Colorado State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

The Colorado Rural Health Center (CRHC) continues to build on previous work in the area of quality improvement with the Critical Access Hospital (CAH) Quality Network, Regional Quality Improvement (QI) Workshops and Improving Communications and Readmission program (iCARE) among other efforts. To measure the benefit of these projects, CRHC utilizes Medicare Beneficiary Quality Improvement Project (MBQIP) data, benchmarking system reports and Flex Monitoring Team (FMT) reports, as well as additional data and information gathered from programs such as iCARE.

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: 

CRHC has implemented Electronic Health Record (EHR) User Group conference calls once each quarter with each of the EHRs and the facilities utilizing that vendor’s product to discuss items from action plans/priority lists, EHR functionality and challenges related to data extraction and reporting, patient portals and disease registry modules. The biggest challenge continues to be the lack of functionality to pull data and generate reports out of the EHR in order to drive quality improvement and decision-making. The success is when a user willingly shares how they located and/or created a report to pull iCARE data and provide instructions on how the other facility using that vendor’s product can do the same.

Program Area: Support for Financial and Operational Improvement: 

In the area of Financial and Operational Improvement, CRHC is offering activities and support that build upon previous achievements. Annually, CRHC updates its CAH Swing Bed and Utilization Management Resource manuals and hosts a webinar series on these topics to provide updates and training on any changes to regulations and best practices. CRHC is also continuing to expand its CAH Financial Workgroup with CAH Cheif Executive Officers (CEOs), Cheif Financial Officers (CFOs) and other members of the CAH finance team. Additionally, CRHC offers education to CAHs through its annual CAH Workshop. CRHC measures the impact of these activities through the Flex Monitoring Team and other rural hospital data.

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

CRHC is not addressing the population health management area through Flex. However, it is a priority area for the organization as CRHC works with similar activities and community health needs assessments (CHNA) through goals outside of Flex funding. The results and related data the organization gathers through these strategies all inform various core areas within CRHC’s Flex work. For example, through CRHC’s Health Awareness for Rural Communities (HARC) Databank, CRHC has been compiling and analyzing population health metrics for rural Colorado to draw conclusions about needs and opportunities and working to synthesize this data with other data such as iCARE and MBQIP. Although CRHC is not addressing emergency medical services (EMS) integration directly through Flex, CRHC is involved with EMS activities through the Colorado Department of Public Health and Environment. CRHC connects with local public health and other community agencies to help raise awareness of community resources and collaborates with the state health department to link providers to technical assistance to strengthen compliance and participation in state trauma system.

Program Area: Support for Designation of CAHs: 

One of the original intents of the Flex Program was for states to assist eligible rural hospitals convert to CAH status to safeguard access to care in vulnerable rural areas. While these activities have decreased over the years as most eligible hospitals have already converted, there is still periodic need for these assessments and assistance. CRHC has provided recent assistance in this area. Four facilities are in the process of completing feasibility analyses with the intent to convert from prospective payment system (PPS) hospitals to CAH within the year. CRHC continues to keep resources pertaining to the CAH Conversion process up-to-date and will offer assistance to any hospital inquiring about its options.

Program Area: Support for Integration of Innovative Health Care Models: 

CRHC expanded on the work occurring through its iCARE program to fulfill its vision to create a community-based, rural-relevant program. iCARE began with Colorado’s CAHs in 2010 through Flex. In 2012, CRHC received additional state funding allowing the program to expand to include CAH provider-based clinics. Through this new innovations opportunity with Flex, CRHC moves forward with opportunities to raise awareness amongst other care providers in rural communities. Through the existing monthly iCARE webinar series, CRHC offers an avenue to explore the care coordination processes between hospitals, clinics, and other care providers including EMS, long-term care, home health and others. Discussion topics within these areas include information transfer protocols between care settings, data transfer, patient communication and follow-up processes.

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

Avoidable readmission rates and transitions in care have come under close scrutiny by payers and policymakers because of the potential of high savings associated with them. Tackling this issue is an opportunity to improve quality and reduce costs in the health care system. Although readmission rates among Colorado CAHs, by virtue of their volume, may be small, there is opportunity for the state to stay ahead of national trends, spotlight the great services Colorado’s CAHs and rural clinics are providing, make improvements in processes that will help maintain low readmission rates and continue to showcase the hospitals and clinics' status as leaders in their communities.

