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Illinois Critical Access Hospital Network

Top Flex Activities

Program Area: Support for Quality Improvement

The Illinois Flex Program supports 51 critical access hospitals (CAHs) and four small rural hospitals in reporting quality data and using the collaborative efforts of everyone to improve patient care. Quality improvement and reporting strategies continue to remain a top priority for the Illinois Flex Program.

  • Patient engagement has been a top priority for Illinois CAHs. All CAHs in the state are currently participating in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), either through an approved Centers for Medicare & Medicaid Services (CMS) vendor or through their own independent collection. With Flex dollars, the Illinois Critical Access Hospital Network (ICAHN) has improved hospital staff awareness and provided educational sessions in all nine domains of HCAHPS. As a result, 17 Illinois CAHs achieved 4 and 5-star ratings for HCAHPS scores from Medicare Beneficiary Quality Improvement Project (MBQIP) reporting
  • Focus areas requiring ongoing attention include discharge planning, transitions in care and medication management as part of a comprehensive approach to quality of care outcomes. The Illinois Rural Community Care Organization (IRCCO) will focus 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 utilization and management of the Medicare Swing Bed Program and quality outcomes from the swing bed population
  • Ongoing efforts to improve CAH participation in Get with the Guidelines program have resulted in improved quality outcomes within 25 CAHs. Since 2016, all 51 Illinois CAHs have achieved and sustained Emergent Stroke Center designation

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

ICAHN recognized hospitals in four areas for 2017 quality awards. Categories and number of awarded hospitals included: 

  • Commitment to advancing quality of care outcomes as demonstrated by participating in all four domains of MBQIP (27 CAHs)
  • Top performance over two quarters in any domain as demonstrated by >95% quality score (33 CAHs)
  • Most improvement over four quarters in any one measure/domain (11 CAHs)
  • Achieving 4-Star rating in HCAHPS/Patient Experience (10 CAHs)
  • Achieving 5-Star rating in HCAHPS/Patient Experience (7 CAHs)

Program Area: Support for Financial and Operational Improvement

The Illinois Flex Program offers small project grants through a juried process to the hospitals so that they can implement new and/or further develop their internal programs and community outreach. The project grants focus on transitional care delivery, customer service, financial improvement and population health/disease management. In addition, funds are 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 series and environmental safety. 

ICAHN offers 16 different peer network groups in which CAH staff members meet quarterly onsite or via webinar to learn about new ideas, share problems or concerns, and simply network among peers. ICAHN staff provide technical support and training to help hospitals develop care transition teams and build outpatient and community care management programs. ICAHN also offers 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 and ST-Elevated Myocardial Infarction (STEMI) response times, as well as provide funding for emergency medical services (EMS) education and training. The Illinois Flex Program supports the work of the EMS Alliance to offer stroke education.

Illinois Flex will also support the ICAHN Board's new rural accountable care organization (ACO) through training and education on care coordination, community health needs assessment (CHNA) and implementation strategy development. ICAHN highlights best practices from CHNA findings throughout Illinois during workshops, webinars, peer group sharing and newsletters.

Please provide information about Collaboration/Shared Services

The Illinois Rural Community Care Organization (IRCCO) is a statewide rural ACO, with 21 CAHs and three small rural hospitals participating. IRCCO begins its fourth year as a participant in the CMS Medicare Shared Savings Program (MSSP) and first year in the Illinois Blue Cross Blue Shield ACO. Seventeen other CAHs participate in a system-based ACO. 

ICAHN is working in collaboration with a state university to pilot a new Rural Health Coach model with two CAHs. This effort will assist the CAHs in addressing population health needs, as well as benefit the students looking to gain practical experience while receiving course credit.

In addition, ICAHN has been able to use Flex funds to support statewide educational efforts to address the opioid crisis by offering two education workshops – one for clinicians and the other for local rural coalitions.

Program Area: Support for Designation of CAHs

ICAHN provides ongoing support to small hospitals as needed to convert to CAH status. One small rural hospital continues its appeal efforts through the courts for CAH designation and a new small rural hospital has inquired about CAH designation. The rural hospital appears to meet the greater than 35-mile distance requirement and is waiting for final financial analysis of CAH designation.

Program Area: Support for Integration of Innovative Health Care Models

Building wellness efforts within the CAHs has been another focus of the innovative health care models. ICAHN is providing technical support, training, and collaboration among hospitals on wellness efforts. Hospitals are training Wellcoaches, developing employee and community wellness efforts, and exploring opportunities to partner with community employers on wellness initiatives. Two Illinois CAHs are working on a pilot project with a regional university and ICAHN to develop a Rural Health Coach program. This project has become a win for all partners involved, and a replicable model for the state is in development. 

The Illinois Flex Program continues to work to develop innovative solutions for CAHs. ICAHN is working collaboratively on the Emergency Department Consumer Assessment of Healthcare Providers and Services (ED CAHPS) project discussed under cross-state collaborations below.

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

Illinois leverages resources throughout ICAHN 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. The addition of quality of care outcome measures will provide additional support for the transition to value-based care close to home. 

Efforts supporting transitions in care communication between long-term care and CAHs have initiated new innovative models of communicating patient care delivery that allows for a continuous transition in care without interruption. New communication tools will be piloted among eight CAHs and over 30 nursing homes to identify best practices and continuity of care.

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 four 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
  • External peer review
  • CHNA
  • Rural nurse preceptor training
  • Wellness coordination and programming
  • Education and training
  • 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 for specific management and leadership roles within the hospitals and clinics. ICAHN also manages MBQIP and the QHi program. In June 2014, ICAHN established IRCCO as an LLC and submitted a 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.

Through the Illinois Flex Program, ICAHN has collaborated with the Indiana Flex Program to enhance the 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, and 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 to the emergency department by using a tablet and asking 12 questions. This method of survey has provided a growth of over 60% response rates in patient feedback as compared to the prior mailed survey utilizing the CMS pilot ED CAHPS tool. Educational offerings on a quarterly basis provide best practices shared 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 the Custom Learning national annual conference.  

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

Data efforts continue to improve as more information becomes accessible. ICAHN utilizes quality reports to assist the hospitals in identifying best practices and areas of opportunity for improvement. The Illinois Flex Program collects and analyzes data from a variety of sources to enhance program efforts.

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


Program Statistics

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

Flex Program Staff

Pat Schou
Executive Director, Illinois
(815) 875-2999
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.