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Illinois Critical Access Hospital Network

Top Flex Activities

Program Area: Support for Quality Improvement

Quality improvement and reporting strategies continue to remain a top priority for the Illinois Flex Program. The quality strategy of better health, better care, and lower cost through efforts of the collaboration of the Illinois critical access hospitals (CAH) has led Illinois to be a top state performer as recognized by the Federal Office of Rural Health Policy (FORHP) in 2016 to 2018. Patient engagement has been a top priority of Illinois CAHs and demonstrated by all CAHs currently participating in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores either through an approved Centers for Medicare and Medicaid (CMS) vendor or through their own collection independently. Through Flex dollars, Illinois Critical Access Hospital Network (ICAHN) has improved hospital staff awareness and provided educational sessions in all nine domains of HCAHPS. This was realized with 22 CAHs achieving 4 and 5-Star ratings for HCAHPS scores from MBQIP reporting. Four CAHs presented best-practices on MBQIP reporting, antibiotic stewardship, ED-1, and ED-2 measures.

The Illinois Rural Community Care Organization (IRCCO) will continue focusing on transitions in care through efforts in transfer communication between hospital and long-term care facility and quality of care outcomes through the use of best practice related to congestive heart failure, chronic obstructive pulmonary disease, and pneumonia. New efforts are being explored for increasing market share through the demonstrated efforts of quality of care outcomes and overall sustainability of rural hospitals and providers. Education and training will focus on the utilization and management of the Medicare Swing Bed Program and quality outcomes from the swing bed population. Illinois will continue efforts to improve CAH participation in Get with the Guidelines (GWTG) program through the American Heart Association. Illinois CAHs are demonstrating improved quality outcomes from the 28 CAHs participating in GWTG and required designation as an Emergent Stroke Center by 50 CAHs in Illinois having achieved and sustained designation since 2016.

Program Area: Support for Financial and Operational Improvement

The Illinois Flex Program plans to continue to offer small project grants by focusing on the 12 CAHs on the Federal Monitoring Teams CAHs at risk. The project grants will focus on financial and operational improvements to assess and determine appropriate outcomes based on their individual facility needs. The Illinois Flex Program will also provide small project grants to assist the hospitals in improving operations, improving transitions of care, developing patient-centered medical homes, and addressing outpatient and emergency department service needs. In addition, funds will be provided for the hospitals and their rural health clinics to participate in Quality Health Indicators (QHi) and provide resources and training on physician documentation and coding, revenue cycle management, practice management, compliance, and environmental safety. ICAHN will continue to offer its 16 different peer network groups where CAH staff members meet onsite or by webinar, quarterly to learn about new ideas, share problems or concerns, and network among peers. ICAHN staff will provide technical support and training to help hospitals develop care transition teams and build outpatient and community care management programs. ICAHN also continues to offer clinical continuing education and ancillary service training programs based on identified needs.

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

The Illinois Flex Program plans to continue efforts to strengthen the CAH stroke readiness program, STEMI response times, and provide funding for emergency medical services (EMS) education and training. The Illinois Flex Program will continue to support the work through the EMS Alliance and partner to provide stroke education. In addition, funds will be provided to the ICAHN Board to support its new rural accountable care organization (ACO) through training and education on care coordination, as well as provide support for highlighting best practices from CAH’s Community Health Needs Assessment (CHNA) and implementation strategy development. This will include continued coalition support on the opioid crisis and behavioral health service needs within rural communities. ICAHN highlights best practices from CHNAs throughout our state during workshops, webinars, peer group sharing, and newsletters. The Illinois Flex Program also provides special project funding to assist hospitals in assessing project feasibilities for population health projects, developing chronic care management programs, and providing technical assistance on population health strategies, wellness, and coaching strategies.

Please provide information about Collaboration/Shared Services

The IRCCO is a statewide rural ACO and has 21 CAHs and three small rural hospitals participating in the ACO. IRCCO begins its fifth year as a participant in the CMS Medicare Shared Savings Program and second year in the Illinois Blue Cross Blue Shield ACO. Seventeen other CAHs participate in a system ACO. ICAHN is working in collaboration with an Illinois university on the second year pilot expanding the new rural health worker/health coach model to undergraduate and graduate students to work with two CAHs. This will benefit both the students looking to gain practical experience while receiving course credit, as well as assist the CAHs in addressing population health needs. During the pilot phase, participation is voluntary in the program with 13 students participating. The Illinois Flex Program continues to collaborate and partner with state partners on population health strategies to address the opioid crisis and behavioral health access, as well as, to support community population health needs through special project funding and funding to train coaches

Program Area: Support for Integration of Innovative Health Care Models

The Illinois Flex Program will continue the work originally started regarding the integration of innovative care models. This year, ICAHN will conduct a follow-up readiness assessment to compare findings from year 1 of the grant cycle to identify gaps and opportunities for education and training. ICAHN will also continue to support the development of care coordination in the CAHs. This includes the care coordination work through IRCCO to capture data, best-practices, and outcomes with congestive heart failure and chronic obstructive pulmonary disease. Many of the CAHs in Illinois are continuing efforts to develop wellness strategies and coaching programs to assist both with employee health and that of their community. Through this initiative, ICAHN has worked to develop a Rural Health Coach program with a regional university. This partnership has allowed us to pilot a program from an urban setting into two rural communities. ICAHN is also developing a similar program that will be used with volunteers.

