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Alabama Department of Public Health

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Program Area: Support for Quality Improvement

All Alabama critical access hospitals (CAHs) receive support for quality improvement (QI) through Alabama's Rural Quality Network (RQN). Please read more below regarding RQN and the activities surrounding RQN to support Flex hospitals.

Program Area: Support for Financial and Operational Improvement

Since the fiscal year (FY) 2016 budget period, two financial feasibility studies have been completed amongst Alabama CAHs. Financial feasibility studies, conducted by a professional hospital consultant, are in-depth reviews of the rural hospitals’ cost reports. From these studies, the CAH administration gains insight regarding recommendations to improve the hospitals financial and operational performance and enhance the hospitals financial sustainability. Implementation of the consultants recommendations made plausible several benchmarks for anticipated outcomes, including improvement in revenue cycle measures, enhancement in Medicare reimbursements, and an increase in internal patient transfers.

Program Area: Support for Population Health Management and Emergency Medical Services Integration 

Alabama’s Flex Program has expanded its program activities to support both Population Health Management and Emergency Medical Services (EMS) Integration in the FY 2018 budget period. In August 2018, the State Office of Rural Health (SORH) and its Flex co-directors at the Alabama Hospital Association (AlaHA) finalized a contract with the Chartis Center for Rural Health to initiate a population health project. The goal of this project is to support the CAHs’ transition to a value-based care model through proactive care of chronic disease and active advancement of health and wellness. Chartis has completed population health assessments for each of Alabama’s four CAHs and will continue to provide data relevant to sustain our population health project.

The Alabama Flex Program has also initiated a supplemental grant project to address EMS Integration. Through collaboration with the state department’s Office of EMS, the SORH will provide support towards continued education training of emergency medical technicians (EMTs) within select rural counties of the state. Continued education training of rural EMTs is direct implementation that will sustain the rural EMS model.

The Alabama SORH's efforts to support EMS Integration have extended its reach toward alleviation of the nation’s substance abuse crisis. Rural counties selected for its supplemental EMS project have high rates of toxicological emergencies, which indicate opiate abuse rates. Collaboration currently exists between Flex co-directors at AlaHA and one CAH to provide training to emergency room (ER) and nursing staff on how to recognize opioid abuse and related protocols.

Please provide information about any efforts to assist CAHs/communities and partner organizations in the transition to value-based care.

Since FY 2017, Alabama CAHs have shifted focus to value-based care. In May 2017, the CAHs were trained on value-based purchasing (VBP) and its applicability to hospitals clinical operations. At the June 2018 Rural Quality Network (RQN) meeting, the CAHs focused on improvement of care transitions for patients. Care transitions training for hospital staff helped to ensure patients understanding of their care during a hospital stay after having left the hospital and between patient care settings/practitioners. The professional hospital consultant provided guidance to hospital administration and nurses on how consistent care transition and discharge planning contributes to value-based care.

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

A major activity related to quality improvement in the Alabama Flex Program has been the creation and development of the RQN. The RQN, which first met in May 2009, has been and continues to be the most popular and best-attended activity of the Alabama Flex Program. Alabama's RQN has set the stage for sharing information, developing strategies to meet needs, and learning about best practices, with the overall goal of improving the quality of care in CAHs. Alabama RQN meetings are held at least once a year with the most recent meeting being held in June 2018.

RQN has created a platform for hospitals to receive professional and high-quality training, information and networking opportunities with peers. RQN was started with 30 participants and is now up to 70 participants (with 100% participation). Hospital administrators are confident in the significance of RQN participation and continue to grant approval for their staff to attend RQN meetings. A valuable benefit of RQN has been that hospital leaders gain insight and tangible data that can be internally implemented for future outcomes.

In addition to benchmarking and training, participating hospitals are prompted to provide an action plan for implementation following the RQN meeting. Action plans recently reported by hospitals include:

  • Improvement of revenue cycle functions
  • Assessment of opportunities to increase revenue
  • Prioritization of ancillary outpatient department growth opportunities
  • Improvement of Rural Health Clinic performance

Please describe how your state Flex Program has enhanced its use of data in the past year.

The Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) tool continues to be a reliable resource for the Alabama Flex Program. Comparative data and graphs specific to CAHs’ financial and quality performance, provided by the tool, allows for SORH staff to identify and address CAH performance measures for improvement. Focal trends in performance measures serve as indicators for prioritization of activities in the program’s work plans and budgets. Use of CAHMPAS also enables comparison of financial, quality, and community indicators between Alabama CAHs and those of other states, in addition to reviews of national averages and trends.

Do you have any hospitals interested in converting to CAH status?:


Program Statistics

Type of Organization State Government
Staffing 3.0 FTEs
Number of CAHs 4
Website URL Organization Website

Flex Program Staff

Chuck Lail
State Office Director, Alabama
(334) 206-5396

Specialty Areas / Background

  • Information technology
  • Program management
  • Rural health development

State Office Director since July 2005

Michael Smith
Flex Coordinator, Alabama
(334) 206-5649

Flex Coordinator since March 2018

Jane Knight
Flex Co-Director, Alabama
(334) 272-8781

Specialty Areas / Background

  • Alabama Hospital Association
  • Rural Hospitals Program Manager
  • Flex Program management

Flex Co-Director since January 1999

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.