Guided Care (GC) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations. In a 6-month quasi-experimental study, we compared the cost and utilization patterns of patients assigned to GC and Usual Care (UC). The setting was a community-based general internal medicine practice. The participants were patients of 4 general internists. They were older, chronically ill, community-dwelling patients, members of a capitated health plan, and identified as high risk. Using the Adjusted Clinical Groups Predictive Model (ACG-PM), we identified those at highest risk of future health care utilization. We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC. Insurance data were used to describe the groups' demographics, chronic conditions, insurance expenditures, and utilization. Among our results, at baseline, the GC (all targeted patients) and UC groups were similar in demographics and prevalence of chronic conditions, but the GC group had a higher mean ACG-PM risk score (0.34 vs. 0.20, p < 0.0001). During the following 6 months, the GC group had lower unadjusted mean insurance expenditures, hospital admissions, hospital days, and emergency department visits (p > 0.05). There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels (at ACG-PM = 0.10, mean difference = $4340; at ACG-PM = 0.6, mean difference = $1304). Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention. These results suggest that GC may reduce insurance expenditures for high-risk older adults. If these results are confirmed in larger, randomized studies, GC may help to increase the efficiency of health care for the aging American population.