The iCARE program has resulted in fewer unnecessary hospital readmissions and improvements in quality outcomes and cost efficiency. Additionally, Colorado is a state that is at the cutting edge of many national initiatives including the Agency for Healthcare Research and Quality (AHRQ) Evidence Now Southwest (ENSW) program, the Centers for Medicare & Medicaid Services (CMS) State Innovation Model initiative (SIM) and the CMS Transforming Clinical Practice Initiative (TCPI). CRHC is a subcontractor on ENSW, SIM and TCPI, to transform health care delivery by building critical infrastructure to help smaller primary care practices apply the latest medical research and tools to improve heart health (ENSW), behavioral health (SIM) and transformation (TCPI) by providing continuous quality improvement with our experienced staff, and technical assistance support from health information technology (HIT) staff.

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 iCARE project brings hospitals and their provider based clinics together to help improve communication and readmissions. Currently, CRHC has 23 CAHs and 32 clinics participating in the project
  • CRHC hosts monthly webinars where data is examined and best practices discussed. The webinars are a great forum for peer learning and provide the opportunity for facilities to hear from one another what they have been working on, what has been working well and where they may have encountered barriers
  • CRHC holds Regional Quality Improvement Workshops each year. They are repeated in multiple locations in an effort to mitigate the distance each facility has to travel. Topics include quality improvement methodologies as well as education and training for MBQIP data submission and analysis
  • CRHC manages the CAH Peer Review Network in an effort to provide objective rural providers chart reviewers from other CAHs who have an understanding of the unique working conditions of rural providers
  • CRHC also manages a Financial Workgroup where quarterly webinars with CAH CEOs and CFOs are able to discuss/learn the latest financial trends and any new regulations
  • CRHC, in partnership with the state quality improvement organization (QIO), hosts bi-monthly CAH Quality Network Webinars that focus on utilizing quality improvement methodologies to build capacity for MBQIP measure reporting and improving data
Please provide information about cross-state collaborations you may be working on related to the Flex Program: 

Telligen is the quality improvement organization (QIO) for Colorado, Illinois and Iowa for quality improvement, value-based purchasing program support and technical assistance. Telligen has been a supporter of the CAH program and has invited CRHC and CAHs to participate on their cross-state hospital quality reporting/improvement update webinars. These webinars allow participants to share best practices and discuss barriers from providers. 

CRHC is continuing as an operating partner with Healthy Transitions Colorado, a statewide initiative which is working to link best practices and resources about care transitions and readmissions efforts across the state.  

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

To evaluate Flex activities related to Quality Improvement, CRHC utilizes the quarterly MBQIP reports received from the Federal Office of Rural Health Policy to measure results. CRHC compiles the MBQIP reports received into a spreadsheet database to better track trends for each participating hospital. CRHC communicates the information back to hospitals through our Flex work and uses the data to guide improvement efforts by focusing on areas where the metrics demonstrate opportunities for improvement. To promote and ensure CAHs report MBQIP data, CRHC sends calendar invitations to all CAH quality improvement staff, at intervals of two weeks prior, one week prior, and day of, for each MBQIP domain deadline.

Program Statistics

What type of organization is your Flex office housed in?: 
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

Michelle Mills
State Office Director, Colorado
(303) 832-7493

Specialty Areas / Background

Colorado Rural Health Center's (CRHC) CEO, Michelle has over 18 years of healthcare experience in quality improvement and patient safety. Michelle has worked extensively with hospitals, nursing homes, and physician offices, and she has been a catalyst for creating synergy for quality improvement and patient safety efforts. Michelle began working with CRHC in January 2010.

State Office of Rural Health Director since August 2012

Jennifer Dunn
Director of Programs, Colorado
(303) 832-7493

Specialty Areas / Background

Jennifer works as the Director of Programs, where she is responsible for the oversight of the CAH, RHC, and Emergency Preparedness programs. Before coming to CRHC, she worked for several years with health insurance programs for underserved children and families. Her experience includes training, program management and product line development. Jennifer has been working at the Colorado Rural Health Center since 2008.

Director of Programs since August 2012

Marcy Cameron
Flex Coordinator, Colorado
(303) 468-3498

Specialty Areas / Background

As the critical access hospital program manager, Marcy is responsible for helping meet the needs of hospitals in rural and underserved areas of Colorado. Marcy is a health care management professional who has over 14 years of experience with health care quality improvement organizations, federal government reporting programs and hospital services. Her experience includes providing technical assistance, education and quality improvement support.

Flex Coordinator since February 2016

Rachel Williams
Administrative Assistant, Colorado

Administrative Assistant since April 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, $1,100,000 (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.