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Minnesota Department of Health - Office of Rural Health and Primary Care

Top Flex Activities

CAH Quality Improvement

Minnesota’s 78 critical access hospitals (CAHs) have a strong history of public reporting, although it has been observed that reporting is not always consistent. In order to support Minnesota’s CAHs and strive towards consistent and accurate reporting, Stratis Health will be providing ongoing technical assistance with a focus in three key areas: reporting support; Emergency Department Transfer Communication (EDTC) Performance Improvement; and Patient Saftey/Inpatient/Outpatient Performance Improvement.

To supplement these Quality Improvement (QI) activities, Stratis Health and the Minnesota Hospital Association (MHA) are leading a collaborative effort in hosting in-person events for CAH quality staff. Best practices and challenges collected from the EDTC and Patient Safety/Inpatient (IP)/Outpatient (OP) improvement activities will be featured at these in-person events, along with covering topics in Stratis Health’s Continuous Quality Improvement curriculum. Quality improvement technical assistance will also be available to Minnesota CAHs through Stratis Health.  

CAH Operational and Financial Improvement

The Minnesota Flex Program has several initiatives in 2020 that are designed to provide opportunities for CAHs to better understand their market position and strategize for future success.  

It comes as no surprise that revenue cycle performance improvement continues to be a major priority for hospital finance, and data remains critical to understanding the effort required to best support sustainable operations. To this end, the Flex program will continue to provide an annual charge comparison benchmark report that ensures appropriate pricing levels, CAH Financial Indicator Reports (CAHFIR), and pull key performance indicators from existing reports while supplementing them with most current data available.  These data resources reduce the leaders' need to gauge performance by precedent which can overlook improvement areas or leave operations under-resourced. In addition, this year they are expanding the report to include diagnostic related group (DRG) charges.   

Other endeavors with this activity include: an assessment is schedule that links participating CAHs' business requirements with quality measures utilized by the Centers for Medicare and Medicaid Services (CMS) in the value-based purchasing program; MHA partnering with Flex staff to develop a data model to aid leaders in this venture; and contacting 78 CAHs to assess telehealth and telemedicine usage in the form of a survey to provide a snapshot of patient acceptance of this emerging technology. 

Additionally, a new chief financial officer (CFO) affinity group is under development to provide a network in confidential peer advisory forums for the purpose of discussing business challenges. This network will be able to analyze their organizational data and collaborate on tools and resources. A webinar will be offered to review key findings in the data and a platform to kick off the discussion.  

These dynamic undertakings are expected to improve efficiency, lower cost, increase patients served, and positively impact operations.  

CAH Population Health Improvement 

The Minnesota Flex Program is working with subcontractors who will be working closely with cohorts of CAHs on population health improvement in their communities over the next five years. Up to sixteen CAHs throughout Minnesota will be participating in the population health assessment and planning, which will help kick-start or advance their population health activities.  

During year-one, participating CAHs will go through readiness assessments to gauge their internal capacity to engage in population health efforts as well as identifying community partners with which to collaborate.  

Following year-one, participating CAHs will be involved in a variety of activities to move them towards the implementation and assessment of population health initiatives. These activities will be concentrated around building strategies to prioritize and address community needs and engage community members to implement community health solutions. Successes and stories from those participating in the five-year process will be shared in a way that will benefit others who are working towards population health improvement. 

Rural Emergency Medical Services (EMS) Improvement 

Greater Northwest Emergency Medical Services (GNWEMS) and Stratis Health are continuing to lead a collaborative arrangement to facilitate the development of emergency medical services (EMS) feedback process and form. The project’s objective is to establish a communication loop from pre-hospital patient interaction, to the local CAH emergency department, to the tertiary care center, back to the local emergency department (ED), and finally back to the initial pre-hospital EMS agency. This pilot project is focusing on trauma and stroke patients  and will be expanded to include ST-elevation myocardial infarction (STEMI) and Sudden Cardiac Arrest. Since the start of the project, it has expanded to include hospitals and EMS agencies in the southwest region of Minnesota, doubling the number of participants. 

In 2015-2016, the Minnesota Flex Program conducted a survey to assess the sustainability of rural EMS agencies. In response to the findings from that survey, the EMS Regulatory Board is conducting individual assessments of one rural ambulance service in each of Minnesota’s rural EMS regions. These surveys provide detailed assessments, recommendations, and technical assistance to help improve the sustainability of rural ambulance services.  

In addition, early groundwork is beginning on the development of a technical assistance center/cooperative to provide tailored assistance, to services that complete the on-site survey to help them implement needed changes.   

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

The Minnesota Flex Program encourages cohorts of hospitals to work together in projects such as those highlighted above. However, because most CAHs are part of hospital systems or have historically established, well-run networks, the Minnesota Flex Program participation in network development or maintenance is not a high priority. 

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) Not provided

Organization Website

Number of CAHs 78

Flex Program Staff

Zora Radosevich
Flex Director, Minnesota
(651) 201-3859

 Flex Director since April 2018

Emma Distel
Flex Coordinator, Minnesota
(651) 201-3528

Flex Coordinator since November 2018

Tim Held
Rural Health System Development Unit Supervisor/Deputy Director, Minnesota
(651) 201-3868

Specialty Areas / Background

Trauma system coordination

Craig Baarson
Reimbursement Fiscal Analyst, Minnesota
(651) 201-3840

Specialty Areas / Background

Reimbursement and finance

Rose Christensen
Office Administrative Assistant, Minnesota
(651) 201-3852

Office Administrative Assistant since October 2018

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.