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Iowa Department of Public Health

Top Flex Activities

CAH Quality Improvement

Identifying high-performing CAHs:|
The Iowa Flex Program will use the Medicare Beneficiary Quality Improvement Project (MBQIP) reports to identify critical access hospitals (CAHs) with MBQIP measures consistently above established benchmark averages and those displaying a consistent increase in MBQIP performance. These hospitals will be contacted to identify best practices, and resources will be developed around these best practices. A rewards and recognition program will be developed to recognize these CAHs and to encourage other CAHs to achieve high-performing status.

Identifying under-performing CAHs:
The Iowa Flex Program will use the MBQIP reports to identify CAHs with MBQIP measures consistently below established benchmark averages and those displaying a consistent downward trend in MBQIP performance. These hospitals will be contacted and offered various assistance opportunities, including site visits, technical assistance, and peer mentoring. For those hospitals that choose to participate in an assistance opportunity, performance will be assessed before and after the opportunity to identify any changes in performance that may be due to the assistance.

Developing a peer mentor program (i.e., "Ask a Peer" program):
Volunteer CAH staff members from high-performing CAHs will be available to provide technical assistance and advice to under-performing CAHs or to other CAHs that request technical assistance. CAHs will be able to request technical assistance by submitting a request or question via an online form. The Flex Program Coordinator will identify a peer volunteer to provide assistance for the request. The goal of this program is to create collaboration amongst hospitals in the state and to share practices among staff members with similar roles, responsibilities, and expertise. 

CAH Operational and Financial Improvement

Identifying CAHs in need of operational improvement:
CAH operational performance indicators will be assessed, and CAHs in need of operational improvement will be identified. These hospitals will receive in-depth consulting, operational assessments, operational improvement plans, and site visits. Follow-up and tracking will occur on a regular basis to determine the success of the intervention. 

Identifying CAHs in need of financial improvement:
Similar to identifying CAHs in need of operational improvement, CAH financial indicators will be assessed and CAHs in need of financial improvement will be identified and contacted for in-depth consulting, financial assessments, financial improvement plans, and site visits. Follow-up will be performed on a regular basis to measure improvement. 

Providing operational and financial consultation on-demand:
An online form will be created for posting on the Iowa Department of Public Health's (IDPH) website. Using this form, CAHs can request financial and operational assistance, including consulting services, or ask a specific question of a financial and operational subject matter expert. 

CAH Population Health Improvement

Opioid Use Disorder (OUD) prevention, treatment, and recovery:
The Iowa Flex Program surveyed CAHs to determine their current resources and what resources are needed. Using this information, a strategic plan was developed to implement activities to address identified gaps and needs. The Iowa Flex Program will continue this work and will begin assessing which activities from the strategic plan to implement first and will begin implementing these activities. This work is accomplished with Stroudwater Associates and includes regular advisory committee calls, with the advisory committee being composed of Stroudwater and Associates staff, Iowa Healthcare Collaborative staff, IDPH staff, and hospital staff.

Provide Community Health Needs Assessments (CHNA) technical assistance:
The Iowa Flex Program works with the Iowa Healthcare Collaborative to identify CAHs in need of CHNA technical assistance. Iowa Healthcare Collaborative provides technical assistance to CAHs in completing their CHNAs, both in-person and via email/call.

Encourage collaboration with local public health to implement population health activities:
The Iowa Flex Program works with IDPH’s Bureau of Planning Services, who coordinates CHNAs at the local public health level. A readiness survey was sent to CAHs, and those who participate in the survey will be enrolled in a population health project. The goal of this project is to encourage the development of coalitions to address an identified community health need. Coalitions will be composed of the hospital, local public health, and other stakeholders the hospital and local public health identify. The final year of the project will be aimed at  sustainability of the projects, including identification of funding opportunities to support continued work and development (e.g., network development program grant opportunities). Technical assistance for these funding opportunities will be performed by the State Office of Rural Health.

Please provide information about network activities in your state to support Flex Program activities.

The Iowa Flex Program seeks to establish a peer mentor system, where hospitals can network and collaborate with each other. In addition, regional “open office hours” meetings will be conducted, where CAH staff members can ask questions about quality, financial, or operational issues via online form, then schedule a time to meet with quality, financial, or operational consultants who will be available in-person. CAHs with similar issues or questions will be identified and encouraged to work together or share information. 

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 1
Website Organization Website 
Number of CAHs 82

Flex Program Staff

Susan Dixon
Policy and Workforce Services Bureau Chief, Iowa

Susan is the Bureau Chief, Policy and Workforce Services for the Deputy Director's Office.

Samra Hiros
State Office Director, Iowa
(515) 423-7900

Samra Hiros joined the State Office of Rural Health Iowa team in November 2019 and currently serves as the State Office of Rural Health Program Manager. Since 2015, Samra has been serving on the board of the Iowa Rural Health Association (IRHA) and looks forward to continuing to serve this organization in her new role. Samra has a Bachelor of Arts degree in Biology from Grand View University and a Master’s degree in Public Health from Des Moines University. Samra has in-depth knowledge of the provision of patient care, strategic planning, and rural healthcare expertise from her work on the IRHA board as well as previous health care employments. 

State Office Director since November 2019.

Cassie Kennedy
Flex Coordinator, Iowa

Flex Coordinator since April 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, $1,009,121 (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.