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NH Department of Health and Human Services

Top Flex Activities

CAH Quality Improvement

The New Hampshire (NH) Flex Program has an integrated quality improvement coordinator who has built relationships with the New Hampshire critical access hospitals (CAHs) over the last five years. Engagement with the CAHs has led to high levels of reporting as well as overall improvement in measures. In addition, hospitals have participated in focused quality improvement projects in exchange for small stipends. Training and technical assistance is also available onsite for hospitals, and all staff have access to a Flex “help desk” for reporting and data analysis questions. 

CAH Operational and Financial Improvement

The New Hampshire Flex Program is working with a contractor to provide the Clinical Documentation Improvement (CDI) project. Sixteen webinar-based modules are available to clinical coding specialists at all thirteen NH CAHs and continuing education credits are associated with each session. Nine of thirteen CAHs are participating in individual chart audits of existing coding practices covering all categories of inpatients, ambulatory surgical patients, emergency department patients, Rural Health Clinic patients, and affiliated physician practices.

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 is also co-chair for the New Hampshire Stroke Collaborative (NHSC), which aims to improve the stroke system of care in New Hampshire. Recent efforts of the NHSC have focused on creating a Rural Stroke Peer Learning Group, supported by the Flex Coordinator, as well as holding learning sessions specifically focused on rural stroke care. 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. Most recently, the Flex Coordinator has partnered with the state coordinator for the Rural Trauma Team Development Course (RTTDC) to inform CAHs about the opportunity for their facilities to receive RTTDC training. Several CAHs anticipate initiating these trainings during the 2020-2021 Flex cycles.

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 and Interim Flex Coordinator, 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

Darlene Laro
Flex Coordinator, New Hampshire
(603) 271-5885

Flex Coordinator since February 2022

Karen M Maloney
Rural Health QI Coordinator
(603) 271-2286

Rural Health QI Coordinator since May 2022

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, $1,560,000 (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.