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It is important for state Flex Programs to understand the community needs of CAH and RHC service areas to develop or leverage program activities in support of health system development, community engagement, and population health improvement.

State Flex Programs can help CAHs transition into value-based systems, population health models, and future opportunities through education, network support, facilitation of new partnerships, and technical assistance.

The Flex Program and CAH designation was established and remains in place because of the financial vulnerability of small rural hospitals. CAH financial and operational improvement is one of the required program areas of the Flex Program.

State Flex Programs must understand QI principles, resources, and trends to support CAHs in advancing QI.

State Flex Programs need to have an in-depth understanding of the policies and regulations governing the Flex Program, as well as a basic understanding of the policy-making process and other policies and regulations affecting rural providers.

State Flex Programs remain vital because of the web of relationships developed and maintained within communities, providers, networks, states, regions, and nationally. It is imperative that state Flex Programs have the skills, capacity, and commitment to build and sustain partnerships, new and old, to support rural providers and rural stakeholders.

Evaluation reporting to program stakeholders should be included in Flex Program activities. Reporting supports overall program transparency and development, stakeholder buy-in, engagement, and accountability.

Planning ought to be purposeful, active, and relevant, with input from key stakeholders such as internal staff, rural provider leaders and staff, and the state rural health and clinic organizations.

View resources related to the Rural Community Ambulance Agency Transformation Readiness core competency EMS Outcomes and Impact.