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Missouri Department of Health and Senior Services

Top Flex Activities

Program Area: Support for Quality Improvement

In order to achieve the objectives in this area, the Missouri Flex Program has contracted with the Missouri Hospital Association (MHA) to offer technical assistance. MHA offers technical assistance for the Medicare Beneficiary Quality Improvement Project (MBQIP), utilizing webinars, conference calls, in-person training, regional training, and one statewide training annually. 

MHA has built a dashboard for critical access hospitals (CAHs) that promotes MBQIP and utilizes quality data for improvement activities. Each hospital has the ability to look at aggregate performance as well as the most current performance averages for the state and nation on the dashboard. The data collected has been used to drive performance improvement in a variety of ways. Low performing hospitals are contacted in regards to the identified gaps and MHA works with them to help address best practice strategies. Furthermore, regional meetings are hosted and attendees actively participate and network with others who might be struggling in the same areas. Additionally, increased reporting for MBQIP measures has been the main focus and continuous improvement has helped increase the number of hospitals reporting on such measures. 

Program Area: Support for Financial and Operational Improvement

The Missouri Flex Program has subcontracted to MHA to offer technical assistance in this area.

MHA has completed a three-year project to provide each Flex participating CAH with a Financial/Operational Assessment performed by BKD. Additionally, Flex funds were used to support a CAH Swing Bed Analysis performed by PYA, which compared swing bed performance against skilled-nursing facility (SNF) bed performance for costs, length of stay (LOS), and outcomes over a 90-day episode.

The CAH Chief Executive Officer (CEO) Network meeting helps guide the financial activities for a select cohort of hospitals that need assistance.

Program Area: Support for Population Health Management and Emergency Medical Services Integration 

The Missouri Flex Program contracts with MHA to conduct population health activities such as providing education and health prevention activities based on common community health issues identified, including developing and distributing chronic care management toolkits and works with participating CAHs to develop and implement strategies. In addition, MHA developed a comprehensive population health assessment survey tool to help gauge where each hospital is in their transition to a value-based environment.  

The survey covered nine categories: leadership, patients and community, workforce, finance, data and technology, operations, legal/regulatory, outcomes, and policy/advocacy. The results were tabulated and mapped to a maturity scale comprised of five categories: Pre-Foundational 1, Pre-Foundational 2, Foundational, Proficient, and Transformational. Furthermore, additional individualized reports were developed indicating overall performance for each of the nine categories and identified each CAH’s position on the maturity scale.  

These results were shared with each hospitals leadership to help them better understand the necessary tools and resources, interventions, and targeted support that is needed to close the gaps identified. Key strategies were also developed to deploy in relation to the category, where they landed on the population health maturity scale. Missouri also participated in the Transition to Value Learning Collaborative through the National Rural Health Resource Center where CEOs completed a survey that provided us with results that we have started utilizing to help close those gaps identified around population health management.  

Please provide information about Collaboration/Shared Services 

Missouri recently participated in a Flex Transition to Value Learning Collaborative through the National Rural Health Resource Center and CEOs responded to a survey that provided us with information that will help us identify the tools and resources that they will need to close the identified gaps. The results have been shared with CEOs and other Flex MBQIP contacts. A collaborative was formed to work with an organization in the southeast region of the state around diabetes.   

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

MHA offers a wide variety of training opportunities for the hospitals. The Flex Program supports these training opportunities for the CAHs.

MHA Quality and Health Improvement page

MHA Events Calendar

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

MHA hosts a CAH CEO Network meeting monthly. This forum is used to identify needs of the CAHs and decide what activities the Missouri Flex Program should focus on. Additionally, three regional meetings are hosted in the spring and fall, and CAHs are also encouraged to attend the Annual Flex Meeting in August that encompasses a variety of topics that include quality and financial improvement. 

Please describe how your state Flex Program has enhanced its use of data in the past year.

Along with utilizing the resources available to all Flex Programs such as the MBQIP Data Reports, FMT and the Critical Acces Hospital Measurement and Performance Assessment System (CAHMPAS), the Missouri Flex Program, through the contract with MHA, has aligned resources with MHA's Quality Improvement Unit which can analyze MBQIP data. MHA has access to the financial and operational data reporting by the hospitals and other resources to make the Flex dollars stretch further. 

Do you have any hospitals interested in converting to CAH status?:


Program Statistics

Type of Organization State Government
Staffing 5.0 FTEs
Number of CAHs 36
Website URL Organization Website

Flex Program Staff

Kathryn Metzger
State Office Director

Began in March 2019

Specialty areas/background: Chronic Disease Prevention and Management, Community and Coalition Building, Social Determinants of Health, Food Policy, Program Evaluation, Epidemiology, Homeland Security, Emergency Management and Planning, Public Information, Health Communication, and Data Visualization

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.