New Hampshire State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

In FY 2016 the New Hampshire Flex Program's focus is on providing technical assistance and information to critical access hospital (CAH) quality improvement (QI) staff on collecting and reporting Medicare Beneficiary Quality Improvement Project (MBQIP) outpatient measures. As of the close of FY 2015, 100 percent of CAHs were reporting patient safety, patient engagement and care transition measures. A staff member is dedicated to assisting the CAHs to report MBQIP measures and to identify and act on opportunities for improvement. The Flex Program also directly trains new CAH staff on data collection, using the Centers for Medicare & Medicaid Services (CMS) Abstraction and Reporting Tool (CART), the Emergency Department Transfer Communication (EDTC) Data Collection Tool and accessing the National Healthcare Safety Network (NHSN).

The Flex Program provides quarterly MBQIP benchmarking charts to the CAH Chief Executive Officers (CEO)/Presidents showing each CAH's data compared to each of the other New Hampshire CAHs. In order to facilitate CAH process improvements, the Flex Program provides quarterly MBQIP reports including run charts of each measure with comments identifying trends and shifts in the data over time, and potential opportunities for improvement. The usefulness of this report will be evaluated using a CAH staff feedback tool, as well as monitoring the MBQIP measures' performance over time.  

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: 

At one CAH, the staff who had submitted the MBQIP outpatient measures left out hospital employment. No one knew how to collect and report the measures. The Flex Program staff includes a Rural Health QI Coordinator; this staff person was able to provide on-site training to six CAH staff at their convenience. The training included:

  • Specifications for the outpatient measures
  • How to locate the patient information needed from electronic health record (EHR) reports they had on hand
  • Step by step instructions for entering data into CART
  • How to submit data files to QualityNet

The Flex staff member rewrote existing CART instructions to be a step by step, easy to follow process that the CAH staff were able to use and practice in CART on the spot. The CAH staff completed a Technical Assistance and Information evaluation tool with positive results.

Program Area: Support for Financial and Operational Improvement: 

Through the program's principle subcontractor, and in coordination with the NH Rural Health Coalition (a working group of CAH CEO/Presidents and the New Hampshire Foundation for Healthy Communities), CAH leaders will attend MACRA training. This training will be followed up with several days of on-site consultation to implement the Merit-based Incentive Payment System (MIPS). CAH financial leaders and other applicable staff will also attend "Medicare Bootcamp" with a goal of using this information to improve the revenue cycle. The Flex Program will evaluate these activities with participant evaluations of learning needs met, and new processes implemented.

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

The primary focus of support for Financial and Operations Improvement in FY 2016 is training on MACRA followed by on-site consultation to implement MIPS.

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 Flex Program works closely with the New Hampshire Rural Health Coalition including monthly meetings to share critical information, obtain feedback from CAH CEO/Presidents and participate in shared decision making regarding the support provided by the Flex Program.

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

The New Hampshire Flex Program is a member of the New England Performance Improvement Network (NEPI). NEPI brings together the Flex Programs in New Hampshire, Vermont, Maine and Massachusetts to collaborate on shared support of New England CAHls. The support has focused on QI and operational improvements by providing online-based educational opportunities.

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

The addition of a dedicated QI staff person is a best practice for the program year. Having a Rural Health QI Coordinator builds ongoing capacity inside the State Office of Rural Health (SORH) and streamlines the technical assistance process for our CAHs. There is one contact for reporting and measures questions, and that same contact person provides in-person training and technical assistance, as well as customized reports back to each CAH.

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

Alisa Druzba
State Office Director, New Hampshire
(603) 271-5934

Specialty Areas / Background

  • Primary care access
  • Primary care workforce development
  • Population health
  • Statewide health systems
  • Oral health
  • Logic models

State Office Director since May 2006

Alia Hayes
Flex Coordinator, New Hampshire
(603) 271-2286

Flex Coordinator since May 2017

Marie Wawrzyniak
Rural Health Quality Improvement Coordinator, New Hampshire
(603) 271-1093

Rural Health Quality Improvement Coordinator since August 2016

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.