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Illinois Critical Access Hospital Network (ICAHN)

Top Flex Activities

CAH Quality Improvement

Quality improvement and reporting strategies remain a top priority for the Illinois Flex Program. After the reporting was suspended during the first wave of the COVID-19 pandemic, the program is focusing on engaging with hospitals to encourage them to return to prior reporting levels. Patient engagement has been a top priority of Illinois CAHs, and has been 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 independent data collection. 

The Illinois Flex Program continues to focus on transitions in care through the creation of Nursing Home Navigator programs meant to engage with long-term care facilities to facilitate efficient transfer communications. These programs will focus on reducing readmissions, improving communication, and increasing the coordination of care as the patient transitions from acute care back to the long-term care setting. 

For the 2021 Flex Grant year, Illinois will be doing the following:

  1. Encourage Illinois CAHs to participate in the Swing Bed Patient Engagement Program, which has been an ongoing project for the Illinois Critical Access Hospital Network (ICAHN). As part of this program, swing bed patient engagement and feedback on their Swing Bed stay will be collected using handheld tablets. This information can be utilized by the CAHs to improve patient experience.
  2. Illinois will coordinate with subject matter experts (SMEs) to provide in-depth training on Medication Safety. After a kick-off webinar to provide training on the data collection process, the hospitals will complete a self-assessment of current practices related to high-alert medications as well as targeted info about opioid prescribing practices. This information will then be used to tailor an educational webinar to address the needs of the hospitals and compare their findings with national benchmarks. This information can be used to identify and prioritize opportunities for process improvement—both at the individual hospital level as well as guiding future Flex initiatives. This activity will be monitored by the number of hospitals participating in the education as well as how many implement changes on  how they handle high-risk medications at their facility. 
  3. The Illinois Flex Program will continue to improve its outpatient departmental quality and productivity benchmarking portal. This portal allows outpatient service departments (currently diagnostic imaging and laboratory) to enter quality data and productivity measures. The departments can then benchmark themselves against other Illinois CAHs. The program allows the departments to download charts and graphs that can then be used in reports to hospital-wide quality groups. This year the Flex program will be working with rehabilitation departments to define quality and productivity measures that are meaningful to their workflows so that they can be integrated into the portal.
  4. The Illinois Flex program has chosen Swing Bed Quality reporting as their Quality Improvement Project for this grant year. The Illinois program is working in coordination with several other states to collect basic information from Swing Bed programs such as length of stay, readmissions, and return to their previous residence. This data is collected monthly, and the aggregated data is shared with the other state programs.
  5. The Illinois Flex program will support the critical access hospitals quality programs by providing targeted QUEST training.  The hospital quality leaders will be educated on multiple quality concepts and tools.  The program will help them devise a quality project, utilize the tools given during the course, and provide technical assistance during the project implementation.

CAH Operational and Financial Improvement

The Illinois Flex Program plans to continue to offer small project grants by focusing on the 15 CAHs on the Federal Monitoring Teams (FMT) CAHs at risk. The project grants will focus on financial and operational improvements to assess and determine appropriate outcomes based on individual facility needs. The Illinois Flex Program will also provide small project awards to assist hospitals in improving operations, conducting community outreach projects identified in the community health needs assessment (CHNA), increasing access to mental health services, supporting local emergency medical services (EMS) through educational awards, and addressing outpatient and emergency department service needs. In addition, funds will provide resources and training on physician documentation and coding, telehealth regulations, revenue cycle management, practice management, and compliance.

ICAHN will continue to offer their 16 different peer network groups where CAH staff members meet via Zoom, either monthly or quarterly, to learn about new ideas, share problems or concerns, and network among peers. ICAHN is continuing to provide a monthly CEO COVID call. This call allows ICAHN to provide regulatory updates as well as allowing the hospitals to share their current policies and discuss COVID challenges. ICAHN continues to offer continuing education and training programs based on identified needs. Accordingly, an advanced practice clinical education is being planned in conjunction with a university provided Simulation lab. The COVID surge continues to challenge the CAHs with the inability to transfer sick patients. Therefore, they must manage these sicker patients for longer periods of time. Patients that previously would have been quickly transferred out to a higher acuity hospital are now being managed by the rural hospital.

For the 2021 Flex Grant Year, Illinois will be doing the following:

