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Montana Hospital Association, Quality Improvement Division

Top Flex Activities

Program Area: Support for Quality Improvement

The Montana Flex Program encourages public quality reporting through:

  • Quarterly Medicare Beneficiary Quality Improvement Project (MBQIP) calls
  • Weekly MBQIP Messages
  • MBQIP Report Cards to hospital administrators and quality improvement staff
  • State-based comprehensive MBQIP manuals with updates
  • Statewide Quality Improvement Studies (QIS) for Healthcare Worker Immunizations, Emergency Department Transfer Communications and Inpatient Immunizations
  • MBQIP to Outcomes (M2O) Program for additional quality improvement projects

The Montana Flex Program conducts statewide QIS that are designed to be high-level improvement projects. Critical access hospitals (CAHs) throughout the Montana Performance Improvement Network (PIN) are asked to commit to providing baseline and remeasurement data for the studies. The Montana Flex Program develops improvement tools and resources specific to the project measures in a toolkit format for Montana CAHs to use as appropriate in their facilities.

The Montana Flex Program uses the M2O Program for additional quality improvement projects. Annually, a cohort of 10-15 Montana CAHs completes a facilitated, targeted improvement project that integrates quality coordinator education, Lean methods and statewide networking using the foundational elements of a rapid improvement project or kaizen event. By request of the CAHs, the fiscal year (FY) 2017 project will revisit care transitions, measuring improvement by the care transitions related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures and hospital readmission rates.

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.

Currently, 36 of 48 Montana CAHs are enrolled in the Center for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN), with a majority of those in the Flex/Hospital Innovation Improvement Network (HIIN) User Group. This user group is set up within NHSN so that the two Montana programs (both housed at the Montana Hospital Association) can have real-time access to data submitted that is related to the two programs. The Montana Flex Program monitors healthcare worker immunization and can pull the data nearly five months before it becomes available in MBQIP Data Reports. The Montana Flex Program and HIIN are also able to monitor and access facility surveys for activities related to preparation for antibiotic stewardship.

In Montana, 45 of 48 CAHs have an HCAHPS Vendor. Of the remaining three CAHs, two are Indian Health Services facilities with a similar required survey and the other CAH has one inpatient admission per year.

After completing two cycles of M2O Projects, 18 facilities have completed all project requirements:

  • Participated in five webinars
  • Attended a full day workshop
  • Submitted a poster-ready value-stream map and A3 report
  • Provided both baseline and remeasurement data

Hospitals participating in the first M2O project focused on HCAHPS care transitions showed significant improvement (between 14-21%) on six of the seven HCAHPS questions used to measure performance.

Program Area: Support for Financial and Operational Improvement

Lean internships have been a cornerstone of the Montana Flex Program for many years. Up to eight hospitals are accepted for a two-week rapid improvement project conducted by Montana State University (MSU) Industrial Engineering students in the summer. The students work in conjunction with hospital stakeholders to apply their knowledge of Lean principles and tools to complete an improvement project of the facility’s choice within a two-week period. Participation in the project provides the opportunity to work on the following activities:

  • Target a specific improvement event identified by the facility
  • Involve project stakeholders in an organized, problem-solving process utilizing Lean methodologies
  • Provide a real-world learning experience for MSU students
  • Utilize outside expertise to rapidly complete an improvement project

Over the past eight years, Lean projects have included inventory/supply chain management, charge capture, staff scheduling, food service/dietary systems, admission/registration processes, patient wait times and workflow.

In FY 2017, the M2O program format was modified to fit in the financial arena in a Finance to Outcomes (F2O) Cohort. This cohort participated in an intensive improvement project focused on the reduction of claims denials. The project incorporated Lean coaching, regional workshops, homework requirements and webinars in the process of project completion. Projects, results, successes and lessons learned are shared throughout the network of CAH finance staff.

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

In FY 2015, the Montana Flex Program developed a pilot project with the Montana Department of Public Health & Human Services (MT DPHHS) EMS and Trauma Systems to identify a trauma measure, design a performance improvement project around the measure and share lessons learned and outcomes with trauma-designated facilities across the state. The FY 2015 project focused on processes to develop and bill trauma team activation fees and critical care charges. The financial impact of this project has been significant and was repeated on a regional basis with a cohort of 14 other trauma designated hospitals in FY 2016. The next level of this project is to offer provider to provider education on proper documentation of critical care charges.

