Michigan Center for Rural Health


United States

Top Flex Activities

CAH Quality Improvement

Michigan Flex Program's activities:

  • Supporting the Michigan Critical Access Hospital (MICAH) Quality Network (QN) activities, including their three strategy groups.
    1. Making care safer by reducing harm caused in the delivery of care
    2. Data management and analysis
    3. Promoting effective communication and coordination of care

Measurement of activities includes engagement with each strategy group and performance on associated metrics: 

  • Supporting the Medicare Beneficiary Quality Improvement Project (MBQIP) measuring reporting performance and improvement
  • Aligning MBQIP metrics into the Blue Cross Blue Shield (BCBS) Pay-for-Performance Program measuring performance on program requirements

CAH Operational and Financial Improvement

Michigan Flex Program's activities:

  • Michigan has 20 CAHs participating in Financial & Operational Benchmarking. Using Microsoft’s BI tool to analyze Departmental, Operational, and Cost KPI, CAHCFO or finance teams meet quarterly by cohort to discuss benchmarking findings and to share best practices. This effort is facilitated by Eide Bailly. The intention of this activity is to use data to drive change and improvements.
  • Supporting bi-yearly meetings of CAH CFOs that feature a broad range of topics from cost reports to compliance and measuring participation and engagement
  • Supporting hospital service line analysis and inpatient and outpatient Lean analysis measuring project-specific performance thresholds
  • Supporting Lean Green Belt Certification in our CAHs
  • Aiding CAHs with education and technical assistance as healthcare delivery and payment models evolve 
  • Supporting CAHs in transitioning to a hospital-based post-acute Transitional Care model in their swing bed programs

CAH Population Health Improvement

The Michigan Flex worked with CAHs to complete the National Rural Health Resource Center Population Health Readiness Assessment. The intent of this activity was to identify where each CAH is on its journey towards population health. Results will help MCRH determine areas of opportunity for education, networking, and resources. The results of this assessment are as follows:

  • MI CAHs averaged 83.19 points overall (out of 105 total possible points) 
  • MI CAHs outperformed the national average in each category
  • 291 Assessments have been completed nationally
  • Each category is scored out of 15 total possible points

By Category:

Data Collection, Management, and Analysis:

  • MI CAH category average: 12.78
  • National category average: 10.33
  • Highest scoring statement: "My organization engages in an ongoing cycle of performance improvement based on data collected for improving the health and quality of care"

Outcomes and Impact:

  • MI CAH category average: 12.30
  • National category average: 9.71
  • Highest scoring statement: "My organization participates in private payer contracts and Centers for Medicare & Medicaid Services (CMS) shared savings models


  • MI CAH category average: 12.19
  • National category average: 10.63
  • Highest scoring statement: "I am aware of the critical role of population health in value-based reimbursement models"

Patients, Partners, and the Community:

  • MI CAH category average: 11.81
  • National category average: 10.13
  • Highest scoring statement: "My organization participates in a community health assessment process to identify health strengths and needs that best serve the people in the community"

Workforce Culture:

  • MI CAH category average: 11.56
  • National category average: 9.11
  • Highest scoring statement: "Board and leadership support a staff culture that is adaptable in the change towards prevention and chronic disease management"

Operations and Process:

  • MI CAH category average: 11.41
  • National category average: 9.62
  • Highest scoring statement: "Staff utilizes health information technology (electronic health records, health information exchanges and telemedicine) to manage care effectively"

Strategic Planning:

  • MI CAH category average: 11.15
  • National category average: 8.91
  • Highest scoring statement: "The board and leadership team support the organization's population health strategies"

Statements with greatest areas of opportunity:

  • Staff receives ongoing education and support for effectively engaging multiple community stakeholders to coordinate transitions of care aimed at reducing re-admissions and improving wellness.
  • My organization educates patients, partners, and the community on the organization's vision and strategies for population health through various modes, including social media

Rural Emergency Medical Services (EMS) Improvement

The state of Michigan has 819 life support units, many of which serve rural communities. The Michigan Center for Rural Health provides EMS programming to Michigan rural communities through:

  • EMS leadership training and education in partnership with SafeTech Solutions
  • Provision of technical assistance and consulting services to rural EMS agencies across the state
  • Provision of EMS advocacy and education
  • Timely and innovative EMS continuing education available to EMS providers free of charge
  • Provision of EMS grant writing resources and technical assistance
  • Provision of specialized EMS training and workshops
  • Participation in local, state, and national EMS committees and workgroups

Rural Health Clinic (RHC) Quality Improvement

RHC Program's Activities:

Michigan Rural Health Clinic Network

The Michigan Rural Health Clinic Quality Network is an initiative started by dedicated RHCs throughout Michigan and the Michigan Center for Rural Health with a goal to measure and improve the quality of care in Michigan RHCs. The Network provides:

  • A mechanism for shared learning among Michigan RHCs
  • Support for an organized approach to measuring the improving quality of care in Michigan’s RHCs
  • A framework for a united voice for RHCs in Michigan
  • Promotes the clinical care that happens in Michigan RHCs
  • Strengthens and brings together the RHC community via networking and relationship building

RHC Flex Quality Improvement Lab

Michigan Center for Rural Health has developed and supports a formal quality improvement project for provider-based Rural Health Clinics (PB-RHC) that are owned and operated by Critical Access Hospitals (CAH). The goal of the project is to help PB-RHCs improve the quality of care for their patients, simplify and streamline transitions of care between primary care and inpatient services, and strengthen chronic disease management processes.

Michigan’s PB-RHCs are motivated and ready to implement a set of clinical and operational best practices that will improve performance in one of the metrics/focus areas listed below:

  • NQF #0018 / Quality ID #236 – Controlling Blood Pressure
  • NQF #0028 / Quality ID #226 – Preventive Care and Screening: Tobacco Use
  • NQF #0038 / eCQM 117v6 – Childhood Immunization Status
  • NQF #0059 / Quality ID #1 – Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
  • NQF #0419 / Quality ID #130 – Documentation of Current Medications
  • COVID – Percentage of Patient Panel Vaccinated

In this initiative, teams will identify, test, and implement changes within their practices.

PB-RHC General Team Requirements and Expectations:

  • Committed leadership 
  • Strong team cohesion
  • Willingness test changes and new strategies within each clinic

PB-RHC Specific Project Requirements and Expectations:

  • Establish an active, committed improvement team 
  • Commit to learn and apply the Model for Improvement and other change strategies 
  • Work with other team members to select and plan recommended improvement strategies and activities
  • Perform tests of change that lead to widespread implementation of improvements for target populations
  • Collect required measurements that support selected strategies and interventions and report data using an interactive web portal
  • Be willing to transparently share information, data, tools, and resources with other teams
  • Receive and seek coaching and technical assistance

Please provide information about network activities in your state to support Flex Program activities.

The Michigan Flex Program has a great working relationship with the Michigan Health and Hospital Association, a member of the Superior Health Quality Alliance, and a subcontractor in the Hospital Quality Improvement Contract.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization Non-profit Organization
Staffing (FTE) 3.75
Website Organization Website
Number of CAHs 37


Organization Contacts

John Barnas

State Office Director, Michigan
(517) 432-9216

Crystal Barter

Flex Coordinator, Michigan
(517) 432-0006

Jeff Nagy

Quality Improvement Advisor, Michigan
(517) 884-8641

Andrea Abbas

EMS Program Manager, Michigan
(517) 355-7757

Jill Oesterle

Manager of RHC Services, Michigan
(517) 353-6891

Laura Mispelon

Social Drivers of Health Manager, Michigan

Social Drivers of Health Manager since September 2022