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North Carolina Office of Rural Health

Top Flex Activities

Program Area: Support for Quality Improvement

The North Carolina Flex Program has created a Quality Improvement (QI) Collaborative in which critical access hospitals (CAHs) can participate. The QI Collaborative meets quarterly and gives hospital staff a chance to network, share best practices and identify opportunities for improvement.

A dashboard is displayed on the North Carolina Hospital Association website for hospitals to keep track of their own quality performance as well as the entire cohort of CAHs. Medicare Beneficiary Quality Improvement Project (MBQIP) reports are reviewed as they are released and high performing hospitals are identified for each area. Monthly coaching calls are offered to assist hospitals with reporting and improving outcomes.

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.

Recently, MBQIP reports revealed that one particular hospital was a high performer for Median Time to Pain Management for Long Bone Fracture. The hospital was invited to present at the next quarterly meeting, which led to a rich discussion on pain management. Several best practices were identified for hospitals to implement in this area.

Program Area: Support for Financial and Operational Improvement

The North Carolina Flex Program has created a Financial/Operational Learning and Action Network (LAN) in which CAHs can participate. The LAN meets quarterly and gives hospitals a chance to network, share best practices and identify opportunities for improvement.

The Flex financial and operational improvement (FOI) contractor, Stroudwater Associates, has created a Tableau interactive dataset with the hospitals' financial and operational measures. This dataset is reported quarterly to the North Carolina Hospital Association. At each quarterly meeting, the LAN discusses the dataset and when high performers are identified, the hospitals share their best practices and are often invited to present at future meetings.

In addition to holding quarterly meetings, monthly calls are held with each of the task force groups, which are smaller groups identified by priorities in previous meetings. These task force groups receive coaching and conduct specific projects around Service Line Optimization, Revenue Cycle Management, Physician Engagement, etc.

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

The North Carolina Flex Program conducts a Population Health Needs Assessment each year by reviewing community health needs assessments (CHNAs) for each hospital. These CHNAs have identified mental/behavioral health as a top priority for almost all hospitals, so several initiatives have been created to assist hospitals in this area. Mental Health First Aid (MHFA) trainings have been offered on-site at interested CAHs. The Flex Program also assists in connecting hospitals to the North Carolina Statewide Telepsychiatry Program (NC-STeP), which helps hospital emergency departments gain access to psychiatrists who can assess and create a care plan for behavioral health patients.

Please provide information about Collaboration/Shared Services (specifically connected to population health management)

As mentioned above, there are collaboratives that meet quarterly for Quality Improvement and Financial/Operational Improvement. The North Carolina Statewide Telepsychiatry Program, which is a state-funded program, has participation from most North Carolina CAHs and assists hospital emergency departments in caring for behavioral health patients.

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

The North Carolina Department of Health and Human Services has submitted an 1115 Waiver to transform the state's Medicaid Program. To assist CAHs during this transition, the North Carolina Flex Program has scheduled meetings with CAHs that center around Medicaid transformation and best practices CAHs' role in value-based care. In addition, discussions are facilitated at quarterly LAN meetings around changes to Medicare, private insurance markets and ways that CAHs can prepare for changes to payment and care models.

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

As mentioned above, the North Carolina Flex Program has created collaboratives around QI and FOI.

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

At the last quarterly meeting, North Carolina CAHs met briefly with South Carolina CAHs for a combined meeting to discuss market updates. This meeting was well received and it is likely that future collaborations will take place between the North Carolina and South Carolina Offices of Rural Health.

Please share any resources or tools that you found useful in your state Flex Program's work this past year that you would recommend to your Flex Program colleagues.

The NOSORH Toolkit for Working with Vulnerable Hospitals

Program Statistics

Type of Organization State Government
Staffing 3.0 FTEs
Number of CAHs 21
Website URL Organization Website

Flex Program Staff

Maggie Sauer
State Office Director, North Carolina

State Office Director since June 2017

Nick Galvez
Flex Coordinator, North Carolina
(919) 527-6467

Flex Coordinator since June 2018

Renee Clark
Rural Hospital Specialist

Rural Hospital Specialist since November 2018

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.