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State Office of Rural Health

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CAH Quality Improvement

The State of Alaska Flex Program partners with the Alaska Hospital and Nursing Home Association (ASHNHA) and Mountain Pacific Quality Health (MPQH) to support quality improvement for the 13 critical access hospitals (CAHs) in Alaska. The primary goal is to ensure all CAHs are reporting and receiving the support and feedback they need to ensure high-quality patient care.

ASHNHA and MPQH provide technical assistance to CAHs to improve the consistency of Medicare Beneficiary Quality Improvement Project (MBQIP) participation and facilitate reporting. MBQIP measure dashboards have been created for each CAH and are reviewed individually with hospitals as updated information is added quarterly. MPQH provides technical assistance with data abstracting and reporting systems. ASHNHA coordinates and facilitates face-to-face meetings, site visits, monthly webinars, teleconferences, newsletters, and mentorship programs to promote peer networking and best practices related to quality improvement measures.

CAH Operational and Financial Improvement

To support Financial and Operational Improvement, the Alaska Flex Program facilitated an in-depth financial analysis to better understand specific service lines that are disproportionately contributing to deficits and to look for ways to reduce costs or increase revenues in those areas. They contracted with a certified public accountant (CPA) and data analyst to collect and analyze CAH financial data on a small sample of interested CAHs. The results of the analysis were presented to the Small Hospital Committee. The committee discussed the sources of revenue and causes of deficits for the participating CAHs in order to strengthen financial viability. CAHMPAS data is shared with individual CAHs and used to retrospectively monitor financial and operational improvement.  Additionally, ASHNHA facilitates a monthly meeting with CAH Chief Financial Officers (CFOs) to prioritize and address financial improvement activities that lead to financial system improvements.

Rural Emergency Medical Services (EMS) Improvement

The Alaska Flex Program implemented a pilot tele-stroke project with the Nikiski Fire Service Area in the Kenai Peninsula Borough. The goal of the program is to improve EMS responders’ ability to assess stroke patients and transport to the appropriate level of care for better patient outcomes. The tele-stroke program is a model for providing high-quality stroke care in rural areas through accurate EMS assessment with a vascular neurologist via tele-assessment for transfer of patients directly for thrombectomy versus other treatment of acute ischemic stroke. The project will improve coordination and integration with hospitals and regional systems of care to minimize brain injury and maximize patient recovery.

Innovative Model Development 

The Alaska Flex Program is continuing to support integration and innovative care by utilizing collaborative networks and communication infrastructure to educate hospital leaders on the changing health care environment and payment models. The innovative approach includes continuing to support hospitals in promoting community dialogue to solicit input in these critical transitions. The Alaska Flex Program is also actively participating in The Alaska Healthcare Transformation Project, which is leading a multi-stakeholder effort involving patients, providers, private payers, Medicaid, and other key entities in researching and evaluating options to transition to value-based care that will work in Alaska. 

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

The hospitals in Alaska are involved in three informal networks:

  • Quality improvement (QI) involving the Chief Nursing Officers (CNO)

  • Operational improvement involving the Chief Executive Officers (CEO)

  • Financial improvement involving the CFOs. They support a monthly CFO Collaborative to identify common financial and operational issues and promote sharing best practices on topics such as revenue cycle, Medicaid reimbursement, swing beds, audits, etc.

The networks have monthly teleconferences and two in-person meetings per year where they share challenges and discuss best practices.

Please provide information about cross-state collaborations you may be working on related to the Flex Program.

The Alaska Flex Program is working with Washington State to determine the number of Alaskan residents that are seeking specialty services in Washington rather than staying within Alaska. Often, the travel to Washington may be faster than the travel to Anchorage for specialized treatment. This will help Alaska understand the number of residents seeking services outside of the state as well as what conditions are being treated.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 1
Number of CAHs 13

Flex Program Staff

Tricia Franklin
State Office Rural Health Director and Flex Coordinator, Alaska
(907) 269-3445

Tricia Franklin has worked for the State of Alaska Division of Public Health since 2000 and has an extensive background in quality improvement and collaboration with diverse partners. She has a broad range of experience working in rural hospitals and public health laboratories, epidemiology, immunizations programs, and grant management. As the Manager of the Alaska Office of Healthcare Access, she coordinates the State of Alaska's Office of Rural Health, Small Hospital Improvement Program, Primary Care Office and State Loan Repayment Program to ensure healthcare access for all Alaskans. 

Flex Coordinator since May 2018

Cate Harmon
SHIP Program Coordinator, Alaska

Cate Harmon joined the Alaska Division of Public Health in September 2019 after previously working for Senior and Disabilities Services and the Alaska Housing Finance Corporation. Cate focuses on the Alaska Flex Program’s MBQIP efforts.

SHIP Program Coordinator/Flex Program Staff Member since September 2019

Terry Kadel
EMS Specialist, Alaska
(907) 269-4695

EMS Specialist since January 2019

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.