Montana State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

Montana encourages public quality reporting through a weekly Monday Medicare Beneficiary Quality Improvement Project (MBQIP) Message, a comprehensive MBQIP manual with updates, quarterly MBQIP calls and MBQIP Report Cards for hospital administrators and quality improvement staff.

The state also conducts Statewide Quality Improvement Studies (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. Ideally, this data is available to the Montana Flex Program through existing MBQIP reporting. The Montana Flex Program develops improvement tools and resources specific to the project measure in a toolkit format for the PIN to use as appropriate in their facilities. The Montana Flex Program has developed a QIS for Healthcare Worker Immunizations and Emergency Department Transfer Communications. Quality Improvement Coordinators from the PIN were asked for input in targeting specific project improvement measures.

MBQIP To Outcomes (M2O) has been designed as a rapid improvement project and integrates quality coordinator education, Lean coaching and project management with a targeted performance improvement project. Improvement is measured with existing MBQIP data. Projects for FY 2016 will be an outpatient and HCAHPS measures, chosen by Quality Improvement Coordinators based on opportunity for improvement in measures with higher volumes.

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: 

In 2016, the Montana Flex Program received data for the first time about healthcare worker influenza immunization rates in Montana CAHs. Eighteen hospitals reported data and the data was shared with CAH quality staff at regional meetings across the state in the fall. Participants expressed concern about the rates and the potential impact on patient care, as well as a desire to improve these rates. Since sharing this data, 36 hospitals have registered to participate in a statewide quality improvement study in this area. The reporting, benchmarking and sharing of this data clearly demonstrated an opportunity for improvement and inspired participation in an improvement project.

Program Area: Support for Financial and Operational Improvement: 

Lean Internships have been a cornerstone Flex project 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:

  • 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 seven 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.

A cohort of 11 hospitals was formed in FY 2015 to target improvement in a financial area. A healthcare financial consultant was engaged and facility-specific improvement plans were developed and implemented. Improvement activities are continuing in FY 2016 and project outcomes will be used to identify additional areas for improvement.  The cohort will be expanded to include additional participants and grow the network.

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

In FY 2015, the Montana Flex Program developed a pilot project with Montana State 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 effect of this project has been significant and in FY 2016 this will be repeated on a regional basis with other trauma designated hospitals interested in participating in the project.

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 implementation plans. Implementation plan data is analyzed to identify areas of need for additional resources.

Please provide information about Collaboration/Shared Services (specifically connected to population health management): 

The Montana Flex Program is working with Montana Department of Public Health & Human Services (MT DPHHS) Chronic Disease 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. The project is currently in the planning and development phase.

Program Area: Support for Integration of Innovative Health Care Models: 

The Montana Flex Program is partnering with the Montana Medical Association to develop a rural healthcare team leadership program, integrating hospital leadership staff, trustees, medical staff, clinic staff and public health. This project is in the early phases and is currently conducting CAH CEO self-assessments, based on the CAH Blueprint for Performance Excellence framework, to determine readiness for value-based care. A gap analysis from the survey results will be conducted and program content will be developed to address identified needs. The goal is to develop multidisciplinary, integrated leadership teams which can lead to change and shape a future that ensures enduring, high quality, accessible health care for their community.

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 (such as financial improvement networks, CAH quality networks, operational improvement with CEOs or EHR workgroups): 

The PIN is a long-time established network for performance improvement in Montana. All Flex Program activities in the state are coordinated through the PIN which is comprised of all 48 Montana 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, sharing the results and processes with the PIN. The Montana Flex Program is also collaborating with CAH financial officers to expand a financial improvement network in the coming year.

From the last Flex Program year, please describe a best practice you would like to share with other states: 

The Montana Flex Program began working closely with the Hospital Engagement Network (HEN) last year. Opportunities to share resources were identified and implemented, including providing support for CAH quality staff to attend HEN workshops. This support was provided for CAHs that were not HEN participants and for workshops with content applicable to MBQIP measure improvement. The collaboration between the two programs has leveraged available resources and strengthened a more comprehensive approach to quality improvement for the CAHs. Duplication of efforts has been reduced and understanding of CAH needs has increased. The Montana Flex Program will continue to collaborate with Hospital Improvement Innovation Network (HIIN, formerly HEN) in the coming year on related projects.

Program Statistics

What type of organization is your Flex office housed in?: 
State Government
What is the number of full time employees (FTE) in your Flex office?: 
How many CAHs are in your state?: 
Do you have any hospitals interested in converting to CAH status?: 

Additional Information

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.