Community & Population Health Community support of the local health care system is vital for sustainability and growth. Learn how to create a healthier and more engaged community by working with The Center.
Health Information Technology Consulting As the national knowledge center on rural electronic health record adoption, The Center offers comprehensive services targeted at rural hospitals, rural health clinics and state and national HIT programs.
Leadership Success begins with strong, informed leadership. The Center offers a variety of services, on-site and remotely, to leaders to assess strengths and identify areas of useful performance improvement.
Workforce The Center understands that rural health care facilities face unique workforce challenges. Since 1991, The Center has assisted rural citizens, health professionals, educators and policymakers with design and implementation strategies to assure the availability of quality health care.
Strategic Planning Effective planning is critical for organizational success. Expertly facilitated services conducted by The Center’s staff of national rural health experts will help hospitals and organizations achieve this success.
Performance Improvement The Center offers a complete spectrum of rural health performance improvement services. With support from The Center, clients succeed in aligning people, processes and resources with their mission.
Technical Assistance & Services Center (TASC) TASC provides performance improvement resources to CAHs and state Flex Programs on quality, finance, operations, systems of care and population health.
Small Rural Hospital Improvement Grant Program (SHIP) SHIP provides funding to approximately 1,600 participating hospitals in 46 participating SORHs to help small rural hospitals participate in value-based payment and care delivery models.
Network Technical Assistance (TA) RHI provides technical assistance (TA) to over 60 networks in the Development and Allied Health rural health network grant programs.
Small Rural Hospital Transition (SRHT) Project The Small Rural Hospital Transition (SRHT) Project supports small rural hospitals nationally by providing on-site technical assistance to assist bridging the gaps between the current health care system and the newly emerging health care delivery and payment system.
Resource Library The Center's Resource Library features webinars, presentations, articles and toolkits developed by trusted industry leaders to guide and support rural health stakeholders.
Events Find information about upcoming webinars, workshops and more hosted by The Center or Rural Health Innovations.
Allied Health Webinars Find recordings and resources from recent technical assistance webinars for Rural Network Allied Health Training grantees.
Health Education and Learning Program (HELP) Webinars Eligible rural hospital leaders and staff can attend a HELP webinar to learn about current financial, operational and quality performance needs that impact their transition to the new health care environment.
Network Development Webinars Find recordings and resources from recent technical assistance webinars for Rural Health Network Development grantees.
Performance Management Group (PMG) Calls Learn from the experience of leading hospital administrators and nationally recognized field experts. PMG calls allow peer-to-peer education focused on preparing rural hospitals for new payment and care delivery models.
State Flex Profiles showcase the beneficial activities occurring at the state-level to support the critical access hospitals (CAHs) and their communities around the country. No two states have the same exact approaches and the profiles are updated annually as an opportunity for states to share their excellent work and to learn from one another. The profiles include information on the work occurring in the five Flex Program areas as well as successes, best practices and innovations. Use the State Flex Profiles to identify approaches to similar rural health issues, identify best practice opportunities and access contact information for individuals at the state-level who are supporting Flex Program activities.
Use the drop-down menu in the gray box at the top of this page to see a specific state's profile. If you are looking for examples of a particular activity, for example, revenue cycle management, use the keyword search provided below.
The focus of the Alabama Flex Program includes supporting a Rural Quality Network, 100% reporting in HCAHPS measures, financial feasibility studies, and training on value-based purchasing.
The focus of the Arizona Flex Program includes supporting the Arizona CAH Quality Network, customized reports with hospital scorecards on MBQIP, financial and operational assessments, assisting CAHs to measure impact of CHNA efforts, statewide EMS needs assessment, trauma program support, a Trauma Injury Prevention Survey, and use of CAHMPAS.
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.
The focus of the California Flex Program includes the use of quality benchmarking tools, distribution to CAHs of customized MBQIP 101 binders, statewide financial analysis to develop CAH trainings, hospital-specific financial improvement projects, Lean training, EMS ST-elevation myocardial infarction (STEMI), stroke and trauma resource kit, RTTD courses, and supporting the California CAH Network.
The focus of the Colorado Flex Program includes supporting the CAH Quality Network, regional quality improvement workshops, Improving Communications and Readmissions (iCARE) program and updates to: financial improvement manuals, educational webinars, 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, EMS educational training, and quarterly webinars on steps to transitioning to value-based care for CAHs.
The focus of the Georgia Flex Program includes supporting real-time quality reporting and review, Patient Safety Culture Survey tool, IHI Breakthrough Collaborative model for antibiotic stewardship, financial and operational assessments and re-assessments, Lean certification, individual community health profiles with CAH strategic planning, PEPPER reports, care coordination, and a CEO network.
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 focusing on patient engagement quality metrics, care transitions, swing bed utilization, supporting 16 different peer network groups, stroke readiness and STEMI response times, training Wellcoaches, Rural Health Coach program pilot, ED CAHPS pilot program with North Dakota.
The focus of the Iowa Flex Program includes supporting influenza vaccination measures, meeting with CAHs in high need of financial and operational assistance on preparation to transition to value-based care, and statewide CAH population health management needs assessment.
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 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 best practice guidance about patient safety events, quality improvement director training, swing bed training, onsite TA for CAHs on financial and operational improvement based on financial indicators, financial and operational improvement trainings, board and leadership trainings, and community paramedicine.
