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Utah Office of Primary Care and Rural Health

Top Flex Activities

Program Area: Support for Quality Improvement

The Utah Flex Program supports the rural independent hospitals by canvassing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) vendor market and summarizing options. Recently, the decision was made to collectively contract with one HCAHPS vendor with a discount on pricing. Participating hospitals gave permission to the Flex Quality Coordinator to access real-time HCAHPS data from this vendor. The Flex Coordinator summarizes the data on a quarterly basis and distributes to participating critical access hospitals (CAHs). Trends are monitored and best practices are shared in areas of decline or deficiency.

The Flex Quality Coordinator has developed spreadsheets for each independent CAH with individual graphs for each emergency department transfer communication (EDTC) measure. As data is submitted on a monthly basis, the Flex Coordinator updates these graphs and distributes to CAHs on a quarterly basis, with observations about trends. CAHs are asked to provide feedback on causes of trends. Processes and procedures that have been effective in improving EDTC measures are shared with all CAHs.

The Flex Program continues to support the nurse managers of the rural independent hospitals in the state. This group is meeting three times per year, taking turns meeting at their respective hospitals. The nurse managers are engaged and enthused about these meetings, which last two days and cover a myriad of topics. They have the opportunity to network and share best practices. Discussion of HCAHPS best practices is also part of regular rural independent hospital nurse manager group meetings.

In August 2016, the Utah Flex Program initiated the organization of a quality coordinator group of the rural independent hospitals. In the 2017-2018 contract year, the Utah Flex Quality Coordinator has taken on the responsibility to coordinate across institutions. The first meeting was held October 23, 2017. The agenda for the meeting included quarterly data, a needs assessment on when and where the meetings would be held in 2018 and a presentation on maternal hypertension. Subsequent meetings are in development and will include a discussion on common trends across institutions, antibiotic stewardship and new reporting requirements.

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

Consistent and timely reporting remains a challenge. All independent rural hospitals struggle with reporting timeliness from time to time and need prompting and reminding. By continuously providing feedback real-time on EDTC data received from all CAHs, all the rural independent CAHs have made a significant improvement over time. Forty-six percent of the CAH facilities report active engagement with quality improvement projects related to both EDTC and HCAHPS data that range from noise at night, access to services during construction, pain management and improved communication between nursing and pharmacy at discharge.

Program Area: Support for Financial and Operational Improvement

The Flex Program assesses the financial status of the CAHs through regular site visits. When it is determined that a CAH is trending toward financial failure and/or financial hardship, interventions are initiated to provide assistance. Examples of effective interventions include:

  • Ask hospital system in the state to send their rural hospital financial team on-site to assess financial condition and provide recommendations
  • Request a seasoned, retired rural hospital Chief Executive Officer (CEO) to mentor an interim CEO to stabilize management
  • Coordinate assistance from a seasoned Chief Financial Officer (CFO) to visit the facility and report to the board on recommended operation and policy changes

The Flex Program also supports multiple hospitals with revenue cycle assessments being conducted by consultants. One of the objectives of this initiative is to be able to compare financial successes between the participating hospitals. 

Three CAHs are participating in a collaborative three-year Studer Group operational improvement program. This collaborative program reduces the cost significantly versus each hospital participating individually.

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

The Utah Flex Program is working with the Bureau of Emergency Medical Services (EMS) on a project to identify and recognize resource hospitals for all EMS agencies. Additionally, the Flex program and the Bureau of EMS are providing rural trauma team development courses (RTTDC) for all rural hospitals. This is in conjunction with helping CAHs who desire to become recognized stroke receiving facilities and/or achieve trauma designations. The trainings are attended by both hospital and EMS personnel. Enhanced relationships between the hospital and EMS personnel are already being seen as a result.

Please provide information about Collaboration/Shared Services

Moab Regional Hospital started their own Addiction Medicine Program in 2017, and they are currently serving about 20 patients each week. They continue to have quarterly visits from the addiction medicine specialists at the University of Utah to provide support and education to their providers. The details of the program are as follows:

  • Moab Regional Hospital currently has three physicians with waivers to prescribe Suboxone medication. Physicians have gone through specific training to prescribe Suboxone and they have a controlled substance monitoring program in place
  • Moab Regional Hospital offers an Addiction Medicine Clinic that is staffed by two physicians with Suboxone waivers, a specialized medical assistant to coordinate care and a social worker to provide psychosocial support services. Patients who participate in the Addiction Medicine Clinic attend weekly appointments with the physicians to manage opioid addiction and dependence
  • In 2017, Moab Regional Hospital initiated a screening program in their primary care clinic for youth at risk of mental health and substance use disorders. Youth who identify as at-risk are matched with the clinic social worker who provides care coordination with local resources
  • Beginning in 2018, Moab Regional Hospital will encourage Addiction Medicine Clinic patients to attend group therapy sessions with the social worker. The group therapy will center on cultivating behavior and thinking patterns that encourage sustainable abstinence from substances. Participants will begin to understand the science behind their disease and foster support with each other while also assessing their existing support networks

