State Flex Profile Navigation

Idaho Department of Health and Welfare, 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 27 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:

  • Annual in-person, full-day educational workshop in November and regional workshop in May facilitated by a consultant
  • Two annual webinars focused on benchmarking facilitated by a consultant; high-performing CAHs share their process and strategies for MBQIP required measures
  • On-site technical assistance site visits for all 27 CAHs by the Flex Coordinator
  • The Flex Coordinator works with the state Quality Improvement Organization-Quality Improvement Network (QIO-QIN) to reach out to individual CAHs over the phone and talk through challenges and barriers in their quality program with a focus on MBQIP measures

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

Four CAHs applied for a competitive Idaho Flex Quality Improvement Cohort subcontract to improve processes for emergency department transfer communication (EDTC). All four CAHs went from inconsistent reporting to consistently reporting for the last year and have sustained 100% in all EDTC measures over multiple quarters. They now have their processes “hard-wired” and have used the data to make permanent staffing and contracting arrangements to support abstraction and reporting. 

All Idaho CAHs have received education on all required MBQIP measures and are actively participating in MBQIP. In addition, all CAHs are reporting HCAHPS and EDTC.

Program Area: Support for Financial and Operational Improvement

The Idaho Hospital Association (IHA) has developed software to collect real-time financial data for all CAHs statewide through a Flex-funded initiative, the 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. CAHs use FMT cost report data for trending, and access the most-current financial data from IHA to facilitate benchmarking. The IHA disseminates quarterly data reports to the Flex Coordinator and is working to create meaningful, hospital-specific reports for the CAH Chief Executive Officers (CEOs) and Chief Financial Officers (CFOs) for early 2018.

The Flex Coordinator implements on-site technical assistance site visits with all CAHs, meeting with the CEO/CFO and discussing FMT data and trends, as well as the IHA FIP initiative. 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. Eleven of the 27 CAHs (41%) have agreed to be transparent with their financial data to support sharing and in-depth conversations amongst peer CAHs. The Flex Coordinator continues to encourage transparency with this initiative.

The Flex Program has contracted with a financial consultant to provide a benchmarking webinar on the top 10 financial indicators and one in-person event in the summer of 2018, which will focus on benchmarking data and provide targeted education to address the indicator(s) where Idaho CAHs are underperforming.

Each fiscal year, the Flex Program supports two CAHs in conducting an in-depth financial/operational assessment. The assessment includes analysis of the ten indicators in the CAH Finance 101 Manual and the creation of an in-depth action plan to address issues in the targeted facilities.

All Idaho CAHs interested in forming cohorts around the top 10 financial and operational indicators are encouraged to submit a competitive application annually. Each application is then reviewed and scored by an impartial Flex Advisory Committee. This year, the competitive application was awarded to Clearwater Valley Hospital in Orofino and St. Mary’s Hospital in Cottonwood. This project will focus on improving financial performance, operational efficiency and enhance the experience of care by piloting a scribe project. This team-based care initiative will allow physicians more time to communicate with patients and less time documenting, improving both hospital’s operating margins. The CAH Flex finance cohort is required to establish baseline data and targets for the financial/operational improvement efforts. The information and best practices gathered from this cohort will inform future training and be shared during site visits.

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 provide real-time implementation for progressive trauma, STEMI or stroke scenarios and target CAHs actively seeking designation for time-sensitive emergencies. The training incorporates telehealth technology (when applicable), and uses Team 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.

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

Idaho Flex releases an annual competitive opportunity for all Idaho CAHs to explore health care transformation models. This opportunity allows applicants to develop and implement an innovative health care model that can impact rural health. This competitive application encourages interested CAHs to develop baseline data and measure improvement related to a specific effort around care coordination.

This year, St. Luke’s Wood River was awarded the opportunity to improve population health and outcomes of at-risk patients by funding home-based services to patients with congestive heart failure (CHF) who cannot afford the health care required for optimal outcomes. Telehealth technology and home health nurse visits will be implemented to work to reduce readmissions, unnecessary emergency department (ED) visits and improve specific disease control metrics.

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

The Idaho Healthcare Quality Consortium, which includes the Idaho Flex program, Hospital Improvement Innovation Network (HIIN), and the QIO-QIN, Qualis Health, meet monthly to discuss initiatives, share ideas, avoid duplication, and, whenever possible, explore opportunities for collaboration. This forum provides an opportunity to discuss ways to support CAHs/communities in their transition to value-based care as well as challenges CAHs and their communities face, and work collaboratively to determine the most appropriate resources available from each agency. A number of the MBQIP additional measures align with the HIIN. The Idaho Flex program works to coordinate with the HIIN and the QIN-QIO to avoid a duplication of efforts around MBQIP additional measures.

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

The Idaho 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 Flex Monitoring Team's (FMT) Critical Access Hospital Measurement & Performance Assessment System (CAHMPAS) tool during every site visit to a CAH. Recently, Idaho CAHs have begun reporting their top 10 finance/operational indicators quarterly. 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 MBQIP Data Reports to benchmark and have in-depth discussions with CAHs during site visits to find ways to better support each QI program. The Idaho Flex program and the HIIN will jointly host a regional workshop to showcase HIIN and MBQIP data. This regional event will provide a forum to use this data to build capacity and knowledge around key measures, as well as share best practices for improvement for all Idaho CAHs.

The Idaho Healthcare Quality Consortium, which includes the Idaho Flex program, HIIN and the QIO-QIN collect data from the CAHs for different measures. These 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. 

Program Statistics

Type of Organization State Government
Staffing 1.65 FTEs
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.