  1. Work with a subject matter expert to present a two-day webinar-based training for both hospital and clinic practice staff. This workshop will focus on rural health clinic general coding and billing issues as well as providing updates to evaluation and management (E/M) coding practices. This activity will be measured both by the number of facilities that participate in the workshop as well as by pre and post-workshop surveys to measure learning and the adoption of the best practices implemented by workshop attendees.
  2. Emergency preparedness is important for all hospitals. However, for the past two years, hospitals have been focused on surviving the public health emergency. Therefore, they may not have had the capacity to do a deep evaluation of their non-pandemic emergency preparedness plans. The Illinois Flex program believes it is important to provide training for the hospitals to analyze their current emergency workflows, prepare their response teams and validate their non-pandemic emergency processes. This project will target all critical access hospitals in the state and will be facilitated by the state hospital association.
  3. The care management services certification program continues to be a popular educational program for the Illinois critical access hospitals.  The Flex program continues to support this program by continually updating the educational content as well as providing scholarships for CAH personnel who participate in the class.  This web-based asynchronous training program allows care management practitioners to better understand the regulations as well as how to implement best practices into their hospital’s care management program. The outcome measures will be the number of people trained and the number of care management programs that are created or enhanced in the CAHs.
  4. The Flex program continues to support the Illinois Critical Access Hospital Leader Fellowship program. Currently, this 8-month program has 16 participants from CAHs from around the state. The participants will meet in person as well as participate in twice-a-month Zoom meetings. These meetings will provide in-depth education about the fellowship’s four Core Learning Pillars: Rural Health, CAH Operations, Finance, and Leadership. This will be a deep dive into rural health care and each participant has been assigned a mentor with experience in rural health care leadership. Mentors provide feedback as the fellows complete a project for their health care system or local community. The success of this activity will be measured by the number of participants as well as by feedback from the second class about the fellowship program.
  5. The Illinois Flex program has also created a Rural Physician Leadership program.  This project was a direct request of several hospital CEO’s.  During the initial Spring 2021 cohort, the topics to be covered included communication styles, developing relationships with senior leadership, how the physician impacts the financial health of the hospital, and building effective teams and coaching for improvement.  The course includes both in-person meetings as well as virtual meetings. 

CAH Population Health Improvement

The Illinois Flex Program will provide support for highlighting best practices from CAHs' CHNAs 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 their 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.

For the 2021 Flex Grant Year, Illinois will be doing the following: (1) ICAHN will continue its Clinically Integrated Network project. This project is supporting a CAH as it works with the coalition that has been created in the community to address diabetes in their local population. The pilot hospital has contracted for technical assistance with the Minneapolis Heart Institute Foundation (Heart of New Ulm Project) on how best to encourage community buy-in and support. This project is bringing together the hospital, school districts, local health providers, public health officials, and civic officials. (2) ICAHN will host another statewide workshop for local coalitions on substance use disorders, medical treatment modalities, and support programs. This is a continuation of previous Flex activities. The workshop brings together providers, community-based programs, and knowledge experts. This activity will be measured by the number of CAHs participating in the program.

Rural Emergency Medical Services (EMS) Improvement

The Illinois Flex Program plans to continue efforts to strengthen the CAH stroke readiness program, ST-segment Elevation Myocardial Infarction (STEMI) response times, and provide funding for EMS education and training. The Illinois Flex Program will continue to support the work through the EMS Alliance and partner to provide stroke education.

For the 2021 Flex Grant Year, Illinois will do the following:

Provide funds to the critical access hospitals to partner with their local EMS agencies to promote educational opportunities for the EMS personnel. Projects for this year include providing Prehospital Trauma Life support certification training, hosting a local EMT basics class, and in-depth education on trauma simulators. Other hospitals have chosen to purchase mannequins that will be used by the EMS personnel to practice airway management, advanced CPR training, and the handling of obstetric emergencies.  

Innovative Model Development

ICAHN will identify two more pilot CAHs to develop and implement a Skilled Nursing Home Navigator Program that oversees the coordination of skilled care services of identified Medicare beneficiaries discharged from a CAH and are moved to a skilled nursing facility outside the hospital organization. The previous pilot hospitals will continue working with the Nursing Home Navigator program to strengthen their workflows. The navigator program would connect the primary care office to the Medicare beneficiary’s plan of care. This activity will be evaluated by the best practices and feedback from the participating pilot sites.

ICAHN is partnering with Lilypad to promote the use of the Practice Operations National Database (POND) tool to collect data from Illinois rural health clinics (RHCs) for benchmarking against national results. Lilypad is providing in-depth technical assistance to allow ICAHN to better understand RHCs and to evaluate the quality and financial metrics of the individual clinics for possible targeted assistance next year.

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 five small rural facilities. ICAHN has created several 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, information technology (IT) technical support, 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 program.

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

The Flex program is working on Patient Experience/HCAHPS quality measures for Swing Bed.  The Kansas Flex program is using the same Patient engagement tool.  Plans are to increase the knowledge transfer between the two states about best practices. 

Please describe how your state Flex Program is reaching out to non-traditional partners to support its work.

ICAHN partners with several different nontraditional partners. One of these is McKendree University. This university has created a Master's of Nursing (MSN) program with a concentration in population health. These students are partnered with Illinois CAHs or public health departments to work on population health projects. The Illinois Flex Grant, through several different grant activities, is including Long Term Care (LTC) facilities in the process of implementing better care management for patients that are shared between the LTC and the CAH. Collaboration between these two partners will increase the quality of care as well as decrease unnecessary health care spending. 

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization Non-profit Organization
Staffing (FTE) 1.2
Website Organization Website
Number of CAHs 51

Flex Program Staff

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

Flex Coordinator since July 2019

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, $1,560,000 (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.