University of North Dakota Center for Rural Health

Top Flex Activities

Program Area: Support for Quality Improvement

The North Dakota (ND) Critical Access Hospital (CAH) Quality Network hosts quarterly meetings to facilitate the exchange of state survey findings between CAHs. Best practices, policies, and other resources are shared to help CAHs prepare for their surveys and to help develop a plan of correction if necessary.  The North Dakota Flex Program maintains CAH participation in the Medicare Beneficiary Quality Improvement Project (MBQIP). The North Dakota Flex Program collaborates with other quality improvement related initiatives involving CAHs and emergency medical services (EMS).

Program Area: Support for Financial and Operational Improvement

The North Dakota Flex Program identifies CAHs in most need through a competitive Request for Proposal (RFP) process and makes available a limited number of subcontract awards for financial and operational improvement projects. In addition, the North Dakota Flex Program provides the CAH Board of Director's Boot Camp and the Peer Exchange Program. For the Peer Exchange Program, the North Dakota Flex 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

• Assists CAHs in identifying specific health needs of their communities and supports planning and implementation of related activities
• Assists CAHs with developing strategies for engaging with community partners and targeting specific health needs
• Assists with building local/regional EMS capacity and performance in CAH communities and improving integration of EMS in local/regional systems of care

Please provide information about Collaboration/Shared Services 

The North Dakota Flex Program, through a competitive RFP process, makes available a limited amount of funding to support programming that addresses a significant need identified by the hospital's most recent community health needs assessment process. These projects encourage collaboration between the CAH, local public health units and other community organizations and stakeholders and promote community engagement and healthy behaviors.

Program Area: Support for Integration of Innovative Health Care Models

The ND CAH Quality Network continues work with a cohort of CAHs using Emergency Department Consumer Assessment of Healthcare Providers and Systems (ED CAHPS) to improve ED patient experience. 

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

To continue toward support of the transition to value-based models and transformation efforts in the health care system, the North Dakota Flex Program will make available technical assistance for select CAHs to study and implement or improve care coordination processes. 

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

The ND CAH Quality Network serves as a common platform for CAHs to share best practices, tools and resources related to providing quality 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 36 of North Dakota's CAHs are members of this network. An executive committee of CAH representatives serve as a decision-making body and provide leadership to the members, as well as oversee 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 Flex Program works with the Illinois Critical Access Hospital Network (ICAHN) on ED CAHPS. ICAHN also serves as a vendor to seven North Dakota CAHs for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) vendor services.

Please describe how your state Flex Program has enhanced its use of data in the past year.

For both HCAHPS and EDTC, the North Dakota Quality Network facilitates quarterly meetings in which data is shared and reviewed, identifying top CAH performers in the state. The Network uses this platform to discuss and share best practices relative to HCAHPS and EDTC areas needing improvement.

Do you have any hospitals interested in converting to CAH status?:

Program Statistics