The focus of the Louisiana Flex Program includes supporting quality improvement training and 1:1 hospital team meetings for technical assistance, coordination with the SHIP Program to improve reporting of outpatient quality measures, financial assessment audits on coding, and value-based care web-based training.
The focus of the Maine Flex Program includes supporting CEO, CNO, QI, CFO, Nurse Manager networks, MBQIP benchmarking, NEPI Network participation including IHI education, CPPS and CPHRM certification, financial and operational improvement education, community paramedicine, statewide trauma system plan, EMSTA, clinical consensus guidelines for patient care and transfer, and trauma care performance measures.
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 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, outmigration analysis, statewide population health assessment, and transition to value-based care education at network meetings.
The focus of the Missouri Flex Program includes MBQIP education including virtual, 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 Nevada Flex Program includes supporting the CAH Quality Network, CAH Infection Control Workgroup, rural hospital performance improvement network, revenue cycle management, 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 New Hampshire Flex Program includes supporting quality measure abstraction and reporting, antibiotic stewardship, pharmacist certification, New England QIN, tele-ED, tele-behavioral health, revenue cycle management, New Hampshire Rural Health Coalition, New England Performance Improvement Network participation, certification, and financial data benchmarking.
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, statewide EMS and CAHED needs assessment, and supporting the Small Rural Hospital network for CEOs.
The focus of the New York Flex Program includes supporting MBQIP measures and fall measures, 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 North Carolina Flex Program includes supporting a Quality Improvement Collaborative, dashboard for MBQIP and quality performance, Financial/Operational Learning and Action Network with task force groups on topics like service line optimization, Mental Health First Aid trainings, Statewide Telepsychiatry Program, and supporting CAHs through Medicaid transformation.
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, F&O improvement education and analysis, QI initiatives including case review and mock surveys, CEO and Quality Director meetings to promote networking, education on the transition to value-based care, and creation 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 STEMI, stroke and cardiac arrest protocols, EMS treatment inequalities, trauma scenario training, and telehealth.
The focus of the Pennsylvania Flex Program includes supporting influenza vaccination and HAI measures, CAH Quality Improvement Directors’ resources website, monthly QI calls, Hospital Strength Index, cost master pilot program, review of Medicaid cost reports, state Health Innovation Plan, Community Health Solution website, trauma system improvement, substance use and obstetric care issues, Pennsylvania Community-Clinical Integration Initiative, and participating in global payment model strategies.
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 support of the following: MBQIP participation and reporting, transition to value-based care, CAH financial and operational activities, EMS/trauma activities, among others.
The focus of the Alaska Flex Program includes supporting MBQIP participation and reporting, hospital quality staff peer mentoring, monthly CFO meetings on financial improvement, exploring value-based care models with various stakeholders, and monthly calls and meetings for a CEO network and a CNO network.
The focus of the Tennessee Flex Program includes support for quality improvement initiatives, financial and operational improvement assessment, development of Population Health Assessment Chart Books, in-depth TA to address substance abuse, use of INDEX, implementation of a CAH Financial Improvement Network and support of a CAH Quality Improvement Network, participation in a national pilot test for Swing Bed outcome measures, among other activities.
The focus of the Texas Flex Program includes supporting MBQIP participation and reporting, identification of quality improvement stakeholders within the state, supporting the transition to value-based care models, hosting an annual CAH conference, and supporting financial and operational improvement through onsite assessments.
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 Utah Flex Program includes supporting HCAHPS vendor selection, real-time HCAHPS data summaries, EDTC data summaries, nurse manager and quality coordinator groups, on-site financial TA, CEO and CFO mentoring, revenue cycle assessments, Studer Group operational improvement, EMS resource identification, Rural Trauma Team Development Course, stroke/trauma designation, Project ECHO, and a formal network of nine rural independent hospitals.
The focus of the Vermont Flex Program includes supporting the state quality improvement network and regional network to improve quality reporting and outcomes, New England Performance Improvement (NEPI) Network participation including IHI education, various clinical certifications, hospital leadership visits, and community paramedicine pilot.
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, Emergency Department 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 focus of the West Virginia Flex Program includes supporting the West Virginia Hospital Association CAH Network, quality improvement benchmarking and education, data collection support with state Health Information Network, 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 Wisconsin Flex Program includes HCAHPS data review and improvement, hospital financial performance improvement projects, EMS Patient Care Assessment, EMS service individualized TA, EMS Agencies Interactive Map, and hospital population health improvement projects.
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.
This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,100,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Recognize HRSA initiatives and resources available for state Flex programs. Determine how state Flex programs can utilize Flex funds to promote accessibility and health equity initiatives.
Identify the strategies that the Wyoming Flex program and WY Office of Health Equity are implementing to advance health equity in the state.
Save the date for the 2019 Flex Program Reverse Site Visit (RSV), scheduled for July 10-11, 2019 in Washington, DC with a pre-event workshop on July 9 on the topic of EMS.
The tentative topic for the August Flex VKG is Grant Logistics: Closing out the Flex Grant Year. Flex VKG webinars provide a forum for state Flex Programs to share successes, discuss challenges and brainstorm strategies for improvement and Flex Program excellence.
