State Flex Programs

State Flex Profiles showcase the meaningful activities that are carried out by State Offices of Rural Health around the country while supporting critical access hospitals and their communities.

The profiles, updated annually, highlight the successes, best practices, and innovations occurring at the state level in the five key Flex Program areas and serve as a valuable educational tool for planning future activities.

The focus of the Alabama state Flex Program includes supporting the Rural Quality Network, a nationwide Swing Bed Quality Pilot Project, financial feasibility studies, educational efforts for diabetic initiatives, and Learning Action Networks.
The focus of the Alaska state Flex Program includes supporting MBQIP participation and reporting, hospital quality staff peer mentoring, rural financial snapshots, monthly CFO meetings on financial improvement, exploring value-based care models with various stakeholders, and monthly calls and meetings for four informal networks.
The focus of the Arizona Flex Program (AzFlex) includes supporting the Arizona CAH Quality Network, customized reports with hospital scorecards on MBQIP, a financial and operational performance improvement network, assisting CAHs to measure the impact of CHNA efforts, EMS agencies training and support, and an EMS-based telemedicine program.
The focus of the Arkansas Flex Program includes provider engagement in influenza vaccination rates, regional learning session meetings, and a statewide financial analysis to set baselines and identify CAHs at risk of closure.
See the contact information for the California Flex Program.
The focus of the Colorado Flex Program includes supporting the CAH Quality Network, regional quality improvement workshops, financial and operational webinars on wing beds, utilization management, admission criteria, and compliance, CAH Financial Workgroup, annual CAH Workshop, extensive data use to support population health, and CAH Peer Review Network.
The focus of the Florida Flex Program includes supporting quality measure reporting and financial reporting via site visits and webinars, multiple COVID-19 activities, EMS educational training and an EMS Leadership series, and quarterly webinars on steps to transitioning to value-based care for CAHs.
The focus of the Georgia Flex Program includes quarterly quality improvement comparison dashboards and extensive quality improvement initiatives, financial and operational hospital service-line assessments, Stakeholder and community engagement assessments, the Vision and Education for Rural Behavioral Health (VERB) Program, and a Swing Bed Management Program.
The focus of the Hawaii Flex Program includes providing MBQIP and QI TA to its nine CAHs, holding quarterly financial and operational meetings, providing TA for conducting CHNAs, developing the ECHO Trauma curriculum, and hosting the Hawaii Performance Improvement Collaborative for CAHs.
The focus of the Idaho Flex Program includes implementing a “Moving the Needle” peer learning collaborative on quality improvement, collecting real-time financial data, financial benchmarking webinar, operational improvement project piloting a scribe, simulation-based team training for CAHs and EMS, home-based care using telehealth, and supporting the Idaho Healthcare Quality Consortium.
The focus of the Illinois Flex Program includes patient engagement quality metrics, swing bed utilization, supporting 16 different peer network groups, stroke readiness and ST-segment Elevation Myocardial Infarction (STEMI) response times, training Wellcoaches, and a CAH Leadership Fellow Program.
See the contact information for the Indiana Flex Program.
The focus of the Iowa Flex Program includes supporting hospital-specific MBQIP reports, quality improvement-related workshops, operational and financial assessments and consultation technical assistance, opioid use disorder strategic planning, CHNA technical assistance, and a peer mentor system.
The focus of the Kansas Flex Program includes supporting influenza vaccination and patient engagement measures, focused discussion groups about CAH financial performance information, training on clinical and operational staffing needs related to the transition to value-based care, key financial performance indicators education, supporting hospital worksite wellness, regional EMS meetings, and trainings.
The focus of the Kentucky Flex Program includes supporting quality improvement with trainings and bootcamps, HCAHPS and stroke education, financial and operational improvement trainings, supporting CAH and RHC networks, an EMS grant writing workshop, mental health training, and cardiac arrest survival EMS training.
See contact information for the Louisiana Flex Program.
