than the current Medicaid payments of $200 per clinic visit in Houston and $175 per emergency department visit in Harrisonburg. In addition to saving money, the program has the potential to reduce congestion in primary care offices and emergency rooms.
No matter what happens to the health law, “Grand-Aides can make expanding health care to millions of Americans affordable,” said Garson, who chairs the Houston-based Grand-Aides Foundation. “And we can do it through the Medicaid program or through private insurance.”
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What a smart idea. Let’s hope provider lobbies don’t kill it.
Bravo! This is an idea that could save health care by lowering costs AND improving care for many people with chronic illnesses who need support services and less technical help than physicians and nurses provide. Garson’s idea needs to manifest.
—Jack Lewin MD
Principal
Lewin and Associates–Health Innovations Strategies
Washington DC
An excellent idea if the grand-aides are well trained, tested on skills and knowledge, and are under the direct supervision of a qualified nurse or physician.
In addition to the 30+ million newly insured in 2014 as well as the expected 13+ million new Medicaid insured the healthcare system will be stressed.
It is becoming increasingly difficult for Medicaid and Medicare patients to schedule appointments to see doctors and other medical providers. The shortage of doctors that currently exists, low reimbursement rates from the government, medical practices dropping out of the system and increases in utilization are making delivery of healthcare very challenging. Grand-aides is worth a try.
What is so important about Grand-Aides and the work of Dr. Garson is that the model addresses an important reason why the traditional case management fails. By providing a relationship with a supporting personality this program can help solve the circumstance of how some of us from infancy. Many of us were taught by parental behavior that in time of stress the default strategy is to avoid. Then when the internal tension is too high to avoid further the patient among us seeks the most convenient care or having emotionally exaggerated the severity of their condition seeks the security of the ED.
Knowing how people react to emotional challenges of illness as taught by infant development moves beyond the mere concentration on management and also promotes the security provided by either a grandmother or Grand-Aides.