State Flex Profile Navigation

Idaho Bureau of Rural Health & Primary Care

Top Flex Activities

Program Area: Support for Quality Improvement

The Idaho Flex Program is implementing “Moving the Needle,” an Idaho peer learning collaborative series which provides an opportunity for all of the Idaho critical access hospitals (CAHs) to participate in quality improvement educational opportunities focused on all required Medicare Beneficiary Quality Improvement Project (MBQIP) measures. This series focuses on providing CAHs with MBQIP benchmarking of all required measures, data collection best practices, and sharing evidence-based tools and strategies to improve outcomes. Activities include:

  • In-person, full-day annual educational workshops in November and April facilitated by a consultant and focused on statewide benchmarking and the provision of evidence-based tools and strategies
  • Two learning collaborative webinars annually focused on a specific quality improvement project facilitated by a consultant
  • Individual CAH technical assistance provided by consultant via telephone or webinar to each CAH to review all hospital-specific MBQIP data and provide tools and strategies to improve
  • Onsite technical assistance site visits are conducted annually to all CAHs by the Flex Coordinator

Program Area: Support for Financial and Operational Improvement

The Idaho Hospital Association (IHA) developed software to collect real-time financial data for all CAHs statewide through a Flex-funded initiative: Financial Indicator Project (FIP). Idaho CAHs are now able to report and compare their financial data using Flex Monitoring Team (FMT) reports and real-time data to enable peer comparisons. The Flex Coordinator can log in and access the data as it is submitted quarterly and is working with IHA to create meaningful, hospital-specific reports for the CAH cheif executive officers (CEOs) and chief financial oifficers (CFOs). The CAHs use FMT cost report data for trending and access the most-current financial data from IHA to facilitate benchmarking. The Flex Coordinator contracts with Eide Bailly to provide a benchmarking webinar on all top 10 financial indicators. Eide Bailly will also help to support a Financial Summit in the summer of 2019 to provide targeted education to assist Idaho CAHs in improving financially and operationally in this changing health care environment.

The Flex Coordinator implements on-site technical assistance site visits with all 27 CAHs to meet with the CEO/CFO and discuss FMT data and trends, as well as the IHA initiative (FIP). These visits enable the Flex Coordinator to better assess need and ensure a comprehensive understanding of the data. The Flex Coordinator provides information and/or best practices to the CAHs as needed. The Flex Coordinator had 14/27 (52%) of CAHs agree to be transparent with their financial data to support sharing and in-depth conversations amongst peer CAHs and continues to encourage transparency with this initiative.

The Flex Coordinator continues to engage CAHs (three per year) to support an in-depth financial/operational assessment. The assessment includes analysis of the ten indicators in the CAH Finance 101 Manual and will enable the creation of an in-depth action plan to address issues in the targeted facilities.

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

The Idaho Simulation Network is providing four annual simulation-based team trainings for CAHs and emergency medical services (EMS) agencies serving CAH communities. These trainings allow for real-time training by implementing progressive scenarios in the field (trauma, ST-Elevation Mycardial Infarction (STEMI) or stroke) and target CAHs actively seeking designation for time-sensitive emergencies. Simulation-based team training incorporates telehealth technology (when applicable), as well as official Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS®) methodology to encourage CAH staff and EMS providers to work as a team to complete the scenarios presented.

In addition, three competitive grant opportunities are being released for CAHs to engage in population health improvement initiatives to support their community health needs assessment (CHNA) and report outcomes at the end of 2019 and again in 2020.

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

The Idaho Healthcare Quality Consortium, which includes the Idaho Flex Program, Hospital Improvement and Innovation Network (HIIN), and the Quality Improvement Organization - Quality Improvement Network (QIO-QIN) Qualis Health, meet monthly to discuss ways to support CAHs/communities in their transition to value-based care. This forum provides an opportunity to discuss challenges CAHs and their communities face and work collaboratively to determine the most appropriate resources available from each agency. 

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

All Idaho CAHs interested in forming cohorts around required or additional MBQIP measures, or the top ten financial and operational indicators, are encouraged to submit a competitive application annually. Every application was reviewed and scored by an impartial Flex Advisory Committee. CAH cohorts are required to establish baseline data and targets for the quality or financial measures to be impacted by their initiative. The information and best practices gathered from these cohorts will inform future trainings and be shared during site visits.

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

The Flex Program Coordinator is participating in the planning committee for the Western Region Flex Conference.

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

The Idaho Flex Coordinator encourages the use of the Critical Access Hospital Measurement & Performance Assessment System (CAHMPAS) tool during every site visit to a CAH. This information provided by FMT helps facilities trend their data over time. Idaho CAHs are reporting their top 10 finance/operational indicators quarterly to the FIP. This allows the Flex Coordinator to strategize efforts to support CAHs through educational topics and grant opportunities. 

The Idaho Flex Program continues to rely on Telligen reports to benchmark and have in-depth discussions with CAHs during site visits to find ways to better support each QI program. The Idaho Healthcare Quality Consortium, which includes the Idaho Flex program, HIIN, and the QIO-QIN Qualis Health, collect data from the CAHs for different measures. These bi-monthly meetings provide an opportunity to discuss CAHs that may need support in a variety of areas and work collaboratively to determine the most appropriate resources available from each agency. 

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


Program Statistics

Type of Government State Government
Staffing 0.9 FTE
Number of CAHs 27
Website URL Organization Website

Flex Program Staff

Mary Sheridan
State Office Director, Idaho
(208) 332-7212

Specialty Areas / Background

Mary is a registered nurse. Her specialty areas include rural emergency medical services, nursing, health care quality, and patient safety.

State Office Director since October 2003 

Stephanie Sayegh
Flex Coordinator, Idaho
(208) 332-7363

Specialty Areas / Background

Stephanie has a M.A. in International Affairs with a focus on socio-economic development. She has supported a variety of health programs in Honduras, Sierra Leone, and Mozambique.

Flex Coordinator since November 2013

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.