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NH Department of Health and Human Services

Top Flex Activities

CAH Quality Improvement

The New Hampshire Flex Program showed an overall improvement in the critical access hospitals' (CAHs) Mediare Beneficiary Quality Improvement Project (MBQIP) scores and in the number of measures reported. Efforts from the New Hampshire (NH) Flex Program included providing training and technical assistance directly at the hospital sites, and having ongoing access to Flex program staff for “help desk” type reporting and data analysis questions.

CAH Operational and Financial Improvement

During Flex Years 2018-2019, the New Hampshire Flex Program is continuing to use a contractor to address claims denials. The nine participating NH CAHs are submitting their denied claims to a portal where they are analyzed to determine why they were denied. Monthly phone calls are held to discuss the trends found across all payors and all hospitals to reduce the number of claims denied.

Rural Emergency Medical Services (EMS) Improvement 

The New Hampshire Flex Program Coordinator is currently working with the Bureau Chief for EMS to design and implement a workforce survey to gather data that can improve recruitment and retention of EMS providers.

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

New Hampshire Flex Program activities are implemented through the Rural Health Coalition, which allows the program to share critical information and obtain feedback from CAH Chief Executive Officers (CEOs) and Presidents regarding the direction for Flex funding. The Rural Health Coalition meets at the Foundation for Healthy Communities and the New Hampshire Hospital Association, which allows the New Hampshire Flex Program to learn of current initiatives involving New Hampshire hospitals.

The Flex Coordinator participates in the New Hampshire Stroke Collaborative to stay informed of efforts to move toward a stroke system of care and keep New Hampshire CAHs informed of any information and activities that may be beneficial for, or affect them. The Flex Coordinator also attends the Trauma Medical Review Committee meetings to stay updated on the trauma system in New Hampshire and relay pertinent information to the New Hampshire CAHs.

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

The New England Performance Improvement Program (NEPI) is a four-state collaborative that consists of Maine, Vermont, New Hampshire, and Massachusetts. The goal of the collaborative is to coordinate technical assistance to CAHs and other rural healthcare providers in the New England States and surrounding areas to improve quality of care and performance.

A diverse list of needs were identified by CAHs from each state. The most pressing need affecting all states was the recruitment and retention of staff by providing training to either enhance their roles through skill development, or to prepare them for new roles within their institutions. NEPI participants defined the group activities to be included for CAHs, Rural Health Clinics (RHCs), and EMS providers associated with CAHs and/or rural municipalities, the following NEPI objectives were defined:

  1. Provide timely and responsive technical assistance and training to CAH, RHC, and EMS staffs.

  2. Conduct annual process to identify training(s) based on commonalities found in the four states’ needs assessments. Choose trainings to be provided based on highest needs and funds available.

  3. Consider the Institute for Healthcare Improvement (IHI) as a likely service delivery option.

  4. Continue to provide reimbursement for certifications that improve relevant job skills.

  5. Measure outcomes as behavioral or skill changes defined in the offerings.

  6. Use a vendor to complete administrative tasks.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 2.35
Number of CAHs 13

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, $1,009,121 (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.