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Nebraska Health and Human Services

Top Flex Activities

Program Area: Support for Quality Improvement

The Nebraska Flex Program uses the Baldrige framework for improving quality and the overall performance of critical access hospitals (CAHs). This model is used because it emphasizes the importance of leadership in changing the culture of the organization and improving communication at all levels. There is also a strong focus on customer satisfaction and measuring results. Nebraska's key activities for quality improvement are:

  • Support CAHs participating in the Medicare Beneficiary Quality Improvement Project (MBQIP)
  • Continue to support the training and implementation of Capture Falls within the CAHs
  • Conduct mock surveys
  • Support participation of CAHs in an annual quality conference in Nebraska

Program Area: Support for Financial and Operational Improvement

Good financial performance is also based on the elements in the Baldridge framework. For example, good leadership and open communication throughout the organization will enhance both operational and financial improvement. Nebraska's key activities within this area are:

  • Provide training and education to CAHs on Lean management techniques, including an online version of the course (new in 2017)
  • Provide technical assistance on the implementation of Lean projects
  • Conduct comprehensive financial and operational assessments for low or negative margin CAHs

Once the financial and operational assessments are completed, a tracking system is developed to assess the progress and changes in meeting the recommendations contained in the report. Follow-up visits are made to determine progress and any additional technical assistance needs.

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

The Nebraska Flex Program is supporting strategies that will lead to a strong regional system of care for patients who need immediate treatment for a heart attack. The Office of Emergency Medical Services (EMS) is working with key stakeholders to develop a statewide cardiac plan to improve the outcomes of ST-segment elevation myocardial infarction (STEMI) patients. When the plan is completed, the office will:

  • Work with stakeholders to set target goals for implementing strategies
  • Provide technical assistance to help the community achieve the target goals
  • Evaluate the implementation activities to determine if the target goals have been achieved

The Office of EMS collaborated with the Wisconsin Flex Program to survey all EMS units in the state (over 400). With a high response rate, the office now has a comprehensive report of training and technical assistance needs for Nebraska EMS units. Planning is ongoing to meet these needs in the coming year.

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

The Nebraska Office of Rural Health hosts an annual Rural Health Conference, which targets health providers at all levels. The agenda includes several sessions focusing on value-based care and the transition process.

Nebraska participated in a Learning Collaborative with the Technical ssistance and Services Center (TASC) to learn more about value-based care and the transitions needed. A survey was sent out to all state CAHs and rural health centers to gauge where they at on this journey and to determine technical assistance needs. Plans are underway to provide strategic planning and value-based care training during the current grant year.

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

The Nebraska Flex Program uses five CAH networks which range in size from seven to 26 members. The networks consist of CAHs and one larger regional or urban hospital. The networks hold regular meetings with member CAHs to share information and identify technical assistance needs. Each network has one to two network coordinators that lead the process. The network coordinators all participate in quarterly network coordinator meetings facilitated by Flex staff. The purpose of these meetings is to network, share best practices and information, and identify technical assistance needs. 

The Nebraska Flex Program sponsors the Quality Steering Committee to monitor all things quality. Regular meetings are held to review current data submissions, identify technical assistance needs, and share best practices.

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

Several of the CAH networks include member hospitals from bordering states. These CAHs participate in network activities.

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

MBQIP data is distributed to all CAHs each quarter. Network Coordinators and CAH quality improvement staff are using this data to guide training and educational activities. Individual CAHs compare their quarterly data to monitor quality improvement.

The Nebraska Flex Program is currently in discussion with NeHii to look at developing an MBQIP Dashboard for use by CAHs.

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


Program Statistics

Type of Organization State Government
Staffing 1.0 FTE
Number of CAHs 64
Website URL Organization Website

Flex Program Staff

Margaret Brockman
State Office Director, Nebraska
(402) 471-6057

Specialty Areas / Background

Margaret Brockman joined the Office of Community & Rural Health in July 2013. As a registered nurse, she has been employed in both rural and urban hospitals.She has experience in Medicaid, Patient Centered Medical Homes, Nursing Education, Certified Case Manager, Certified Occupational Health Nurse, commercial insurance, workers compensation and as a private business owner of a healthcare consulting firm.

State Office Director since July 2014

Nancy Jo Hansen
Flex Coordinator, Nebraska
(402) 471-4616

Specialty Areas / Background

Nancy Jo Hansen joined the Office of Community and Rural Health in December, 2014. Prior to joining the Rural Health Team, she spent 20+ years working in the field of HIV prevention and health promotion. Nancy Jo served as a team member of the HIV Prevention Program at Nebraska Department of Health and Human Services where she worked closely with community members and local public health agencies. Nancy Jo also served as the Program Coordinator for the HIV Prevention Program at the Nebraska Department of Education where she worked with local school personnel to develop HIV prevention curriculum.

Flex Coordinator since December 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.