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

ICAHN leverages resources throughout the network by sharing best practices from the top performing hospitals. Through the Illinois Flex Program, 38 CAHs have participated in enhancing or developing their swing bed program. Twelve CAHs began participation in the quality measures related to the swing bed program with all 12 showing improvement in these measures. The addition of quality of care outcome measures will provide the additional piece to support the transition to value-based care close to home. Efforts to assist in the transition to value-based care include the aforementioned patient health outcomes within the swing bed program and additional efforts to improve health outcomes related to chronic disease management of congestive heart failure and chronic obstructive pulmonary disease within the network. Currently, 21 CAHs are engaged in the monitoring of chronic disease management measures and tracking outcomes. Further engagement efforts related to patient satisfaction within both inpatient and outpatient settings has enhanced focus on prevention-based patient services. To date, all CAHs within Illinois participate in inpatient and 10 CAHs in outpatient settings. Efforts to further promote Patient-Centered Medical Home and patient outcomes have provided enhanced methods to engage communities in their health care management and patient-provider alignment. 

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

ICAHN began as a 501(c)(3) not-for-profit corporation in 2003 and now comprises all 51 CAHs, along with six small rural facilities. ICAHN has created a number of cost-effective hospital services based on member need, such as rural recruitment, access to group purchasing, HCAHPS, engagement surveys, external peer review, CHNA, rural nurse preceptor training, rural nurse residency program, wellness coordination and programming, education and training, information technology (IT) technical support, and access to managed care contracting, coding, and other shared services. ICAHN hosts 16 peer network groups and has more than 45 listservs designated to specific management and leadership roles within the hospitals and clinics. ICAHN manages the MBQIP and the QHi program. In June 2014, ICAHN established the IRCCO as an LLC (Limited Liability Company) and submitted a Medicare Shared Savings Program (MSSP) application to CMS, which was approved on November 18, 2014. There are 21 CAHs and three rural hospitals participating in the IRCCO program.

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

Patient Experience/HCAHPS quality measures. More than 25 hospitals in both states participated in a pilot program focused on medication management, discharge planning, and transitions in care. Each participating hospital implemented one of two offered best practices in each domain and shared outcomes, implementation strategies, successes, and hurdles faced during implementation. Ongoing efforts will focus on case management and transitions in care over the next year and bring in Iowa, Florida, Georgia, and North Dakota for voluntary participation.

ICAHN has collaborated with North Dakota for the last two years to improve patient experience in the emergency department. Eleven hospitals have participated in a pilot program to offer patient feedback immediately during their visit in the emergency department by using a tablet and asking 12 questions. This method of surveying has provided a growth of over 60% response rates in patient feedback as compared to the prior mailed survey utilizing the CMS pilot Emergency Department Consumer Assessment of Healthcare Providers and Services (ED CAHPS) tool. Quarterly educational offerings provide sharing of best practices among the pilot hospitals as well as those shared nationally via web research. The results of this collaborative have been offered to the National Rural Health Association and offered at Custom Learning national annual conference. 

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

The Illinois Flex Program has partnered on data to begin to address the opioid crisis and developing a tool on mental health resources. The program has also used high priority goals from the CHNAs to guide programming and share best practices. ICAHN has also worked to develop a quality web portal for CAHs to used better market and use the MBQIP data within their facility. Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) was also utilized to determine hospitals of focus for targeted financial assessments.

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

Yes

Program Statistics

Type of Organization Non-profit Organization
Staffing 1.6 FTEs
Number of CAHs 51
Website URL Organization Website
 

Flex Program Staff

Pat Schou
Executive Director, Illinois
(815) 875-2999
Laura Fischer
Flex Coordinator
815-875-2999

Flex Coordinator since July 2019

Angie Charlet
Director of Quality Services, Illinois
(815) 875-2999
Matt Comerford
ICAHN Operations Coordinator, Illinois
(815) 875-2999

Specialty Areas / Background

  • Grant administration
  • Project development

Operations Coordinator since April 2004 

Julie Casper
Center for Rural Health Program Coordinator, Illinois
(217) 782-1624

Specialty Areas / Background

  • Grant writing
  • Grant project administration
  • Rural policy

Public Administrator since February 1999 

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.