North Dakota State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

North Dakota's focus areas include:

  • Encourage public quality reporting
  • Maintain critical access hospital (CAH) participation in the Medicare Beneficiary Quality Improvement Project (MBQIP)
  • Identify specific quality benchmarking and quality improvement activities through the North Dakota CAH Quality Network
  • Collaborate with other quality improvement related initiatives involving North Dakota CAHs and emergency medical services (EMS)
Program Area: Support for Financial and Operational Improvement: 

North Dakota's focus areas include:

  • Assist CAHs in identifying potential areas of financial and operational performance improvement
  • Support CAHs in planning and implementing interventions for improving financial performance
  • Support CAH finance related webinar series
  • Provide North Dakota CAH Board of Directors Boot Camp
  • Identify CAHs in most need, and through competitive Request for Proposal (RFP) process, make available a limited number of subcontract awards for:
    • Comprehensive revenue cycle analysis, to include charge master review
    • Chart Audit project
  • Provide support for CAH Economic Impact Studies
  • Peer Exchange Program - provides travel support for individuals or small groups to meet with similar entities from other areas of the state and share information, ideas and successful approaches to improving quality and access to health care services
Program Area: Support for Population Health Management and Emergency Medical Services Integration: 

North Dakota's focus areas include:

  • Determine collective issues and trends in population health management for CAHs
  • Assist CAHs to identify specific health needs of their communities and support planning and implementation of related activities
  • Assist CAHs to develop strategies for engaging with community partners and targeting specific health needs
  • Assist local/regional EMS capacity and performance in CAH communities and improve integration of EMS in local/regional systems of care
  • Support EMS/CAH collaboration to address mental/behavioral health patient care
  • Support the sustainability and viability of EMS within the community
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 North Dakota CAH Network serves as a common platform for the CAHs to share best practices, tools and resources related to providing quality of care. The mission of the Network is to support ongoing performance improvement. Goals of the Network include improving information sharing and networking at the regional and state level among CAHs, tertiary facilities and other stakeholders to prevent duplication of efforts. All of the 36 CAHs are members of the Network. An executive committee of CAH representatives serve as a decision-making body and provide leadership to the members and oversight of the Network's efforts. A stakeholder committee, represented by statewide partner organizations, provides feedback and a link to increase communication.

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

The North Dakota CAH Quality Network, in partnership with the Illinois Critical Access Hospital Network (ICAHN) is working to facilitate the development of a cohort of four North Dakota CAHs and seven Illinois CAHs on the Emergency Department Hospital Assessment of Healthcare Providers & Systems (EDCAHPS).

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

The Center for Rural Health in North Dakota (the Center) has historically conducted community health needs assessments (CHNAs) for CAHs. The Center has revised the approach in order to build local skills and capacity around the CHNA process by increasing the information provided to the CAHs about the value of the CHNA as a planning tool for communities to inform decisions on services/programs to improve health and health care. The project is a partnership between the Center, CAHs (pay a portion of the cost) and local public health units. The process includes a community survey tool, key informant interviews as well as two community meetings. The first community group/focus group meeting is used to engage a variety of stakeholders to identify needs in their community. The second community meeting is used to review data collected (i.e., community survey, focus groups, key informant interviews, secondary data about health conditions) and prioritize the health needs of its community. In-depth reports for each assessment detailing its findings are provided.

While the needs assessments are ongoing and each community is unique with specific needs, results to-date reveal several broad categories of needs are common to multiple communities throughout North Dakota. The dominant needs among assessed communities involve the following:

  • Health care workforce shortages
  • Obesity and physical inactivity
  • Addressing mental health and substance abuse issues
  • Chronic disease management

The Center has worked with many CAHs on strategic planning related to implementation strategies to address significant needs identified in CHNAs, including facilitation of strategic planning workshops and drafting plan reports. The Center also provides access to resources (i.e., HRSA Network, Outreach and Blue Cross Blue Shield of North Dakota grants, etc.) as possible funding sources to support the cost of projects related to the needs identified through CHNAs. In addition, the Center conducts Grant Writing Workshops, upon request, as part of the State Office of Rural Health grant activities.

