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California Department of Health Care Services

Top Flex Activities

Program Area: Support for Quality Improvement

The California Flex Program focuses on the provision of Medicare Beneficiary Quality Improvement Project (MBQIP) training and education to improve overall quality and to reach the goal of 100% MBQIP participation.

The California Flex Program supports the use of Quality Health Indicators (QHi), a benchmarking tool, for all MBQIP measures, but specifically for Emergency Department Transfer Communication (EDTC). This allows Flex Program staff and CAH staff to track reporting and quality improvement (QI) progress monthly and quickly identify challenges and best practices. The California Flex Program facilitates semi-monthly QHi meetings that focus on the benchmarking data, highlighting national and state best practices and discussing solutions, tools and resources. Comparing the EDTC measures for CAH QHi users to CAH non-QHi users, a higher percentage of CAHs using QHi are at 100% for compared to CAHs who do not use QHi.

The California Flex Program makes funding available to CAHs for hospital-specific projects focused on reporting and quality improvement. CAHs must submit a request for proposal outlining the project, addressing how it meets Flex Program objectives and must also include baseline data, which is updated at specified time periods after implementation to help determine the effectiveness of the project.

The California Flex Program conducts onsite technical assistance site visits to educate and assist CAHs in MBQIP with a focus on hospitals with new staff. At the site visits, Flex Program staff engage with the Chief Executive Officer (CEO), provide an overview of the Flex Program to QI staff, walk through their MBQIP data and provide technical assistance for reporting measures. The CAH is also provided with a customized MBQIP 101 binder that includes relevant tools and resources.

Please share a success story about reporting quality data or using quality data to help CAHs in your state improve patient care.

The California Flex Program is using QI data to drive all QI initiatives, and both EDTC and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures and reporting reflect this effort. Not only are reporting percentages (and maintaining reporting) improved for both sets of measures, but scores across measures and in key areas that the state Flex Program have focused on have improved.

Program Area: Support for Financial and Operational Improvement

The California Flex Program is contracting with a nationally recognized health care consulting firm specializing in rural issues to provide a statewide financial assessment and analysis on CAHs. Their report includes a hospital-specific analysis of each CAH that allows the state Flex Program to identify more in-depth financial and operational challenges and strengths. Information is being used to inform decisions on the most efficient use of Flex funding for financial and operational improvement activities. Currently, the statewide assessment is being used to develop trainings and/or webinars. The in-depth analyses are being used to identify and support two or three hospital-specific improvement projects. California Flex plans to measure the impact of these projects through appropriate financial indicators.

Through a contract with the California Hospital Association and the University of Southern California, the California Flex Program supports Lean training for hospitals that demonstrate need and readiness.

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

The California Flex Program completed an emergency medical services (EMS) needs assessment and based on the findings has developed and provided an EMS ST-Elevatin Myocardial Infarction (STEMI), Stroke and Trauma resource kit to CAHs and ambulance services. In addition, the California Flex Program supports improvement in the quality of trauma care by hosting Rural Trauma Team Development (RTTD) courses. Pre- and post-testing is used to measure improvement.

Program Area: Support for Designation of CAHs

The California Flex Program assists small, rural hospitals in obtaining CAH status on an as-needed basis. Activities recently completed include working with the California Department of Transportation to ensure distance requirements are met, acting as a liaison between a CAH and the California Department of Public Health regarding licensing requirements and timeframes and general CAH application assistance.

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

The California Critical Access Hospital Network (CCAHN) meets quarterly to develop and implement network-based strategies that include building financial health and improving workforce development. Using their strategic plan as a guide, CCAHN provides member education on a broad range of topics including the transition to value-based care, swing bed reimbursement strategies and 340B Drug Discount program training. In addition, CCAHN conducts Chief Financial Officer (CFO), Materials Management, Patient Financial Services, information technology (IT) and Human Resources committee meetings on a regular basis. In partnership with the California Hospital Association, the California Flex Program provides MBQIP updates to CCAHN, participates in committee meetings, and shares best practices. 

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

The California Flex Program collaborates with Arizona, Nevada, Hawaii and other western states to support CAH participation in the Western Region Flex Conference.

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

The California Flex Program is now reporting data back to CAHs in new formats and with additional analyses. This is being done as part of the QI roundtable meetings as well as through new MBQIP measure dashboard reports. This is important for CAHs that are addressing challenges, and also for the CAHs that are performing well as it gives them new targets and areas to focus their work. The California Flex Program is also working with QHi, a benchmarking tool, to build additional reporting capacity within the tool and to establish a standard dashboard report for all CAHs.

Please share any resources or tools that you found useful in your state Flex Program's work this past year that you would recommend to your Flex Program colleagues.

  • MBQIP Monthly
  • QI tools created by Stratis Health
  • Flex Program Reverse Site Visit
  • California rural health conference

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


Program Statistics

Type of Organization State Government
Staffing 1.0 FTE
Number of CAHs 34
Website URL Organization Website

Flex Program Staff

Sandra "Sam" Willburn
State Office Director, California
(916) 449-5778
Jennifer Brooks
Flex Coordinator, California
(916) 324-7942

Flex Coordinator since September 2015

Corinne Chavez
Health Program Manager, California
(916) 324-7937

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.