South Carolina State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

In this area, South Carolina plans to support and assist critical access hospitals (CAHs) in implementing quality improvement activities to improve patient outcomes which include:

  • Improving patient and community safety, ensuring that health care providers and eligible patient populations receive influenza vaccinations
  • Supporting the improvement of patient experience of care through the use of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
  • Supporting the improvement of transitions of care from the CAH to other health care settings in order to improve patient outcomes
  • Supporting the improvement of the care provided in CAH outpatient settings in order to improve patient outcomes by determining baseline measures for OP-1, OP-2, OP-3 and OP-4 using Medicare Beneficiary Quality Improvement Project (MBQIP) data
  • Supporting the improvement of the care provided in CAH outpatient and emergency department (ED) settings through addition measures
  • Promote and improve the reporting of quality of care data by CAHs to assist all CAHs in the state to consistently publicly report data on all required measures by monitoring public reporting of required measures for all CAHs, providing technical assistance with reporting, outreaching to any CAHs who are not publically reporting and determining barriers and providing resources and support to overcome barriers, root cause analysis to determine barriers to reporting outpatient care measures

Successes are measured by CAH participation in CAH quality meetings, publicly available data, technical assistance requests, quality improvement activities and shared best practices, along with completion of site visits, coaching calls, root cause analysis and action plans.

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: 

The South Carolina Office of Rural Health (SCORH) Flex Program currently has two CAH workgroups; one that is focused on quality and the other that is focused on finance. The CAH quality workgroup is comprised of Chief Nursing Officers and Quality Directors and the CAH finance workgroup is comprised of Chief Executive Officers and Chief Financial Officers. During the last CAH quality meeting, the quality workgroup walked through each of the MBQIP measures in great detail. The detailed MBQIP measure walk through allowed for the group to discuss who, what and how each of the measures are currently being collected at the individual CAHs. This best practice sharing discussion sparked greater involvement of not only the quality staff at the CAHs but CEO and CFO leadership as well. To date, two of the lower MBQIP reporting CAHs have taken an active role in improving their quality data reporting. In addition to the CAH Quality workgroup, a greater emphasis has been placed on the CAHs' Star Ratings, or lack of Star Ratings, on Hospital Compare.

Program Area: Support for Financial and Operational Improvement: 

In this area, South Carolina plans to support and assist CAHs by providing financial and operational in-depth assessments for CAHs to identify financial and operational strengths and challenges, and to identify statewide strategies for improvement. Activities include:

  • Action planning for CAHs to educate and prepare for new/alternative health care payment and delivery models through technical assistance via phone, email or on-site support, quarterly Financial Workgroup meetings, staff trainings, site visits and utilizing a financial assessment consultant. Success is measured by participation in technical assistance activities, number of CAH/CFO workgroup meetings, sharing of best practices, number of CAHs identified as “high need” and number of CAH financial and operational assessments completed
  • Providing assistance to address CAH operational improvements by helping patients in SC CAH communities seek care locally. This would be addressed by developing a state-level report that identifies potential out-migration risks for SC CAHs communities, determining baseline and target measures for SC CAHs using report data, performing root cause analysis to better understand out-migration issues and developing an action plan to mitigate out-migration in at least one service line. Success is measured by the number of reports completed and distributed, baseline and target measures identified, number of analyses completed and distributed and number of action plans completed
Program Area: Support for Population Health Management and Emergency Medical Services Integration: 

In this area, South Carolina plans to support and assist CAHs by developing a statewide CAH population health management needs assessment to determine collective issues and trends in population health management for CAHs. Activities include:

  • Annual assessment of CAHs’ population health indicators, and distributing results of the assessment to individual CAHs and their community partners. Success is measured by knowledge gained through the population health needs assessment
  • Improve emergency medical service (EMS) capacity and operational projects by assisting CAHs to develop strategies for engaging with community partners and targeting specific health needs. This is achieved by identifying a performance improvement activity for each of the EMS agencies studied, developing an action plan, determining baseline and target measures based on performance activities and providing technical assistance via site visits and coaching calls to help in the implementation of the action plan and to develop collaborative linkages with the local CAHs based on the action plans. Success is measured by the number of performance activities identified, number of action plans created, baseline and target measures identified, number of site visits and coaching calls
Please provide information about Collaboration/Shared Services (specifically connected to population health management): 

In this program area, South Carolina performed five EMS assessments from the 9-1-1 agencies that serve a CAH community. It was really interesting to see the CAHs from the eyes of EMS. During the individual EMS assessments, a focus was placed on the CAH's strengths and weaknesses, likes and dislikes about the hospital, interactions with emergency department (ED) department and the Chief Officers and a personal assessment of the relationship between their agency and the CAH. This discussion has quickly become a best practice when talking with 9-1-1 EMS agencies that serve a CAH community because it helps get a whole picture of the CAH and reflects the hospital’s dedication to their partnerships with community stakeholders.

Program Area: Support for Designation of CAHs: 

South Carolina provides activities that support appropriate conversion of small rural hospitals to CAH status. This is done by monitoring the state of all rural hospitals to determine the likelihood of conversion or closure as well as providing technical assistance as requested to communities seeking to convert to CAH status, decertify from CAH status or relocate/reopen/convert to other types of facilities. Success is measured by the status of rural hospitals reviewed semi-annually and at-risk facilities documented, and the number of technical assistance requests received.

