Alaska State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

The three top quality improvement (QI) activities for the Alaska Flex Program are:

  • Provide technical assistance to critical access hospitals (CAHs) through collaboration with the quality improvement organization (QIO) to improve consistency of Medicare Beneficiary Quality Improvement Project (MBQIP) participation and facilitate reporting, including zero cases
  • Work through the hospital association to involve CAHs in a multi-hospital QI collaborative that facilitates face-to-face meetings, site visits, monthly webinars, teleconferences and newsletters to promote peer networking, best practices and data collection
  • Support mentoring programs to match more experienced quality professionals at larger hospitals with less experienced quality staff at CAHs to receive peer support, establish relationships to combine resources and build knowledge and skill through shared experiences


  • MBQIP: The Flex Coordinator encourages all CAHs to report MBQIP measures. MBQIP reports are monitored to look for missed opportunities and further analyzed for overall trends. A standard report is sent to each CAH with a separate summary report from the Flex Coordinator. The separate report is a more detailed analysis of the hospital's progress. All improvements are congratulated, and the QI staff person is asked to what they attribute their success. Missed opportunities and downward trends are noted, and the QI staff person is asked about any planned activities that might address those issues
  • Collaborative: All CAHs are encouraged to participate in the QI collaborative, participation is monitored. CAHs within the collaborative set targets and then participate in activities to achieve their target. The number of CAHs setting targets and their progress toward meeting that target is reported and analyzed quarterly
  • Mentoring: Pairs participate in activities to learn QI skills. At the conclusion of the training, the pairs choose projects of interest they will work on over the next few months. At the conclusion of the project, pairs are encouraged to do a poster presentation on their QI activity discussing their challenges and whether they met their goals
Please share a success story about reporting quality data or using quality data to help Critical Access Hospitals (CAHs) in your state improve patient care: 

The Alaska Flex Program has instituted bi-weekly calls between the State Division of Public Health, the QIO and Alaska State Hospital and Nursing Home Association to discuss the CAHs and their quality performance. Struggling CAHs are identified and resources are then best directed to help the CAH, allowing the CAHs to receive help in real time rather than waiting for a quarterly report to identify problems.

Program Area: Support for Financial and Operational Improvement: 

Operational and financial improvement activities for Alaska include:

  • Work through the hospital association to involve CAH Chief Financial Officers (CFOs) in a multi-hospital financial collaborative that facilitates in-person meetings, educational events and teleconferences for participants to share best practices and resources around financial indicators
  • Provide technical assistance to CAHs to improve financial performance through contracts with financial/operational experts who help improve CAHs revenue cycles and operational efficiency and improve operational performance through sharing best practices
  • Monitor Flex Monitoring Team (FMT) reports, such as the CAH Financial Indicators Reports (CAHFIRs), to detect CAHs that may be in financial distress
  • Foster group purchasing or contracting of goods and services, such as peer review, among CAHs


  • Collaborative: The number of CAHs and financial staff participating, the number of activities, overall satisfaction with the activities and the number of changes made as a result of participation in the collaborative
  • Technical Assistance: The number of CAHs participating in activities to improve revenue and operations, the number of CAHs that have made changes to the revenue cycle as a result of participation in the activity
  • FMT Reports: Annual monitoring of the FMT reports and a knowledgeable accountant is used to lead a discussion around the reports and possible strategies for improvement 
  • Group Purchasing: The dollars saved as a result of participating in a group rather than each CAH purchasing these services independently
Program Area: Support for Integration of Innovative Health Care Models: 

New federal and state initiatives focused on health care delivery system reform are increasing with an effort to move the health care system toward paying providers for value of care rather than volume of care. The activities in this area will focus on assessing CAH readiness and supporting one or more multi-stakeholder processes to explore new models of care for rural communities. The activities in year one will focus on technical assistance subcontractor support to explore options and best practices suited to CAHs through a multi-stakeholder effort involving patients, providers, payers, Medicaid and other key entities.

Measures: The number of CAHs who complete a survey during year one and indicate their readiness to transition to new models

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

A number of national experts on the transition from volume to value have been brought to Alaska to meet with a working group of Chief Executive Officers (CEOs) from the CAHs. While the CAHs have learned about models that are being instituted in several states, it has been difficult for Alaska to find a model that can accommodate both the larger and smaller CAHs in the state. The Alaska Flex Program will pursue more of a paper model until next year so it can develop more expertise within the hospitals and perhaps find some commonalities for direction.

Please provide information about network activities in your state to support Flex Program activities (such as financial improvement networks, CAH quality networks, operational improvement with CEOs or EHR workgroups): 

The hospitals in Alaska are involved in three informal networks: 

  • QI involving the Chief Nursing Officers (CNOs) as the leaders and the QI from the hospitals
  • Operational improvement involving the CEOs
  • Financial improvement involving the CFOs

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

From the last Flex Program year, please describe a best practice you would like to share with other states: 

Weekly half-hour webinars on quality by organizations or facilities who have successfully problem-solved difficult quality measures have helped the Alaska CAHs that are struggling or simply want to improve quality measures by giving them a great foundation for building implementation strategies.

Program Statistics

What type of organization is your Flex office housed in?: 
State Government
What is the number of full time employees (FTE) in your Flex office?: 
How many CAHs are in your state?: 
Do you have any hospitals interested in converting to CAH status?: 

Additional Information

Flex Program Staff

Heidi Hedberg
State Office Director, Alaska

Background / Specialty Areas

As Chief of Rural and Community Health System:

  • Provides administration and oversight to Health Emergency Response Operations, State EMS Office, Trauma Program and the Office of Healthcare Access
  • Advises senior leadership on all administrative and operational aspects of departmental disaster preparedness and response planning, training, exercise, education and resource development
  • Oversees development of statutory and regulatory changes related to Section operations in coordination with the Division of Public Health legislative liaison, Public Health Directors Office and Department

As Director for the State Office of Rural Health:

  • Develops and sustains planning and partnerships to ensure health care delivery and access to all Alaskans 

State Office Director since April 2017

Debbie Lowenthal
Small Hospital Program Coordinator, Alaska
(907) 586-1790

Small Hospital Program Coordinator since April 2012

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.