The focus of the Maine Flex Program includes supporting a CAH Quality improvement Network and quality trainings, operation and financial needs assessment and activities including ones that compliment the SHIP grant goals and objectives, addressing community health needs, and an EMS Trauma Advisory Committee.
The focus of the Massachusetts Flex Program includes maintaining and improving MBQIP required core measures, continuing the Rural Hospital CEO/CFO Forum, on-site financial and operational assessments to CAHs, EMS agency partnership s and improvement, and participating in the New England Rural Hospital Performance Improvement (NEPI) Network.
The focus of the Michigan Flex Program includes supporting the Michigan Critical Access Hospital Quality Network, supporting MBQIP measuring reporting, CAH Financial and Operational Benchmarking, supporting CAHs in completing Population Health Readiness Assessment, and EMS Leadership Academies.
The focus of the Minnesota Flex Program includes a Culture of Excellence on quality and patient safety, abstraction training, customized financial and operational summary reports, integrating behavioral health, and an EMS feedback form pilot to establish a communication loop to patient care providers from pre-hospital to emergency department and tertiary care.
The focus of the Mississippi Flex Program includes quality reporting and improvement TA and education, revenue cycle activities, lifestyle coaching training for diabetes prevention, outmigration analysis, and financial and operational education at network meetings.
The focus of the Missouri Flex Program includes MBQIP education including virtual and in-person regional and statewide events, quality improvement dashboard, monthly CEO network, financial TA, statewide population health assessment, population health strategies, and a population health website for resources.
The focus of the Montana Flex Program includes quarterly calls, weekly messages report cards, and state-based manuals to support MBQIP, MBQIP to Outcomes Program, statewide quality improvement studies, Performance Improvement Network, Lean, trauma measurement and performance improvement pilot, CHNA implementation plans, wellness programs pilot, antibiotic stewardship program implementation plan, and leadership education.
The focus of the Nebraska Flex Program includes using Baldrige framework for CAH quality and performance improvement, Capture Falls training and implementation, mock surveys, Lean education and training, financial and operational assessment, statewide EMS assessment, five CAH networks and statewide cardiac plan, and activities on ST-segment Elevation Myocardial Infarction (STEMI) outcome improvement.
The focus of the New Hampshire Flex Program includes supporting quality improvement projects, a Clinical Document Improvement project, an EMS workforce survey, the New Hampshire Stroke Collaborative, Trauma Medical Review Committee meetings,
The focus of the New York Flex Program includes supporting MBQIP, supporting the New York State CAH Performance Improvement Network on quality, finances and operations, Value-Based Payment Bootcamp, and identifying hospitals that may not be regularly submitting data for TA.
The focus of the New Mexico Flex Program includes supporting quarterly Quality Directors meetings, patient safety education and process improvement, targeted Performance Improvement Plan for each CAH on market, quality, operations and finances, improving EMS quality care, and supporting the Small Rural Hospital network for CEOs.
The North Carolina Office of Rural Health works with 20 CAH statewide on quality improvement, population health, and financial and operational improvement activities.
The focus of the Ohio Flex Program includes supporting influenza vaccination and EDTC measures, Flex Quality, Financial and Operational Improvement Network, financial and operational assessments and workshops, financial data benchmarking, statewide CAH population health management needs assessment, EMS and safety net provider network, and community-level EMS system assessment.
The focus of the Oklahoma Flex Program includes facilitation of the CHNA process, financial and operational improvement education and analysis, quality improvement (QI) initiatives including case review and mock surveys, a CEO/CFO webinar series, education on the transition to value-based care, and creating quality benchmarking data to supplement MBQIP reports.
The focus of the Oregon Flex Program includes quality improvement peer learning and benchmarking reports, CAH Quality Reporting Guide, financial indicator and service line analysis, Rural Listening Tour, community benefit reporting, primary care database, Areas of Unmet Health Care Needs report, CAH Community Engagement Report, standardized ST- segment Elevation Myocardial Infarction, stroke and cardiac arrest protocols, EMS treatment inequalities, trauma scenario training, and telehealth.
