Washington State Department of Health


United States

Top Flex Activities

CAH Quality Improvement

The Washington State Flex Program provides support for quality improvement and the Medicare Beneficiary Quality Improvement Project (MBQIP) through continuous data monitoring and evaluation, training and practical application of quality improvement skills, and supporting quality improvement initiatives at individual critical access hospitals (CAH). Some of the activities they are conducting in fiscal year (FY) 2020 include:

  • Quality Improvement Request for Applications (QIRFA) – the Washington State Flex Program accepted proposals for quality improvement (QI) projects CAHs wanted to conduct at their facilities to improve sets of data they see as a priority. The Washington State Flex Program awarded 11 proposals with a small amount of funding to conduct their proposed project as well as full support from Flex staff.

  • MBQIP First Time Reporter Training Process and Materials – The Washington State Flex Program is in the third year of streamlining and implementing a process for CAH staff that are new to reporting any part or all of the MBQIP measures. This process will ensure staff are trained within the next full reporting quarter to report MBQIP data to shrink the gap in reporting that develops with staff turnover.

  • Washington State MBQIP Annual Report – The second annual report for the Washington State Flex Program has been published. This second report has expanded from an MBQIP focus to encompass all activities of the Flex program. This report highlights accomplishments of the State as well as individual CAHs, network activities, and cohorts. The Washington State Flex Program also highlighted the areas in need of most improvement and how the program can address these.

  • They provided 400 hours of technical assistance across their program focus areas in Fiscal Year (FY) 19.

  • In collaboration with the Washington State Hospital Association, the Washington State Flex Program has worked with CAHs to assist in quality certification needs. This program includes the Certified Professional in Healthcare Quality (CPHQ) as well as a number of other credential programs related to patients, healthcare, and safety.  To date, they have assisted 125 individuals from all 39 CAHs in this program.

CAH Operational and Financial Improvement

As part of a yearly assessment during CAH site visits, conferences, and meetings, the Washington State Flex Program asks what challenges they are having. The Washington State Flex Program learned that many of the hospitals have taken their billing back from an outside billing agency and are now hiring and training billers. Based on recommendations from business office managers and other Flex programs, the Washington State Flex Program has contacted several organizations that do training workshops for billing for Medicare and Medicaid claims. The Washington State Flex Program plans to provide the workshop twice – on both sides of the state – and provide some scholarship funds if the CAH is coming from a long distance. The Washington State Flex Program will measure outcomes by the number of CAHs that attend the workshops, and then after 6 months will inquire if their receivables have increased by enhanced billing methods. 

The Washington Flex Program continued funding for an additional year of Quality Health Indicators (QHi) portal access for all 39 CAHs. Previously, only the CAHs associated with the two rural health hospital networks had access through their memberships, leaving out 14 hospitals that were not eligible. With this new contract, all hospitals are able to post both QI and financial measures. At this time, one of the rural health networks, the Rural Health Collaborative that includes 15 CAHs, is using QHi for financial measures.

CAH Population Health Improvement

The Washington State Flex Program is continuing to provide funding for Population Health projects. In FY19, nine CAHs successfully executed population health projects. In FY20, 6 CAH proposals were accepted and their projects are currently underway. These projects are a means for CAHs to develop skills and knowledge that build capacity for the new incentives for care and payment. The initial goal was to provide an opportunity for CAHs to assess the social determinants of health in their community based on data review, selecting a project that could improve population health, and strategizing and collaborating with community partners to ensure project success. The Washington State Flex Program is now opening up the projects to additional CAHs to apply. At the end of each year, the hospitals provided a final report showing successes, achievements and lessons learned. These reports have helped guide the program as CAHs shared outcomes and topics of the projects, which in turn has created collaboration between the CAHs when they learn of another CAH doing the same project.

Rural Emergency Medical Services (EMS) Improvement 

The Washington State Flex Program is continuing their third year of providing payment vouchers for volunteer EMS personnel in rural communities. Working with the state Rural EMS section at the Washington State Department of Health (DOH), the Flex Team identified that volunteer EMS workers were often unable to complete their testing due to the cost of the National Registry test. With Flex funds, the state was able to purchase EMS, emergency medical technician (EMT), and Advanced EMT (AEMT) vouchers that rural EMS agencies can apply for. This supports Washington Flex's goal of increasing volunteer EMS personnel in rural communities. 

Innovative Model Development

The Washington Flex Program continues to support the integration of innovative health care models through participation in the Washington Rural Health Access Preservation (WRHAP) group and through funding population health projects. In addition, the Washington Flex Program is working with Washington Technology Solutions (WaTech) to develop EMS volunteer recruitment videos.

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

The Washington Flex Program funds state networks in developing the use of the QHi reporting portal among their CAH members.

The Washington State Flex Program also provides funding to the Washington State Hospital Association to provide an online monthly QI Leaders Forum, bringing in relevant topics and speakers. This a forum of great value to CAH QI staff and is well-attended.

Washington Rural Health Collaborative: Twelve CAHs working on clinical QI, financial improvement, and accountable care organization (ACO) development. All but one CAH is on the west side of the state.

Northwest Rural Health Network: This network includes 14 CAHs and one sole rural sole community hospital. The network has worked primarily on health information technology (HIT) and care coordination. The network has a chief financial officer (CFO) group that meets regularly and are looking at developing an ACO. In 2018, they received a Health Resources and Services Administration (HRSA) opioid grant. They will be starting this new project soon and will be working closely with their community organizations as they begin the project. In addition, Flex is facilitating their collaboration with the DOH opioid workgroup so that they share resources.

Public Hospital Joint Operating Board: This board is comprised of 18 hospitals that have an agreement to negotiate joint contracts with health insurers. This group is working on preparing for value-based contracting.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 2.25
Website Organization Website 
Number of CAHs 39


Organization Contacts

Pat Justis

State Office Director, Washington
(360) 236-2805

Specialty Areas / Background

Patient-Centered Medical Home Collaboratives both statewide and regional, expertise in quality improvement, primary care pratice transformation, patient safety, patient and employee experience.

State Office Director since August 2014

Lindy Vincent

Flex Coordinator, Washington
(360) 236-2826

Flex Coordinator since March 2016

Danielle Messier

Flex Quality Improvement Coordinator, Washington
(360) 236-4863

Flex Quality Improvement Coordinator since August 2016