State Flex Profile Navigation

Arizona Center for Rural Health

Top Flex Activities

CAH Quality Improvement

The Arizona Flex Program continues to provide training and education to Arizona’s critical access hospitals (CAHs) on the Medicare Beneficiary Quality Improvement Project (MBQIP) by monitoring and evaluating data, creating and disseminating reports to CAH leadership, and reviewing best practices so that Arizona can get to and sustain 100% MBQIP reporting. Activities include: monthly webinars with the Arizona CAH Quality Network; onsite technical assistance site visits to educate and assist CAHs in MBQIP; monthly MBQIP reminders and tips; customized reports with hospital scorecards on the MBQIP domains; and a quality listserve to support CAHs and share best practices.

CAH Operational and Financial Improvement

The Arizona Flex Program is working with the Arizona Hospital and Health Care Association (AzHHA) to address financial and operational issues. At each meeting, they will invite one of their CAH “experts” to present best practices they have successfully used or implemented at their facilities to address identified topics. Following the presentation and discussion, next steps will be identified as well as follow-up with hospitals. Follow-up will focus on practices that have been implemented, or if not, what steps would need to be taken to implement the practice or process. Consultants will be used as appropriate to augment in-house “expert” presentations.

CAH Population Health Improvement 

The Arizona (AZ) Flex Program will assist AZ CAHs to address existing health needs as identified through 2016-2018 community health needs assessments (CHNAs) through community collaboration and integration with statewide health initiatives. The health needs include: access to care; behavioral health services, healthy lifestyle factors, and the needs of an aging population.

Rural Emergency Medical Services (EMS) Improvement 

The Arizona Flex Program continues to collaborate with the Arizona Department of Health Services (ADHS) Bureau of Emergency Medical Service (EMS) and Trauma System, and the 40 trauma centers (Level I, III and IV) in the state. The Arizona Trauma Managers Work Group has been meeting regularly for over seven years and continues to meet face-to-face quarterly, rotating through trauma center sites around the state. Over 100 people actively participate in a Trauma Program Manager listserv that is managed and maintained by Arizona Flex to share ideas, policies, best practices, etc.

The Arizona Flex Program will provide training and support to EMS agencies located in CAH communities to utilize results from the 2016 Needs Assessment to enhance local EMS capacity.

They will promote and provide assistance to EMS agencies to participate in Arizona’s web-based pre-hospital registry (based on the EMS Needs Assessment conducted in 2016).

The Arizona Flex Program also will collaborate with the Arizona Department of Health Services Bureau of EMS and Trauma System to assess and support the quality of services identified

If your Flex Program was funded for one of the eight competitive Flex EMS awards, please describe your project, your partners, and intended long-term outcomes.

Arizona Rural EMS Advanced Telemedicine Demonstration Initiative (AzREADI) will improve access to high-quality EMS care by implementing a rural, EMS-based telemedicine program linked to board-certified emergency medicine physicians. Recent improvements in wireless broadband capability (FirstNet), allow rural EMS agencies to extend communications and facilitate comprehensive, real-time vital sign patient telemetry and diagnostics to board-certified EMS physicians. The established Arizona Treat and Refer system – with its Medicaid cost recovery - and the proposed AzREADI platform,will be timely, feasible, effective, and sustainable. AzREADI is being piloted with two rural EMS agencies with the goals of reducing unnecessary and/or long-distance ambulance transports, assuring high quality and sustainable pre-hospital care, and improving patient satisfaction. 

Two rural EMS agencies serving southern Arizona will work with the University of Arizona (UA) Department of Emergency Medicine and the Arizona Rural Hospital Flexibility Program to implement a telemedicine demonstration program (AzREADI), test its ability to improve rural EMS care, and decrease unnecessary air transport costs. The two partner EMS agencies are the Rio Rico Fire and Medical District, serving the rural area just north of the Arizona-Mexico border, and the Sonoita-Elgin Fire District, serving rural communities between Tucson and Sierra Vista, Arizona. The UA Department of Emergency Medicine provides medical director oversight for both. Their EMS service areas include 19,941 Arizona citizens and spans 792 square miles in southern Arizona.

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

As mentioned in the financial and operational section, the Arizona Flex Program is working with the Arizona Hospital and Health Care Association (AzHHA) to address financial and operational issues in a program called the AzCAH Leadership Group Project.

The Arizona flex Program also runs a Quality Network to help AZ CAHs in reporting MBQIP measures. The focus in past years has been to get CAHs just to report. Now with most reporting, the Flex Program can work on improving measures.

And lastly, the Arizona Flex Program runs a State Trauma Managers workgroup. This group meets quarterly and works on supporting and improving trauma programs statewide.

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

By way of the Rural Veteran Access Grant proposal submitted last February, the Arizona Flex Program was able to establish a new partner, The Arizona Coalition of Military Families. The Flex Program did not receive funding for this grant, however, they were able to pull resources together and help rural veterans access services through the "Be Connected" Program.  Jill Bullock was invited to attend the Governor's Challenge to Prevent Suicide Among Service Members, Veterans and their Families. Other states that were in attendance had no awareness to their State Offices of Rural Health.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization University
Staffing (FTE) 3.5
Website Organization Website
Number of CAHs 15

Flex Program Staff

Daniel Derksen, MD
Director, Center for Rural Health, Arizona
(520) 626-3085

Specialty Areas / Background

Director of the Center for Rural Health (CRH), Walter H. Pearce Endowed Chair and Professor, Director of the Community, Environment and Policy Division at the University of Arizona’s Mel and Enid Zuckerman College of Public Health. As CRH Director, he oversees the State Office of Rural Health, the Rural Hospital Flexibility Program (Flex), and the Small Rural Hospital Improvement Program (SHIP). He chaired the American Academy of Family Physicians Commission on Governmental Advocacy in 2013-14. He served on the American Hospital Association’s Governing Council Section on Rural or Small Hospitals, and on the Arizona Hospital and Healthcare Association Small Rural Hospital Constituency Group.

State Office Director since July 2013

Jill Bullock
Flex Coordinator, Arizona
(520) 626-3722

Specialty Areas / Background

  • Network development
  • Physician outreach
  • Healthcare program navigation and Medicaid eligibility 

 Coordinator of Rural Health Services since September 2011

Joyce Hospodar
Manager, Health Systems Development, Arizona
(520) 626-2432

Specialty Areas / Background

  • Health services research including quality improvement and health systems development
  • Health planning
  • Network development

Health Systems Development Manager since 2001

Bryna Koch
Special Projects Coordinator/Internal Evaluation, Arizona
(520) 626-6253

Specialty Areas / Background

  • Evaluation
  • Evaluation capacity building at the local, state and national levels

Special Projects Coordinator/Internal Evaluation since August 2016

Melissa Quezada
Program Coordinator, Arizona

Flex Support Staff since October 2017

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.