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Iowa Department of Public Health

Top Flex Activities

CAH Quality Improvement

Creating Medicare Beneficiary Quality Improvement Project (MBQIP) reports:

The Iowa Healthcare Collaborative (IHC) has partnered with the Iowa Department of Public Health (IDPH) to provide quality improvement activities as part of the Iowa Flex Program. IHC has developed hospital-specific MBQIP reports that include graphs and provide hospitals insight on how performance compares to other hospitals, both nationally and statewide.

IHC offers free training opportunities to hospitals. This year, four webinars were offered to CAHson reporting updates, quality improvement best practices, quality improvement ideas, infection prevention and control, NHSN, antibiotic stewardship improvement measures, and HCAHPS survey scores. In addition, a series of NHSN Quick Take 5-minute videos, led by an infection prevention subject matter expert, were developed. These videos walked the user through various aspects of navigating the NHSN reporting system. Ongoing technical assistance is provided to Iowa CAHs through check-in calls, site visits, and emails.   

CAH Operational and Financial Improvement

Identifying CAHs in need of operational improvement:

HomeTown Health has partnered with IDPH to provide financial and operational improvement activities as part of the Iowa Flex Program. CAH operational performance indicators are assessed, and CAHs in need of operational improvement are identified. These hospitals receive in-depth consulting, operational assessments, operational improvement plans, and virtual or in-person site visits. Follow-up and tracking 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 are assessed, and CAHs in need of financial improvement are identified and contacted for in-depth consulting, financial assessments, financial improvement plans, and virtual or in-person site visits. Follow-up is performed on a regular basis to measure improvement.

Providing operational and financial technical assistance:

HomeTown Health has developed listservs around various topics Iowa CAHs can opt into. These listservs assist participating CAHs by allowing hospital personnel to ask questions to the listserv members and receive advice or best practices from their peers. In addition to financial and operational improvement webinars and workshops, HomeTown Health has developed a series of peer-podcasts, providing on-demand financial and operational improvement discussions for subject matter experts and peer Iowa hospital financial leaders.

CAH Population Health Improvement

The Iowa Healthcare Collaborative (IHC) partnered with IDPH to provide three virtual webinars, led by a subject matter expert, that addressed and explained the step-by-step process for completing the Community Health Needs Assessment for Charitable Hospital Organizations - Section501(r)(3). The education series, as is the case with all Iowa Flex Program training, are available for viewing on-demand.  Following the webinar series, additional community planning and engagement resources and tools were developed to support this priority area of interest. This included a community action planning checklist, logic model, and template. To support a fluid transition into a priority population health focus area, two modules on social determinants of health were incorporated into one pre-recorded webinar for CAHs.

Provide Community Health Needs Assessments (CHNA) technical assistance:

The Iowa Flex Program works with IHC to identify CAHs in need of CHNA technical assistance. IHC provides technical assistance webinars to assist CAHs with CHNA development.

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

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.

Wanda Hilton, Ed.D, CHES
Flex Coordinator, Iowa
(515) 322-9708

Specialty Areas / Background

Wanda Hilton joined the Iowa Department of Public Health in July 2021, as the Rural Hospital Flex and SHIP Program Coordinator. She brings 12 years of experience teaching public health and health education courses in higher education in South Dakota, Pennsylvania, and Iowa, and 7 years of public health experience in state government at the Nebraska Health & Human Services System (NHHS), Minnesota Department of Health, and Iowa Department of Public Health. Wanda also served as a Program Development Consultant for Des Moines Area Community College in helping create four new associate degree health programs in Health & Public Services on the Ankeny Campus. In the county where she resides, Wanda serves on the Warren County Board of Health. Wanda received her Bachelor of Science degree in Psychology from South Dakota State University, and both a Master of Arts degree in Health and a Doctorate of Education in Adult & Higher Education from the University of South Dakota. Wanda grew up near a certified Critical Access Hospital in Winner, SD, and she feels passionate about helping to promote good health in rural communities.

Flex Coordinator since July 2021

Susan Dixon
Policy and Workforce Services Bureau Chief, Iowa
(515) 218-2183

Susan leads the Iowa Department of Public Health, Bureau of Policy and Workforce Services (PWS). Bureau staff support the internal IDPH workforce, Iowa’s Health Care workforce as well as rural and primary care initiatives in Iowa. The bureau focuses on Public Health Policy, Rural Health and Primary Care, Designation of Health Professional Shortage Areas (HPSA) in Iowa, Certificate of Need, Administrative Rules, Department COOP/COG planning and IDPH Human Resources support.  Prior to leading the PWS Bureau, Susan filled leadership roles at the Iowa Department of Homeland Security and Emergency Management, the Rebuild Iowa Office, and the Iowa Department of Natural Resources.  Susan received her B.S. in Environmental Science from Iowa State University, a Master of Public Administration from Drake University, and a Master of Arts in Security Studies from the Naval Postgraduate School, Center for Homeland Defense and Security. 

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, $1,560,000 (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.