Illinois State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

The Illinois Flex Program will continue efforts to encourage critical access hospitals (CAHs) to improve scores in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), as currently all CAHs have contracts with an approved HCAHPS vendor or are collecting independently. The CAHs are reporting in the Medicare Beneficiary Quality Improvement Project (MBQIP).

The Illinois Critical Access Hospital Network (ICAHN) is assisting hospitals in expanding their HCAHPS programs, increasing reporting and improving overall scores to include stroke and ST-Elevated Myocardial Infarction (STEMI) response times, emergency department transfer communication measures and vaccination compliance, with a goal of 90 percent participation. A best practice identified by the CAHs for improved vaccination rates from top performing hospitals included enforced policies and immunization carts with necessary forms and equipment. ICAHN will work with CAHs to increase participation in HCAHPS and develop customer service strategies to improve scores with a focus on response rates, teach back methods, strategies to improve quietness, and scripting with discharge. ICAHN is also working with the CAHs to improve participation in Get with the Guidelines program and assist the CAHs in efforts to maintain Emergent Stroke Center designation.

As of 2016, all of the CAHs in Illinois are designated. Education and training will focus efforts on managing swing bed programs and gathering quality measures. The Illinois Rural Community Care Organization (IRCCO) will be focusing on improving transitions of care from the CAH to other healthcare settings in order to improve patient outcomes.

Please share a success story about reporting quality data or using quality data to help Critical Access Hospitals (CAHs) in your state improve patient care: 

The Illinois Flex program supports the 51 CAHs and four small rural facilities in reporting quality data and using quality data to improve patient care. This year three of the facilities were recognized by the National Rural Health Association (NRHA) as Top Performers for CAHs. Mason District Hospital in Havana, Illinois was in the Top 20 for Best Practice in Patient Satisfaction and Sparta Community Hospital in Sparta, Illinois and St. Joseph’s Hospital in Highland, Illinois both ranked in the Top 20 for Best Practice in Quality. 

ICAHN uses best practices from the state's top ranking hospitals to identify best practices and resources to share in the network. Through these efforts with the Illinois Flex Program, ICAHN was able to provide immunization carts, an identified best practice, to 20 hospitals to assist in their efforts with employee immunizations to improve overall compliance. The Illinois Flex Program also supports the improvement of critical times for stroke and STEMI, as well as reporting of data. All 51 CAHs along with the two who have applied for CAH status have received the Illinois Stroke Center designation. Through the support of a Stroke and STEMI expert, Illinois CAHs are below the state goal of 60% of achievement of door-to-needle timeframes of 60 minutes.

Program Area: Support for Financial and Operational Improvement: 

The Illinois Flex Program plans to continue to offer 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 will focus on transitional care delivery, customer service, financial improvement, and population health/disease management. In addition, funds will be provided for the hospitals and their rural health clinics to participate in a benchmarking system and provide resources and training on physician documentation and coding, revenue cycle management, practice management series and environmental safety. ICAHN will continue to offer its 16 different peer network groups where CAH staff members meet quarterly, onsite or by webinar, 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 new rural EMS Alliance, developed through Flex dollars. ICAHN plans to offer small project grants to encourage hospital initiatives in population and disease management, as well as fund an EMS Community Care Navigator pilot. 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 the community health needs assessment (CHNA) and implementation strategy development.

Please provide information about Collaboration/Shared Services (specifically connected to population health management): 

IRCCO, a new statewide rural ACO, has 23 CAHs participating and one small rural hospital, which is in its second year of a Medicare Shared Savings Program. Seventeen other CAHs participate in a system ACO. ICAHN is also working to improve collaborative relationships with local colleges and universities by developing a pilot rural health worker/health coach model. 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. ICAHN is also working to address the opioid crisis in Illinois by assisting the CAHs to develop partnerships and develop local coalitions to begin to address substance abuse in rural communities.

Program Area: Support for Designation of CAHs: 

ICAHN did not request funding for designation assistance; however, ICAHN provides ongoing support to small hospitals as needed to convert to CAH status. Right now, two small rural hospitals are still seeking CAH designation but have yet to be approved after two years in review.

Program Area: Support for Integration of Innovative Health Care Models: 

The Illinois Flex Program plans to support financial and operational transition to value-based models and healthcare transformation models in the health care system. ICAHN is working with the CAHs to assess innovative health care models designed to have a positive transformational impact on rural health. Through IRCCO and ICAHN, efforts are being made to develop and pilot an emergency department patient satisfaction survey program, to address educational programming for self-management for patients with chronic diseases, to develop health and wellness programs for employees and the community, and to assist in the development of a rural community health worker or health coach.

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

The Illinois CAHs are transitioning to value-based care in many areas as indicated in the iVantage report for the Top 100 CAHs. Twenty Illinois hospitals are mentioned for financial, 16 for quality, 21 for patient perspective and 12 for patient outcomes. ICAHN leverages resources throughout the network by sharing best practices from the top performing hospitals. Through the Illinois Flex Program, ICAHN has also been able to work with a consultant to further develop efforts for its swing bed service line. The Illinois CAHs now have a swing bed manual and have identified quality metrics for tracking and reporting purposes. The hospitals will begin collecting data in 2016 in an effort to improve collaborations with larger facilities by sharing the value of their services with patient care outcomes and assist community members in receiving care closer to home.

Please provide information about network activities in your state to support Flex Program activities (such as financial improvement networks, CAH quality networks, operational improvement with CEOs or EHR workgroups): 

The 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, HCAHPS, external peer review, CHNA, rural nurse preceptor training, 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. ICAHN manages the MBQIP and the benchmarking system program. In June 2014, ICAHN established the IRCCO as an LLC and submitted a Medicare Shared Savings Program (MSSP) application to the Centers for Medicare & Medicaid Services (CMS), which was approved on November 18, 2014. There are 23 CAHs and one rural hospital participating in the IRCCO program. In addition, Illinois CAHs will have an opportunity, through IRCCO, to participate in Blue Cross Blue Shield's Intensive Medical Home/care coordination program, beginning April 2015.

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

Through the Illinois Flex Program, ICAHN is working with Wyoming, Nebraska, North Dakota and California to collaborate on best practices for emergency department transfer communications (EDTC), as well as working on an Emergency Department Consumer Assessment of Healthcare Providers and Services (ED CAHPS) project with North Dakota.

From the last Flex Program year, please describe a best practice you would like to share with other states: 

ICAHN has been able to add a Clinical Informatics Specialist to assist with coding and billing support for the CAHs. The Clinical Informatics Specialist has assisted in developing coding and billing workshops as well as peer coding audits. Outside audits can be expensive for the hospitals, but necessary so the coding does not become subjective without periodic outside analysis and feedback. Five hospitals worked together to develop a solution by establishing the audit criteria, sampling size and developing audit teams. The only cost associated with this peer review was the time away for their facility to conduct the audit, which was offset in the end by all the cost-savings of this process. The Illinois Flex Program was also able to assist with 20 coding audits with the participants from the coding workshop.

Program Statistics

What type of organization is your Flex office housed in?: 
Non-profit
What is the number of full time employees (FTE) in your Flex office?: 
1.60
How many CAHs are in your state?: 
51
Do you have any hospitals interested in converting to CAH status?: 
Yes

Additional Information

Flex Program Staff

Pat Schou
Executive Director, Illinois
(815) 875-2999
Mary Jane Clark
Flex Coordinator, Illinois
(309) 331-4472

Flex Coordinator since September 2016

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.