The Montana Flex Program actively collaborates with the Montana Office of Rural Health to support up to eight CAHs' efforts to develop community health needs assessment implementation plans. Implementation plan data is analyzed through the development of a global report to identify areas of need for additional resources.

Please provide information about Collaboration/Shared Services.

The Montana Flex Program is working with MT DPHHS Chronic Disease Prevention and Health Promotion staff to develop a population health management project for a cohort of CAHs. Employee health plan members will be the targeted population for the project. Six CAHs are serving as a pilot group. These hospitals are working with regional DPHHS local health educators in developing a sustainable and impactful wellness program, following the Wellness Council of America (WELCOA) benchmarks.

The Montana Flex Program is part of a unique collaboration to address multiple needs for antibiotic stewardship assistance and to align various programs and efforts throughout the state. The Montana Antimicrobial Stewardship (ABS) Collaborative is a group effort to create a statewide Antimicrobial Stewardship Program (ASP) implementation plan. The goal is to collaborate, assist and offer resources, expertise and tools through multiple programs for use by Montana inpatient and outpatient facilities. Montana ABS Collaborative members include the Mountain-Pacific Quality Improvement Organization (QIO), Montana Flex Program, MT HIIN, MT DPHHS and University of Montana Skaggs School of Pharmacy.

Program Area: Support for Integration of Innovative Health Care Models

The Montana Flex Program has partnered with the Montana Medical Association to develop a rural health care team leadership program with the intent of integrating hospital leadership staff, trustees, medical staff, clinic staff and public health staff. CAH Chief Executive Officers (CEOs) completed self-assessments based on the CAH Blueprint for Performance Excellence Framework to determine readiness for value-based care. From the results, a gap analysis was conducted and program content developed to address identified needs with the help of an advisory group. The goal is to develop multidisciplinary, integrated leadership teams which can lead change and shape a future that ensures enduring, high quality, accessible health care for their community. Education sessions are scheduled to begin in March 2018.

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

The work towards the transition to value-based care will begin with the Montana Flex Innovation Project, which will tie together hospital leadership and staff, clinics, public health and community stakeholders.

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

All Montana Flex activities are coordinated through the PIN which is comprised of all 48 CAHs. Network activities are supported through a PIN listserv, website and regional meetings. This grant year, the primary focus is on cohort work; having hospitals with similar needs work on projects and share project results and processes with the PIN.

The Montana Flex Program is also collaborating with CAH financial officers to expand a financial improvement network.

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

Montana Flex, along with the HIIN, developed a user group in NHSN that CAHs can join so Montana Flex and HIIN have immediate access to influenza summaries, influenza surveys and facility surveys for antibiotic stewardship. This user group has enabled both programs to use the data submitted on a timely basis. In the case of health care worker immunization, CAHs have performance data from last year to use for targeted improvements. No additional reporting is required for CAHs!

With the availability of raw data from the Federal Office of Rural Health Policy (FORHP), Montana Flex has also developed state-based reports that trend MBQIP data each quarter and compare the CAHs to their peer group as well as state and national levels.

Program Statistics

Type of Organization State Government
Staffing 3.5 FTEs
Number of CAHs 48
Website URL Organization Website

Flex Program Staff

Kristin Juliar
State Office Director, Montana
(406) 994-6003
Jack King
Flex Coordinator, Montana
(406) 457-8016

Specialty Areas / Background

Jack is the Flex Program Director at the Montana Hospital Association and has an extensive background working with critical access hospitals (CAHs), rural health networks, telemedicine and grant project development and management.

Flex Coordinator since July 2017

Leslie Howe
Flex Program Manager, Montana
(406) 444-9519

Specialty Areas / Background

Leslie has worked for the State of Montana Department of Public Health and Human Services since 2000 and has extensive experience working with a variety of community based service programs and state facilities. She is skilled in team-building, meeting planning, report writing and quality improvement.

Flex Program Manager since March 2015

Jennifer Wagner
Flex Program Specialist
(406) 442- 1911, ext. 100

Flex Program Specialist since November 2012

Jamie Schultz
Rural Hospital Quality Coordinator
(406) 442-1911, ext 102

Rural Hospital Quality Coordinator since September 2014

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.