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Illinois Critical Access Hospital Network (ICAHN)

Top Flex Activities

CAH 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 Illinois critical access hospitals (CAHs) collaboration, has led Illinois as a top state performer, recognized by the Federal Office of Rural Health Policy (FORHP) in 2016 to 2019. 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 their own collection independently.

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. 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 the Get with the Guidelines (GWTG) Program.

For the 2019 Flex Grant year, Illinois will be doing the following:

  1. Promote all Illinois CAHs to participate in the Swing Bed Quality Improvement Program, which has been an ongoing project for the Illinois Critical Access Hospital Network (ICAHN). A Swing Bed Quality Manual was created and updated with the current regulations during the last Flex cycle. Swing Bed patient engagement and feedback will be collected using tablets or paper. This information can be utilized by the CAHs to improve the patient experience. Educational webinars about the changes in current swing bed regulations will be created and distributed to all CAHs. This activity will be measured both by the number of hospitals participating in the program as well as the change in patient engagement scores over time as the swing bed programs implement best practices.
  2. Illinois will continue to support the CAHs' participation in the Get with the Guidelines (GWTG) Stroke Program. Flex dollars will be used to help defray the cost to the hospitals for the GWTG subscription. ICAHN’s subject matter expert (SME) will continue to produce monthly webinars and stroke newsletters. The SME will also provide technical assistance to the CAHs to help maintain their emergent stroke readiness status. This activity will be monitored by the total number of hospitals that maintain their stroke designation as well as monitoring the change in common stroke benchmarks such as “Door to CT time”.
  3. The Illinois Flex Program will work with CAHs and their local nursing homes to promote the use of Care Transition Huddles. These huddles will facilitate the communication process and coordination of patient treatment plans as they are transferred from nursing homes to CAHs. This activity will be monitored by the number of hospitals that are committed to using Care Transition Huddles as part of their workflow. 

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, revenue cycle management, practice management, compliance, and environmental safety. ICAHN will continue to offer thier 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. Additionally, ICAHN staff will provide technical support and training to help hospitals develop care transition teams and build outpatient and community care management programs. ICAHN continues to offer clinical continuing education and ancillary service training programs based on identified needs.

For the 2019 Flex Grant Year, Illinois will be doing the following:

  1. Present a three-day coding boot camp for both hospital and clinic and practice staff, presented by a SME. This workshop will focus on general coding and billing issues as well as topics that are specific to rural healthcare providers. 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 shown during the workshop.
  2. Sponsor training programs to help CAH facilities managers prepare for and take the exam to become certified in Facilities Management. This training has been requested by multiple hospitals over the years and will increase the knowledge and the engagement of facilities personnel at the hospitals. This activity will be measured by the number of people that participate in the workshop
  3. Acare management services certification program will be created for rural providers and a pilot program will be implemented. Toolkits and manuals will be created and distributed to the pilot programs. Program training will be either in-person or through a series of webinars. 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.

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 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.

For the 2019 Flex Grant Year, Illinois will be doing the following: (1) ICAHN and Illinois Hospital Association will work to develop a pilot program to create community worker programs for CAH. Community health workers are specially trained, community-based support people who support patients with issues navigating the health care system as well as other community-based support services. This activity will be measured both by the number of workers trained but also by the robust implementation of community healthcare workers into the services provided by the CAHs participating in the pilot programs; (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 2019 Flex Grant Year, Illinois will do the following:

  1. ICAHN will award flex money to interested CAHs to participate in an Active Shooter Training Program. The hospital can use the money to cover registration costs, training gear, and other educational materials needed to participate in the program. This activity will be measured by the number of people participating in the drills at the various hospitals. Hospitals that participate will be asked to share information learned on the ICAHN list-serv so that other CAHs can evaluate their own programs.
  2. Illinois will partner with the Illinois Department of Public Health (IDPH) EMS Division and regional EMS directors to conduct a rural EMS assessment for the state.

Innovative Model Development

ICAHN will identify two pilot CAHs to develop and implement a Skilled Nursing Care 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 navigator program would connect the primary care office to the Medicare beneficiary’s plan of care. During the first year of this program, the activity measurement will be based simply on the number of patients that are part of the pilot program. 

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 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, 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. In June 2014, ICAHN established the IRCCO as an Limited Liability Company (LLC) 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.

The Fles program is working 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 for asking 12 questions. This method of surveying has provided 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, as well as at Custom Learning national annual conference. 

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, during the course of their studies, 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
Flex Coordinator, Illinois

Flex Coordinator since July 2019

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, $1,009,121 (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.