North Carolina State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

The North Carolina Office of Rural Health (ORH) has subcontracted the following activities:

  • Identify the best source of data within three months of the start of Year 1
  • Have critical access hospitals (CAHs) submit data for baselines within six months of Year 1
  • Establish individual baselines and report back to each CAH by end of Year 1
  • Follow-up with each CAH and identify opportunities for improvement within three months of start of Year 2
  • Have CAHs submit data within six months of Year 3
  • Assess effectiveness of improvements by end of Year 3

The ORH Flex Program Manager will monitor the contract to meet the proposed timelines.

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: 

Through its contract with ORH, the North Carolina Quality Center (NCQC) held seven content and networking webinars featuring the following:

  • A 3-month series on TeamSTEPPS providing key communication and leadership tools/strategies
  • Improvement success stories using TeamSTEPPS and Lean from a CAH in Oregon

As a result of the webinars, site visits and Learning and Action Network (LAN) meetings conducted by NCQC, North Carolina CAHs increased quality reporting in outpatient measures (67 percent to 71 percent), Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures (71 percent to 81 percent), and emergency department transfer communication (EDTC) measures (81 percent to 86 percent).

Program Area: Support for Financial and Operational Improvement: 

The ORH Flex Program Specialist will provide technical assistance (TA) to CAHs and their owned physician practices such that they can access the appropriate resources (internal or external) in order to assess the benefits and feasibility of converting these practices to Centers for Medicare & Medicaid Services (CMS)-certified rural health clinics (RHCs). ORH will continue its contract with for the following activities:

  • Refine and update the North Carolina-specific financial indicator report by end of Year 1
  • Provide analysis and recommendations by end of Year 1

The ORH Flex Program Manager will monitor the contract to meet the proposed timelines. In addition, ORH has contracted with a consulting firm to do the following:

  • Organize a LAN within three months of start of Year 1
  • Hold ongoing LAN activities through the course of the grant period
  • Assess effectiveness of improvements by end of Year 3

The ORH Flex Program Manager will monitor the contract to meet the proposed timelines.

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

ORH will continue its contract with the North Carolina Hospital Association (NCHA) to do the following:

  • Analyze Flex Monitoring Team's (FMT) community benefit data within three months of Year 1
  • Conduct surveys of CAHs within six months of Year 1
  • Provide analysis with recommendations by end of Year 1

The ORH Flex Program Manager will monitor the contract to meet the proposed timelines. After Year 1, the NCHA will do the following:

  • Organize a LAN within three months of Year 1
  • Hold ongoing LAN activities through the course of the grant period
  • Assess effectiveness of improvements by end of Year 3
  • Identify possible MH programs by end of Year 1

Ongoing TA will be provided with respect to population health management and accountable care organization (ACO) practice transformation. The ORH Flex Program Manager will monitor the contract to meet the proposed timelines. The ORH Flex Program Specialist will provide ongoing encouragement and TA for CAH involvement in the statewide telepsychiatry initiative.

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

Through its contract with ORH, the NCHA organized a LAN around mental health best practices and improvement. After conducting several meetings, which brought together regional CAHs and mental health managed care organizations, NCHA compiled a list of possible initiatives to improve mental health across the state. CAHs were sent a survey to prioritize the proposed mental health initiatives, and ORH will utilize this information to initiate programming to provide TA or other resources to CAHs.

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

Through its contract with ORH, a vendor has conducted several LAN meetings, which offer TA regarding financial and operational improvement. Some of these TA initiatives have included a population health readiness assessment, market and policy updates regarding MACRA, and different models of care being employed by CAHs across the country.

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 work of North Carolina's Flex Program creates three LANs that foster CAH collaboration and education. These LANs will meet quarterly to discuss quality improvement initiatives, financial and operational improvement and population health management.

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

The LAN approach has been very helpful for CAHs to network and share best practices with one another. We have received very positive feedback about these meetings, which have helped to provide focus on each area of the Flex Program.

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?: 
3.00
How many CAHs are in your state?: 
21
Do you have any hospitals interested in converting to CAH status?: 
No

Additional Information

Flex Program Staff

Maggie Sauer
State Office Director, North Carolina
919-527-6450

State Office Director since June 2017

Brian Cooper
Interim Flex Coordinator, North Carolina
919-527-6494

Specialty Areas / Background

  • Telepsychiatry & Rural Hospital Specialist
  • Hospital administration
  • Health information management

Interim Flex Coordinator since July 2017

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.