Ohio State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

The Ohio Flex Program is focused on several quality improvement projects. Three specific projects include:

  1. Improving patient safety in critical access hospitals (CAHs) in Ohio and the community by ensuring all health care providers and eligible patient populations receive their influenza vaccinations in collaboration with the Health Services Advisory Group, Inc. (the quality improvement organization (QIO) for Ohio) to increase the number of CAHs reporting HCP/OP-27 data to 33 (100 percent). The impact is that all CAHs will be trained on entering HCP/OP-27 data, running and utilizing reports
  2. Improving the transitions of care with emergency department transfer communication (EDTC) from the CAHs to other health care settings in order to improve patient outcomes to increase the percentage of CAHs reporting EDTC measures
  3. To continue, maintain and support the Flex Quality, Financial and Operational Improvement Network (Flex QI Network) with the use of a consultant for quality improvement services and training for CAHs. The Flex QI Network has existed since 2004 and is supported by subcontractor in benchmarking, web-based reporting and quality measures improvement technical assistance and training
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: 

Some success stories regarding the Ohio CAHs reporting quality data and/or using quality data to improve patient care includes the following: 

  • CMS Quality Rating Ohio's UHHS Geneva was the only CAH nationally awarded a 5-star rating
  • MBQIP Certificate of Excellence – Ohio State Quality Performance ranked in top 10 states on quality and performance
  • Becker’s Hospital Review -2016 Edition, CAHs to Know – listed Ohio's H.B. Magruder Hospital and UHHS Geneva

Some success stories regarding the Ohio CAHs reporting financial data and/or using data to improve financial operations through financial assessments includes the following (breakdown of improvements noted by hospital for the INDICATOR assessment provided by iVantage Health Analytics, Inc.):  

  • Aultman Orrville - Although the overall cost excess for the facility has increased, significant improvements in cost excess have been noted in supplies ($20k reduction in cost excess), and clinical service lines ($7k reduction in cost excess). The labor excess alone was reduced by $70k, with the greatest cost reduction in overhead areas. Clinical areas remained at or above existing levels
  • Fulton County - Although the overall cost excess for the facility has increased, significant improvements in cost excess have been noted in administration ($600k reduction in cost excess) and supplies ($400k reduction in cost excess)
  • Henry County - The overall cost per adjusted admission has dropped by $400, from a high of $7,026 in 2013 to $6,543 in 2015. Significant gains in cost excess reduction can be seen in administration ($92k), supplies ($40k) and imaging ($140k)
  • Highland - The overall cost excess has been reduced by roughly $1 million from 2015 through annualized 2016 data. Significant cost excess has been seen in support services ($178k), supplies ($280k) and selected ancillary services ($38k)
  • Hocking Valley - The overall cost per adjusted admission has dropped by nearly $1k from a high of $5,991 in 2014 to $5,021 in 2016. Cost excess reduction can be seen in support services ($92k) and selected ancillaries ($400k). FTE excess has been reduced by 12 FTEs for a labor savings of $547k
  • Morrow County - The overall cost per adjusted admission has dropped significantly from a high of $8,135 per admission in 2010 to $3,750 in 2015. $596k in cost excess has been reduced from 2014 to 2015, with significant reductions noted in administration ($227k), IT ($198k), supplies ($76k), imaging ($94k), rehabilitation services ($100k) and selected ancillaries ($190k). Labor excess has been reduced by $38k from 2014 to 2015
  • Fostoria - Although the overall cost per adjusted admission has increased from 2014 to 2015, cost savings can be seen in support services ($182k), supplies ($236k), rehabilitation services ($47k), selected ancillaries ($515k) and nursing ($25k). The labor component of this excess reduction totaled $250k
  • Defiance - Overall cost excess has been reduced by $1.2 million, with significant reductions noted in administration and ancillary services
Program Area: Support for Financial and Operational Improvement: 

The Ohio Flex Program is focused on the following financial and operational improvement projects:

  • Conducting a financial and operational assessment with use of a consultant
  • Maintaining and supporting the financial and operational workshops within the QI Network
  • Facilitating the sharing of best practices, resources and expertise regarding financial and operational projects within the QI Network
  • Utilizing the tools purchased through the Small Rural Hospital Improvement Grant Program (SHIP) funding for quarterly benchmarking and individual analysis of financial and operational improvement with the Flex subcontractor
  • Providing two workshops and/or webinars with experts to educate CAHs on financial and operational evidence-based practices
  • Conduct a financial and operational in-depth assessment and action plan with the use of a subcontractor
Program Area: Support for Population Health Management and Emergency Medical Services Integration: 

The Ohio Flex Program is engaged in population health management and emergency medical services integration through the following activities: 

  • Conducting a statewide CAH population health management needs assessment through updating CAHs' community health needs assessments (CHNAs) through use of a subcontractor
  • Developed a network of emergency medical service (EMS) providers and safety net providers in southeast Ohio consisting of four county EMS systems
  • Conducting a community-level rural EMS system assessment utilizing the existing data from the Ohio Department of Public Safety and a subcontractor to identify capacity and performance issues and identify priorities for CAH communities
Please provide information about Collaboration/Shared Services (specifically connected to population health management): 

The Ohio Flex Program, in collaboration with the Ohio State Office of Rural Health (SORH) and the Ohio Department of Health, is updating the Ohio State Rural Health Plan which will include EMS, population health, CHNA and market assessment data of CAHs, small and rural hospitals, local health departments, rural health clinics and other health care providers and community organizations. Additionally, the Flex and SORH are active participants in the Ohio Healthcare Quality Collaborative (consisting of the Ohio Department of Health Diabetes program, Department of Aging, Ohio Hospital Association, Health Services Advisory Group (QIO), Ohio Pharmacists Association and Ohio Health Information Partnership and its quality innovation network (QIN)).

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 Ohio Flex Program created the QI Network in 2004, and it has grown and maintained momentum and continued participation. The QI Network focuses on quality, financial and operational improvement through training and technical assistance. There are over fifty-five participants that include chief executive officers, chief financial officers, directors' of nursing and other quality staff in the 33 CAHs in Ohio.

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

The QI Network face to face meetings, webinars, benchmarking, technical assistance and training opportunities in group settings are a best practice from last year. Allowing the CAHs to share their experiences and challenges has been very beneficial for Ohio's CAHs. They learn well from each other and there is also a small sense of competitiveness and synergy to improve.

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?: 
How many CAHs are in your state?: 
Do you have any hospitals interested in converting to CAH status?: 

Additional Information

Flex Program Staff

Shane Ford
Interim State Office Director, Ohio

Interim State Office Director since October 2017


Daniel Prokop
Flex Coordinator, Ohio

Specialty Areas/Background

  • Master of Science in Health Systems Administration
  • Lean Six Sigma Green Belt
  • Worked in project management at 2 large health systems
  • Managed a housing program at a small AIDS Service Organization
  • Grant management experience

Flex Coordinator Since December 2016

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.