Moab Regional Hospital serves as an important leader in a community-wide Youth Prevention Coalition. The Coalition’s strategy is to foster collaboration with several community agencies to decrease risky behaviors in Moab youth. Risky behaviors, many of which are substance abuse behavior, are identified in the Student Health and Risk Prevention (SHARP) Statewide Survey performed every two years. 

Program Area: Support for Designation of CAHs

Beaver Valley Hospital converted to CAH status in July 2016 and Garfield Memorial Hospital converted in January 2017. The Utah Flex Program is currently working with one other rural hospital interested in converting to CAH status in the future. There are currently 13 CAHs in Utah.

Program Area: Support for Integration of Innovative Health Care Models

The Utah Flex program is working with Project ECHO (Extension for Community Healthcare Outcomes) at the University of Utah to improve the capacity of rural primary care physicians and practitioners to treat and manage complex chronic conditions and receive additional support and training. Project ECHO is a cost-free partnership between community providers and a University of Utah Health interdisciplinary team of professionals developed to treat chronic and complex disease in rural and underserved areas through the use of technology. The Project ECHO launched a new behavioral health clinic in October of 2017 and two CAHs participated in the training on how to conduct a mental health interview in the primary care setting. Other topics that will be covered as part of this clinic are mood disorders, anxiety disorders, substance use disorders and child and adolescent disorders.

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

The Flex Program continues to provide information and resources concerning the transition to value-based care to all CAHs. Utah Flex also encourages CAHs to participate in the Small Rural Hospital Improvement Grant Program (SHIP) and develop projects that will assist them in their transition to value-based care. 

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

A formal network of the nine rural independent hospitals in the state was organized in 2013. The network has articles of incorporation and by-laws, with the board chair position filled by a hospital CEO. The Flex Program works closely with this group to help advance programs and projects that take advantage of economies of scale with nine hospitals as a group, versus each hospital alone. There have been successful programs implemented to help this group of hospitals, mainly along the lines of financial and operational improvement. For example, the hospitals entered into an agreement with a law firm in the state to provide unlimited initial legal advice and assistance for a nominal monthly fee. Other programs include a common insurance broker for property insurance, mobile MRI and group purchasing organization (GPO) services. Subgroups have been formed to network and share best practices, including nurse leaders, human resource managers and quality coordinators. The network continues to grow and has taken on a part-time Executive Director.

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

The Utah Flex Program is currently working on creating hospital-specific snapshot reports that combine quarterly data from both quality and financial measures and compare them across the state. The reports would also pinpoint areas that need improvement in both quality and financial measures. Utah Flex is considering working with CAHs to collect this data monthly or quarterly so that the results are timely and actionable. Currently, data measures are being tracked from the Telligen Reports, Flex Monitoring Team and the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS), but the turnaround time is so long that the results are not relevant enough to be actionable.

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


Please share any resources or tools that you found useful in your state Flex Program's work this past year that you would recommend to your Flex Program colleagues.

The Utah Flex Program participated in the Flex Program Technical Consultation Project in 2017 and found it to be very beneficial. Utah Flex would recommend this program to any state interested in learning more about the Flex Program and how to create an action plan to make significant improvements.

Program Statistics

Type of Organization State Government
Staffing 1.6 FTEs
Number of CAHs 13
Website URL Organization Website

Flex Program Staff

Matt McCullough
State Office Director, Utah

Specialty Areas/Background

Matt McCullough is the current Director of the Utah Office of Primary Care and Rural Health. He previously was a Senior Research Analyst within the office and responsible for the PCO program. Matt has over 10 years of experience with GIS and spatial/data analysis and is completing a doctorate degree in medical/health geography.

State Office Director since August 2017

Greg Rosenvall
Flex Coordinator, Utah
(801) 793-0426

Specialty Areas / Background

Prior critical access hospital administrator for 15 years

Flex Coordinator since September 2011

Hannah Robinson
Flex Program Specialist, Utah

Flex Program Specialist since March 2018

Iona Thraen
Flex Quality Improvement Coordinator
(801) 273-6643

Dr. Thraen has close to 30 years of health quality improvement and patient safety experience. She has a M.S.W. in Macro/Micro Social Work from the University of Nebraska and PhD in Medical Informatics from the University of Utah. 

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.