The focus of the Pennsylvania Flex Program includes quality improvement initiatives including their EDTC program and their Emergency Department Performance Improvement Model, Medicaid supplemental funds provided by the Commonwealth of Pennsylvania and CMS, the Pennsylvania Rural Health Model, assisting RHCs with utilizing Lilypad®’s Practice Operations National Database (POND), supporting COPD initiatives
The focus of the South Carolina Flex Program includes supporting CAH quality meetings, MBQIP Measure Abstraction Process, financial and operational assessments and education, transition to value-based care education and TA, CFO work group meetings, statewide population health management needs assessment, EMS agency performance improvement, partner engagement, annual Population Health Summit, six Rural Health Networks, and implementing the South Carolina Rural Health Action Plan.
The focus of the South Dakota Flex Program includes supporting MBQIP participation and reporting, transition to value-based care, CAH financial and operational activities, EMS/trauma activities, among others.
See contact information for the Tennessee Flex Program.
The focus of the Texas Flex Program includes supporting MBQIP participation and reporting and a one-stop reporting portal, an annual statewide financial and operational needs assessment, their Flex32 Summer Initiative, a state regionalization approach, and quarterly rural hospital stakeholder group meetings.
The focus of the Nevada state Flex Program includes supporting the CAH Quality Network, CAH Infection Control Workgroup, rural hospital performance improvement network, provider relief funds education, Nevada Rural and Frontier Health Data Book, Health Careers in Nevada guide, rural local boards of health development, Project ECHO, Nevada Instant Atlas, and the Western Region Flex Conference.
The focus of the North Dakota Flex Program includes supporting the CAH Quality Network, Flex Program National Healthcare Safety Network (NHSN) access, EDTC web-based data collection, Board of Directors Boot Camp, Peer Exchange Program, board and trustee resources, community health strategy development, local/regional EMS capacity development, ED CAHPS pilot program with Illinois, and patient messaging care coordination pilot.
The focus of the Wisconsin Flex Program includes a Sepsis Tracking and Improvement project, antibiotic stewardship, three financial improvement projects for CAHs, population health projects for obesity reduction and substance abuse, EMS service director trainings, and a Time Critical Diagnosis (TCD) Patient Management Improvement Project.
The focus of the Utah Flex Program includes supporting HCAHPS vendor selection, real-time HCAHPS data summaries, EDTC data summaries, the Rural 9 Independent Hospital Network financial and operational activities, population health needs assessments, and the Rural Veterans Health Access Program.
The focus of the Vermont Flex Program includes quality improvement, statewide community health needs assessments and participation in the statewide Accountable Care Organization (ACO), OneCare Vermont.
The focus of the Virginia Flex Program includes implementing the Virginia Hospital Coaching Collaborative to support quality and operational improvement, quarterly Leadership Development Institutes, individual hospital quality improvement activities, CAH and EMS listening tour/needs assessment, ED utilization, and supporting the Virginia CAH Network.
The focus of the Washington Flex Program includes quality improvement leadership and training; Certified Professional in Healthcare Quality, clinical data exchange and Certification in Infection Control exam support; EDTC abstraction tool; MBQIP workshops; Washington Rural Health Access Preservation Pilot; CFO Financial Summit; community population health projects including social determinants of health; EMS training vouchers and volunteer recruitment videos; Stroke Triage Tool; Northwest Rural Health Conference; and a variety of rural health networks.
The West Virginia Flex Program’s focuses include supporting the West Virginia CAH Network, quality improvement benchmarking and education, Balanced Scorecard, financial, clinical and operational performance analysis, financial and operational education and TA, various listservs, and annual CAH needs assessment.
The focus of the Wyoming Flex Program includes supporting whiteboard communications, discharge planning packets, Patient Safety Culture Surveys, antibiotic stewardship, peer review, plans to benchmark hospital financial and operational measures, Time-Sensitive Critical Diagnosis, statewide EMS assessment and collaborating to support diabetes, health disparities, and language access.