Indiana State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

Indiana's Medicare Beneficiary Quality Improvement Project (MBQIP): 

  • Aids critical access hospitals (CAHs) in publicly reporting specific inpatient and outpatient measures to Hospital Compare as well as reporting on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient assessment of care survey measures and emergency department transfer communication (EDTC) measures. This allows for improvements to health care service, processes and administration
  • Provides technical assistance to CAHs to implement quality improvement (QI) initiatives to improve patient safety scores, HCAHPS scores, EDTC scores and outpatient scores

Indiana also provides CAH Quality Education Programs focused on quality improvement and leadership development.

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: 

Indiana's CAHs' commitment to improving patient care is evidenced by their reporting data. Compared to all other CAHs nationally, Indiana’s CAHs reported at a rate that was higher for inpatient measures (97.1 percent vs. 84.7 percent nationally) and outpatient measures (77.1 percent vs. 50.7 percent nationally). Indiana’s CAHs rank 13th for inpatient measure reporting and 7th for outpatient measure reporting among the 45 states participating in the Flex Program. Compared to scores for all other CAHs nationally, from Q2 2014 through Q1 2015, Indiana’s CAHs have significantly better scores on seven process of care measures, significantly worse scores on seven measures, no significant differences on 19 measures and insufficient data to compare 5 measures.

Program Area: Support for Financial and Operational Improvement: 

Indiana will focus on the following initiatives:

  • Annual conference on financial improvement and hospital operational topics for CAHs to discuss their financial and operational needs and share best practices among peers
  • Fifteen CAHs participating in Studer Group Rural Collaborative Coaching Model (RCCM)
  • Fifteen CAHs participating in process improvement and rapid improvement event trainings
Program Area: Support for Population Health Management and Emergency Medical Services Integration: 

CAH community health needs assessments (CHNA) are reviewed annually and analyzed to identify specific health needs of CAH communities. The CHNAs help provide a brief overview of the hospital and allows the Flex Program to have some knowledge in advance while talking to hospitals.

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

The Indiana State Office of Rural Health is working with CAHs and local first responders to develop community paramedicine payment models to be introduced to the Centers for Medicare & Medicaid Services (CMS).

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 Flex Quality Network Council meets every other month via webinar to provide CAH quality staff updates on MBQIP, share best practices and provide updates from the quality improvement organization (QIO).

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

The Indiana Flex Program subcontracts to provide a project designed to grow health care systems that achieve operational excellence evidenced by consistent, affordable quality care. The  three-year program begins with leadership development. Projects will be selected based on organizational strategic goals and needs. Executive champions and teams will be identified and trained within the first year. The subcontractor will provide assistance with project selection through process improvement completion that impacts care and quality measures. Year Two will grow the leadership's capacity to understand value streams for a systems approach to improvement projects and align with organizational goals through training and assistance provided through improvement project completion. Year Three will formalize the improvement process to achieve operational excellence. Improvement initiatives will be developed by leadership and prioritized using organizational goals, leading to improved health care outcomes.

This project leverages the significant investment previously committed to process improvement initiatives within Indiana CAHs. In addition, it is estimated that over 100 CAH staff will participate in Lean Six Sigma green and yellow belt training and projects each year. The goal of this project is to build organizational structure and support that encourages, requests and requires project initiatives that improve quality, lower costs and align with organizational goals through:

  • Leadership Training
    • Strategic planning, value stream management, operational excellence
    • Aligning improvements and strategic planning
  • Building improvement capacity, champions
    • Lean Six Sigma yellow and green belt certifications
    • Project coaching 
  • Encouraging collaboration and connectivity among CAHs in Indiana

Program Statistics

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

Additional Information

Flex Program Staff

Ann Alley
State Office Director, Indiana
(317) 233-7451

Specialty Areas / Background

  • Health care
  • Housing
  • Economic development

State Office Director since July 2009

Abigail Garcia
State Office Manager, Indiana

State Office Manager since February 2017

David Conrad
State Flex Coordinator, Indiana

State Flex Coordinator since February 2017

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.