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Alabama Department of Public Health

Top Flex Activities

CAH Quality Improvement

Alabama’s critical access hospitals (CAHs) participated in quarterly network meetings with the Rural Quality Network (RQN), where they worked to address specific quality measures. The hospitals shared best practices and tools to address the Emergency Department Transfer Communication (EDTC) and Medicare Beneficiary Quality Improvement Projects (MBQIP) measures along with Hospital Compare measures. Alabama’s CAHs have been participating in the voluntary nationwide Swing Bed Quality Pilot Project. Through in-person meetings and webinars, Alabama’s CAHs have improved standards of care and are successfully returning discharged patients to their communities. Internal quality reporting has also been improved as a result of this project.

CAH Operational and Financial Improvement

Flex funds are utilized to assist CAHs with feasibility studies on a rotating basis. Financial feasibility studies, conducted by a national consultant, are in-depth reviews of the hospital’s cost report resulting in recommendations to improve the financial and operational performance. Participation in the swing bed project also addressed the impact of swing beds and the financial bottom line of the hospital.

CAH Population Health Improvement 

Alabama’s Flex Program expanded its activities to support both population health management and emergency medical services (EMS) integration in the Fiscal Year (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 (Chartis) 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 the active advancement of health and wellness. Chartis has completed population health assessments for each of Alabama’s four CAHs. Through the RQN, education on diabetes and combatting the crisis of opioids was also shared.

The Alabama Flex Program has also initiated a supplemental grant project to address emergency medical services (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 has extended its reach toward the 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 network activities in your state to support Flex Program activities.

A major activity of Alabama’s Flex Program is the RQN, which first met in 2009, and has continued to be the most attended and requested 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 Alabama’s Small Rural Hospital Improvement Grant Program (SHIP) eligible hospitals. RQN started with 30 participants and is now up to more than 75 participants (with 100% participation). Hospital administrators are confident in the significance of RQN participation and continue to grant approval for their staff to attend meetings and for the data to be un-blinded. A valuable benefit of the RQN has been that hospital leaders gain insight and tangible data from the benchmarking of peer group hospitals that can be internally implemented for future outcomes. This year, the RQN hospitals also participated in Learning Action Networks (LAN) through the RQN.

Please describe how your state Flex Program is reaching out to non-traditional partners to support its work.

The Alabama Flex Program is working closely with the newly established Rural Hospital Resource Center, located within the University (ORHPC) has a seat on the Center’s board of directors, and will be instrumental in identifying the technical assistance of the state’s 34 small rural hospitals and developing infrastructure and plans to address those needs.

Program Statistics

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Type of Organization State Government
Staffing (FTE) 1.4
Website Organization Website
Number of CAHs 5

Flex Program Staff

Karl Bryant
State Office Director, Alabama
(334) 206-5517
Nick McRae
Flex Coordinator, Alabama

Flex/SHIP Coordinator since April 2021.

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, $1,009,121 (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.