Guided Care

Multistate

The Guided Care model is licensed by Johns Hopkins University, who developed the program in 2001. The model employs a trained Guided Care nurse who works closely with elderly, high-needs patients as a care coordinator and case manager. Several studies have shown that the model improves the quality of care and can reduce utilization. The Guided Care model has been adopted by eight health systems across the country (Massachusetts, Maryland, Michigan, Virginia, Rhode Island, New York and North Carolina) and over 300 nurses have been trained in the program online. The model strives to forge a middle-ground between phone-based care management and operationally intensive management programs.

Partner Organizations

• Johns Hopkins University
• Harvard Vanguard Medical Associates 
• Johns Hopkins HealthCare
• Kaiser Foundation Health Plan of the Mid-Atlantic States
• MidMichigan Home Care 
• Piedmont Community Health Plan 
• TUFTS Associated HMO 
• Chautauqua Integrated Delivery System 
• Coastal Carolina Quality Care

Target Population

Elderly individuals with high-utilization or complex needs

Care Team

Nurse as care manager

Timeframe

2001 - present

Results/ Studies

Results

Funding

Health system

Resources

Program website

Profile by the Commonwealth Fund (2016)