Program Area: Support for Integration of Innovative Health Care Models: 

South Carolina supports the integration of innovative health care models to develop/implement and assess innovative health care models designed to have a positive transformational impact of rural health in the state. Activities include: 

  • Technical assistance in improving outcomes and partner engagement, identifying and distributing lessons learned and best practices during semi-annual network meetings, using statewide data to identify CAHs who need extra assistance through site visits and partner engagement, providing targeting strategic planning, providing a statewide annual Population Health Summit with state partners for CAHs, Rural Health Networks (RHN), community partners and stakeholders
  • Analysis presentation on the root cause analyses completed in FY15 on the factors that differentiate rural population health outcomes from urban ones and the South Carolina state rural health plan development
  • Support the development of new provider types including community paramedics, community health workers, health coaches and care coordinators

Success for support is measured by number of technical assistance calls, emails and site visits; the number of RHN meetings held; the number of best practices shared; the number of CAH, RHN, community partners and stakeholders attending the Summit; presentations completed; and the number of stakeholder meetings hosted and attended.

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

SCORH's 2016 Annual Rural Health Conference, attended by all five CAHs along with their colleagues from rural health clinics, RHNs and rural EMS, had a large focus on educating and supporting these CAHs, their communities and partner organizations in transitioning from volume-based care to value-based care by identifying transformational strategies and core competencies that improve this transition. Sessions included a focus on the Quality Payment Program, population health management, rural hospital closures, the current rural health care landscape and the impact of MACRA legislation on rural providers.

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): 

There are six RHNs in South Carolina comprised of vertical network members, including CAHs, small rural hospitals, rural health clinics (RHCs), federally qualified health centers (FQHCs), technical colleges, mental health and substance abuse treatment providers and local human service coordinating agencies. These networks meet monthly and work toward improving access to quality health care in their communities. In addition, there are two informal CAH workgroups that meet quarterly: one that is quality focused for Chief Nursing Officers (CNOs) and Quality Directors and one that is finance focused for Chief Executive Officers (CEOs) and Chief Financial Officers (CFOs). The two workgroups have one annual meeting each year to network, discuss their individual workgroup outputs and to get Flex Program updates. There is also a South Carolina Small Rural Hospital Improvement Grant Program (SHIP) Network, which includes all five CAHs plus three other small rural hospitals. This network is focused on financial benchmarking and ICD-10 implementation, which is coordinated with the Flex Program Operational and Financial Improvement program area.

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

The South Carolina Flex Program works closely with the South Carolina Hospital Association and Carolinas Center for Medical Excellence on an informal basis. Many quality programs overlap for the hospitals so these entities meet on a semi-regular basis to check-in on hospital and/or project status(es). Network activities are supported by another South Carolina Hospital Association collaboration, AccessHealth South Carolina. EMS activities are made possible by work with the South Carolina Department of Health and Environmental Control's Office of EMS and Trauma, four Regional EMS Offices, South Carolina EMS Association and the Joint Committee on Rural Emergency Care (JCREC). SCORH also actively participates in the South Carolina Heart Care Alliance, bringing together ST-segment elevation myocardial infarction (STEMI), stroke, sudden cardiac arrest and heart failure care under one umbrella group.

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

SCORH, in partnership with SC Hospital Association, SC Department of Health and Environmental Control, SC Area Health Education Consortium, SC Institute of Medicine and Public Health and SC Primary Care Association, hosted the first-ever South Carolina Population Health Summit in 2016. The Summit brought together grassroots community leaders, along with those who run organizations that directly impact the health and economic well-being of each community to discuss and develop next steps in improving the health of the populations they serve. The two sessions that focused heavily on improving health outcomes and community health improvement were Spartanburg Way to Wellville and Live Well San Diego. The Population Health Summit was unique for South Carolina because for the first time teleconferencing capabilities were used to facilitate the five simultaneous sessions around the state. This event was so successful that another South Carolina Population Health Summit has been scheduled for 2017.

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

Dr. Graham L. Adams
State Office Director, South Carolina
(803) 454-3850

Specialty Areas / Background

  • Technical assistance to individuals and organizations developing strategic plans
  • Funding resources
  • Infrastructure
  • Collaboration to improve access to quality health care in rural communities

State Office Director since 2002

Melinda Merrell
Flex Coordinator, South Carolina
(803) 454-3850

Specialty Areas / Background

  • Technical assistance in operational and quality improvement for rural hospitals and emergency medical services
  • Former rural health network director in South Carolina

Flex Coordinator since July 2010

Tiffany Simpson-Crumpley
Director of Network Development, South Carolina
(803) 454-3850

Specialty Areas / Background

Technical assistance in multi-disciplinary collaboration to help communities sustain systems of care for their uninsured residents

Director of Network Develpment since July 2010

Sarah Craig
Innovation Program Coordinator, South Carolina
(803) 454-3850

Speciality Areas / Background

  • Technical assistance to rural health clinics and rural emergency medical services providers in quality, operational,and financial improvement
  • Patient-Centered Medical Home recognition knowledge and experience
  • Community paramedicine program development knowledge and experience

Innovation Program Coodinator since January 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.