Inside All Metro Health Care’s Value-Based Care Strategy

As the U.S. health care system shifts away from a fee-for-service mentality toward value-based care, in-home care providers must find new ways to improve patient outcomes and demonstrate their value. That’s especially true as the health care system is stretched thin amid the coronavirus public health emergency.

For All Metro Health Care — a large, multi-state home care provider that’s part of Simplura Health Group — the shift to value-based care has partly meant getting better at tracking any changes of condition among its patients.

“Originally, what attracted me to the business of home care was the concept of having caregivers in the home,” Richard Keller, president of All Metro Health Care, told Home Health Care News. “They know what’s going on with a patient as well as anybody — or even better. The key for us has been figuring out how we use that information.”


Founded in 1955, All Metro Health Care provides in-home care services across Florida, New Jersey and New York. While the majority of All Metro’s business comes from Medicaid, it also works with Medicare in some of its markets, in addition to long-term care insurance and private-pay arrangements.

Combined with Simplura Health Group’s other six unique brands, All Metro helps care for roughly 14,000 clients a day.

To better keep track of changes of condition, All Metro adopted a tool known as “STOP and WATCH,” developed by the publicly available INTERACT quality improvement program. “STOP and WATCH” is an acronym where each letter corresponds to an early warning sign for potential hospitalization.


“It’s a proven tool that’s been used for years,” Keller said.

On top of the tool itself, All Metro enrolls its aides into interactive training classes with Ladders to Value, one of New York’s Workforce Investment Organizations (WIOs). Then, to digitalize the STOP and WATCH tool, All Metro teamed up with HHAeXchange, a home care management platform.

All Metro started using the HHAeXchange-supported change-of-conditions process in September, slowing building onto the program in March and April.

Today, All Metro assesses roughly 200 clients a week through the program. The provider is seeing some pretty encouraging results, too, according to Keller.

“We’ve avoided potential [health] escalations on 8% of the clients in the program,” he said. “Monitoring change of condition can sometimes be subjective and not very structured. I think what we really wanted to do was turn the traditional process on its head and turn it into an objective review of the situation to better evaluate how we’re doing.”

Apart from avoiding negative health outcomes, the HHAeXchange-supported tool has also helped All Metro in terms of caregiver retention.

In an internal survey, 93% of All Metro’s aides reported that the tool has made it easier to report changes in clients’ condition, with 97% of aides saying that the tool has improved their communication with office staff.

As All Metro continues to refine its value-based care strategy, it’s also recovering the initial COVID-19 disruption, according to Keller.

“We’ve seen a dip in services as a result of clients choosing to put care on hold due to their concerns about the virus,” he said. “Over the past couple of weeks or so, we’re beginning to come back and rebound.”

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