In September 2023, Rural Health Innovations, the for-profit consulting arm of the National Rural Health Resource Center, was contracted by the Episcopal Health Foundation to conduct a review and assessment of the Texas Community Health Access and Rural Transformation (CHART) Model design and rollout. The assessment included an examination of Centers for Medicare and Medicaid Innovation initiatives, an analysis of the Texas CHART Model design and related communications with hospitals and partners, an analysis of state hospital finances, and interviews with more than a dozen key informants.
Resources
The Center's searchable Resource Library features articles, reports, webinars, podcasts, toolkits, and other materials developed by trusted industry leaders to guide and support rural health stakeholders.

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Resources related to Population Health: Quality, Operations, and Processes Resources
The Critical Access Hospital Financial Sustainability Guide guide is intended for use by state Medicare Rural Hospital Flexibility (Flex) Program personnel, leaders of critical access hospitals (CAHs), and other individuals and/or teams that provide guidance and assistance to these providers in managing their long-term financial stability.
Interactive
Frequently Asked Questions
Access the answers to questions frequently asked about the Rural Hospital Stabilization Program (RHSP).
The National Rural Health Resource Center (The Center) has launched the 2025 update to its Population Health Toolkit, which is designed to assist State Offices of Rural Health, state Medicare Rural Hospital Flexibility (Flex) Programs and individual health care organizations as they seek to better understand, manage and improve population health in their communities and states.
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.
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.
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 must understand QI principles, resources, and trends to support CAHs in advancing QI.
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 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.
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.
Small Rural Hospital Improvement Program (SHIP) State Grantees can find details on how to apply for and administer SHIP funds, as well as templates for reporting.
Toolkit
Coordinator Tools
This page comprises the best practice resources, webinars, and learning collaboratives for SHIP Coordinators.
View a list of resources related to electronic clinical quality measure (eCQM) reporting that is intended to aid CAHs seeking to meet the reporting requirements for the Promoting Interoperability Program, formerly the Medicare EHR Incentive Program. This list will be regularly updated to reflect new resources as they become available.
This video provides board of directors, leaders, and physicians a basis to understand what a corporate compliance program is and why the seven elements are important to include in a hospital’s corporate compliance program.
This video discusses the importance of board engagement in the physician-driven activities within its organization and provides practical approaches and methods for engagement with management (and physicians). Board members and senior leaders will gain a better understanding of How physicians can drive strategy, How to govern the risk associated with physician contracts, and The importance of ‘leaning-in’ on the numbers related to provider arrangements.
In this module, we’re going to take a broad look at your health care organization and help you think about how you and your team contribute to its long-term success. We’ll also explore the ways you impact culture and relationships through your daily interactions with others.
Video
Managing Performance
In this module, we’re going to explore ways that you can work to influence the behavior of those on your team. We’ll share best practices for communicating expectations, giving and receiving feedback, and recognizing others.
In this module, we’re going to dig into some things that are hard for many of us: Communication, conflict, and difficult conversations. We’ll look at what it means to be a collaborative communicator and share tips for becoming a better listener, keeping conflict constructive, and having difficult conversations.