Program Statistics

What type of organization is your Flex office housed in?: 
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

Gary Hart, PhD
Director, Center for Rural Health, North Dakota
(701) 777-3899

Specialty Areas / Background

  • Rural health
  • Health workforce (physician, nurses, oral health personnel)
  • Rural geographic taxonomies
  • Access to care
  • Rural, state and federal policy
  • Rural healthcare for the elderly, infants and the underserved

Center for Rural Health Director since October 2010 

Lynette Dickson
Associate Director/Community Outreach and Engagement, North Dakota
(701) 777-6049

Specialty Areas / Background

Lynette directs the State Office of Rural Health (SORH) grant program, Medicare Rural Hospital Flexibility (Flex) program, Small Rural Hospital Improvement Grant Program (SHIP), Area Health Education Center (AHEC), other workforce related projects and a health information technology (HIT) project funded by Medicaid. She is currently appointed, by the Governor, to the North Dakota HIT Advisory Committee and serves as chair; as well as the ND Emergency Medical Services (EMS) Advisory Committee. In addition, she serves as the director of the Area Health Education Center program office. As part of the core function of the programs listed above she provides direction to projects related to HIT, workforce development, recruitment and retention; and is actively involved in health policy, government affairs, community development, strategic planning and grant development.

Associate Director since March 2003 

Brad Gibbens
Deputy Director, Center for Rural Health, North Dakota
(701) 777-2569

Specialty Areas / Background

Brad Gibbens is the deputy director of the Center for Rural Health at The University of North Dakota (UND) School of Medicine and Health Sciences and an assistant professor at the School of Medicine and Health Sciences. His primary areas of responsibility are community development, community engagement techniques, program development, and health policy.

Gibbens works closely with health policy, government affairs, community development (including assessments, strategic planning, and community engagement), program and grant development, and information dissemination activities. Center programs that address community development include the following: State Office of Rural Health, Rural Hospital Flexibility, Small Hospital Improvement Program, Blue Cross Blue Shield of ND Rural Health Grant Program, small program evaluation, and the Dakota Conference on Rural and Public Health. 

Deputy Director since January 1988

Jody Ward, MS, RN, APHN
Flex Coordinator, North Dakota
(701) 858-6729

Specialty Areas / Background

As a Senior Project Coordinator, Jody coordinates the activities of the North Dakota Medical Rural Hospital Flexibility (Flex) program administered by the Center for Rural Health at The University of North Dakota (UND) School of Medicine and Health Sciences. She has been with the Center since 2008. Jody has led the North Dakota Critical Access Hospital Quality Network in a number of quality and patient safety initiatives and serves as a liaison to statewide stakeholders, facilitating the exchange of information and network development through the Flex program. Jody has a Master of Science degree in Advanced Public Health Nursing (APHN) from the University of North Dakota and a registered nurse (RN) Bachelor's degree from Minot State University, Minot, North Dakota.

Flex Coordinator since January 2013

Kylie Nissen
Senior Project Coordinator
(701) 777-5380

Specialty Areas / Background

Kylie assists in the coordination of the activities for the State Office of Rural Health, the Medicare Rural Hospital Flexibility (Flex) program, Area Health Education Center (AHEC) and other workforce related projects. She is also the principal investigator of the Blue Cross Blue Shield of North Dakota rural health grant program and coordinates the Scrubs Academy and Scrubs Camps, HIPAA certification and the Dakota Conference on Rural and Public Health. She currently serves on the National Organization of State Offices of Rural Health Board as treasurer.

Special Projects Coordinator/Internal Evaluation since August 2016

Angie Lockwood
Project Coordinator, Center for Rural Health, North Dakota
(701) 777-5381

Specialty Areas / Background

Angie Lockwood is a Project Coordinator for the Center for Rural Health. Angie works with a diverse team that provides support to rural hospitals and their partners throughout North Dakota. Her role includes program coordination, providing outreach and technical assistance, tracking budgets, reporting on program outcomes, and information collection and dissemination.

Project Coordinator since January 2014

Julie Frankl
Project Assistant, North Dakota
(701) 777-6781

Specialty Areas / Background

Julie Frankl is a Project Assistant at the Center for Rural Health at the University of North Dakota (UND) School of Medicine and Health Sciences in Grand Forks.

Project Assistant since March 2014

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.