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Montana Department of Public Health and Human Services

Top Flex Activities

Program Area: Support for Quality Improvement

The Montana Flex Program encourages public quality reporting through Quarterly Quality Calls, weekly Medicare Beneficiary Quality Improvement Project (MBQIP) emails, Montana-based manual in printable format, and on the Montana Flex Performance Improvement Network (PIN) website.

To directly impact improvement and provide education, the Montana Flex Program has two formats. The first is the Quality Improvement Study (QIS) designed to be high-level improvement. Critical Access Hospitals (CAHs) throughout the Montana 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. To further this work for FY 2018, the Montana Flex Program is working with Cynosure Health to support CAH participation and performance in MBQIP through a combination of regional workshops, interactive webinars and best practice toolkits to address challenging topics and themes.

The second format used by the Montana Flex Program is called MBQIP 2 Outcomes (M2O). Annually, a cohort of 10-15 Montana CAHs complete a facilitated, targeted improvement project that integrates quality coordinator education, Lean methods, and statewide networking using the foundational elements of a rapid improvement project. The FY 2018 project will be focused on the outpatient cardiac measures. Previous projects have involved patient satisfaction of care transitions, emergency department (ED) throughput, and patient satisfaction of nursing communication.

In addition to these touchstone projects, the Montana Flex Program and Hospital Improvement Innovation Network (HIIN) programs are partnering with the National Association for Healthcare Quality (NAHQ) to offer a 2-day Certified Professional in Healthcare Quality (CPHQ) Live Preparation Course for up to 20 participants from Montana Hospitals. Also, for those in need of more basic training, one-year access to NAHQ’s HQ Solutions for healthcare quality fundamentals will be offered.

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 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 2018, the Montana Flex Program will contract with subject matter experts (SMEs) to provide state-wide education on CAH Financial Indicators (as identified by the CAH Financial Leadership Summits), ways to improve and develop a timely data source for these indicators.

The Montana Flex Program will also look at CAH owned and operated rural health clinics (RHC) financial health, develop a cohort, and implement a project to provide an assessment on applicable indicators for RHCs and provide strategies and interventions on improvement for RHC operations.

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

The Montana Flex Program will pilot a Community Mental Health First Aid (MHFA) training program in two CAH communities. Trainings will involve all community stakeholders, not just CAH staff, to develop pathways and relationships between primary points of contact for those in need of assistance. The Montana Flex Program is inviting the CAH to take the lead on the project by reaching out to the stakeholders, hosting the training, and gathering the partners at the conclusion of the training to decompress and share resources. In addition, after each training, a community resource guide will be developed and provided to all.

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 (CHNA) implementation plans. Implementation plan data is analyzed through the development of a global report to identify areas of need for additional resources.

Progress is on track for all six CAHs participating in the Department of Public Health and Human Services (DPHHS) worksite wellness project. More sites will be added in the new grant year and two more evidence-based worksite wellness programs will be offered that will support wellness policies: Chronic Disease Self-Management Program and Walk with Ease. Both programs are 6-weeks in duration.

The Montana Flex Program and DPHHS Emergency Medical Services (EMS) and Trauma Systems will be working on a Community Paramedicine activity with the formation of a Community Health EMS (CHEMS) Coalition. A national facilitator will work with community stakeholders on organization and development of a strategic plan. Work groups will be developed on specific parts of the plan and quarterly meetings held.

The Montana EMS Sustainability Project will include comprehensive community surveys completed by a subcontractor using a tool developed in the previous grant year. Data will be collected during surveys and from an online survey tool and at regional meetings. The survey results will supply supporting data so a strategy can be developed to meet challenges to sustainability for rural Montana EMS services.

Please provide information about Collaboration/Shared Services 

The Montana Flex Program is part of a unique collaboration to address multiple needs for antibiotic stewardship assistance and to align various programs 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 and RHCs (new this year). Montana ABS Collaborative members include DPHHS, the Montana Flex Program, Montana Health Improvement Innovation Network (HIIN), Mountain-Pacific Quality Health Quality Innovation Network-Quality Improvement Organization (QIN-QIO), and the University of Montana Skaggs School of Pharmacy.

Training for the Community Mental Health First Aid is courtesy of a collaboration between two Montana Area Health Education Centers (AHEC) directors certified as Mental Health First Aid trainers.

The Mworksite wellness project is part of a collaboration with local health educators.

Program Area: Support for Integration of Innovative Health Care Models 

Over the last couple of years, the Montana Flex Program offered the Rural Health Leadership Effectiveness Program, which tied together hospital leadership, staff and boards. This program wrapped up in FY 2017 and will be evaluated in FY 2018 to determine what changes may be needed to increase the effectiveness.

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

As part of the “Trustee Track” at the annual MHA convention/conference, a session was provided titled “Preparing CAHs for the Future” which provided strategies and interventions for all CAHs in preparation for the eventual implementation of value-based payment models.

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

All Montana Flex Program activities are coordinated through the PIN which is comprised of all 48 CAHs. Network activities are supported through a PIN listserv, website and regional/statewide meetings. The Montana Flex Program focuses primarily on cohort work; having hospitals with similar needs work on projects and share project results and processes with the entire PIN.

Please provide information about cross-state collaborations you may be working on related to the Flex Program.

The Montana Flex Program recently met with Flex Coordinators from Oregon, Idaho, and Wyoming to have a preliminary conversation about the potential development of a shared Board Education and Trustee Development that could be shared among the Flex Programs.

The Montana Flex Program has also had conversations with the Idaho Flex Program to consider collaboration with a Montana-based Tertiary System that has provided a common IT platform in select Montana CAHs and some Idaho CAHs. The intent of the collaboration would be to help address common platform issue relative to improving the collection and reporting of the MBQIP data.

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

The Montana Flex Program, along with the HIIN, has a user group in the National Healthcare Safety Network (NHSN) to allow immediate access to influenza summaries and facility surveys. This user group has enabled both programs to use the data immediately. This has been valuable for efficiency in getting projects running but also in the ability to monitor submissions and provide reminders so there are no missed deadlines. Of the 48 CAHs, 38 are members of the NHSN user group.

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


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 Health Research and Education Foundation (MHREF), a division of the Montana Hospital Association. Jack has an extensive background working with critical access hospitals (CAHs), rural health networks, telemedicine, and grant project development and management. MHREF is the primary contractor to the state-designated awardee for Flex Program activities.

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 (DPHHS) 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. Montana DPHHS is the state-designated awardee of Flex Program funding.

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.