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Utah Office of Primary Care and Rural Health

Top Flex Activities

CAH Quality Improvement

The Flex Quality Improvement Coordinator (FQIC) works closely with critical access hospitals (CAHs) and their quality managers to improve quality reporting and improvement practices in the state.

In 2016, the Utah Flex Program facilitated the development of a Quality Managers cohort group of all 13 CAHs and in 2019 partnered with the state’s Quality Improvement Organization/Quality Improvement Network (QIO/QIN), Comagine Health, to help facilitate this group. The FQIC and Comagine Health coordinate quarterly Quality Managers meetings where they share Medicare Beneficiary Quality Improvement Project (MBQIP) data trends, quality improvement related training, regulatory updates, and facilitate sharing of best practices. Beginning in November of 2020, the Office of Primary Care and Rural Health has formally contracted with Comagine Health for them to provide one on one hospital technical assistance, project implementation, and in-depth support for CAH Quality Improvement initiatives.

The FQIC reviews all MBQIP data quarterly and shares it with participating CAHs. Historically, the Utah Flex Program has used Excel to model MBQIP data trends for the CAHs. In 2018, the Utah Flex Program began collecting Memorandums of Understanding (MOUs) from all participating CAHs to utilize the Quality Health Indicators (QHI) data management and benchmarking platform. Utah CAHs are in the process of selecting a set of quality measures to track using the QHI platform for benchmarking purposes and increased peer sharing. The Utah Flex Program is now transitioning to utilizing the QHI platform for CAH emergency department transfer communication (EDTC) data submission as well as displaying MBQIP data trends so they are more readily available to CAHs.

The OPCRH is currently funding two Critical Access Hospitals for participation in the University of Washington Tele-antimicrobial Stewardship Program (UW-TASP) each Flex Fiscal Year. The goal of participation in UW-TASP is for Utah CAHs to receive support related to Antibiotic Stewardship programs, and to ultimately improve these programs. The UW-TASP Program offers the hospitals weekly teleconferences with clinical didactics case discussions, telemonitoring with Infectious Disease physicians, pharmacists, and nurses. The program also provides antimicrobial stewardship site assessments.  Additionally, the OPCRH is collaborating with Washington, Oregon, Idaho, Arizona, and UW-TASP to provide further education and support to CAHs in addressing antimicrobial stewardship.

CAH Operational and Financial Improvement

The Utah Flex Program collaborates with the Utah Hospital Association (UHA) to support the financial and operational improvement efforts of Utah CAHs. The UHA Rural Hospital Improvement Director acts as the coordinator for all Flex financial and operational improvement activities. At the UHA, one of his primary roles is to act as Director for the Rural 9 Independent Hospital Network, making him uniquely qualified to oversee the Flex financial and operational improvement activities. The Rural 9 Independent Hospital Network is made up of the nine rural independent hospitals (eight CAHs, one prospective payment system) in the state, which tend to be small community safety-net hospitals.  The current UHA Rural Hospital Improvement Director was a Chief Executive Officer (CEO) of a small CAH in Utah for 15 years.  One successful strategy in providing high-quality, low-cost resources to the Rural 9 hospitals is collaborating with the University of Utah and Intermountain Healthcare to share expertise and training.  Examples include:

  • Leadership Development Training
  • Revenue Cycle Improvement and Regulatory Compliance Training Webinars
  • Hands-on Nurse Shadowing and Training
  • Simulation Lab Access

The Utah Flex Program continually assesses the financial and operational needs of Utah CAHs through regular site visits, frequent communication and review of the annual Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) financial data.  Interventions are targeted to meet the specific needs of the hospitals. Examples of effective interventions include:

  • Chargemaster review
  • Service line assessment
  • Charge capture analysis
  • Coding review and education
  • Overall revenue cycle review

CAH Population Health Improvement 

The Utah Flex Program, in partnership with a consultant, completed in-depth population health readiness assessments for four independent, rural hospitals. The assessments were largely focused on data collection and analytics capacity of each facility. Several challenges and barriers were identified that were consistent across all four hospitals: not having a dedicated analytic resource, not having integrated data beyond the EMR, recognizing there are opportunities to improve clinical outcomes but are unsure how and where to look. In conjunction with the CDC funds for Health Equity, the OPCRH is pursuing an RFP to continue the work that was started with the four hospitals. The work will include providing data integration and analytics platform as well as providing training and consulting services specific to CAHsregarding implementation of the platform and increasing staff knowledge and capacity to collect, analyze, and utilize the data to better identify and understand the needs of their communities.

Rural Emergency Medical Services (EMS) Improvement (please complete this question if completed on the cooperative agreement application)

The Utah Flex Program works with the Bureau of Emergency Medical Services and Preparedness (EMSP) in the Utah Department of Health to monitor and address the EMS needs of CAH communities. The Bureau of EMSP provides Rural Trauma Team Development courses (RTTDC) and high-performance Cardiopulmonary Resuscitation (CPR) training to rural hospital and EMS agencies. The Bureau of EMSP also assists CAHs in becoming recognized as stroke-receiving facilities and/or achieving trauma designations. This year, the Flex Program is working with the Bureau of EMSP to plan and conduct a Rural EMS Agency Medical Director’s Workshop to improve the quality of EMS care and the management of time-sensitive diagnosis as well as providing technical assistance for data reporting. Finally, the Bureau of EMSP conducted needs assessments with many of the rural EMS agencies in the state and developed subsequent action plans with each agency based on the findings of each individual assessment. The Bureau of EMSP employs three Rural EMS Liaisons who are tasked with working closely with each of the rural agencies on implementing their action plans.

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

There are a total of 13 CAHs in the state of Utah. Of those 13, eight are independent and five are part of a larger health system. In 2013, the UHA facilitated the development of a formal network of rural independent hospitals, known as the Rural 9 Network. All of the rural independent CAHs and one additional rural non-CAH participate in this network. The network has articles of incorporation and by-laws, with the board chair position filled by one of the rural hospital CEOs. There have been a number of successful programs implemented to help this network improve financially and operationally. For example, the network entered into an agreement with a law firm in the state to provide unlimited initial legal advice and assistance for a nominal monthly fee. Some other examples include a common insurance broker for property insurance, mobile magnetic resonance imaging (MRI), group purchasing organization (GPO) services, leadership development trainings, compliance and regulatory trainings, compliance assessments, and governance board training.

The Rural 9 Network has also created a number of functional cohort groups that meet quarterly to share best practices. In the past year, two new groups have been formed. Some of the active groups include:

  • Chief Executive Officers CEOs
  • Chief Financial Officers (CFOs)
  • Chief Nursing Officers (CNOs)
  • Pharmacists
  • Human Resource (HR) Managers
  • Health Information Management (HIM)/ Billing Office (BO)
  • Risk Managers
  • Quality Managers
  • IT Directors
  • Governing Board Chairs

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

In 2018, the Utah Flex Program began collecting MOUs from all participating CAHs to utilize the Quality QHI data management and benchmarking platform from the Kansas Hospital Association. Utah CAHs are in the process of selecting a set of quality and financial measures to track using the QHI platform for benchmarking purposes and increased peer sharing.

Please describe how your state Flex Program is reaching out to non-traditional partners to support its work.

The Utah Flex Program was awarded the Rural Veterans Health Access Program and has coordinated with various agencies and organizations to increase coordination of care for veterans in their rural communities. This has included funding subgrants to organizations that assist veterans with accessing Veterans Affairs (VA) benefits to be better able to connect with local healthcare facilities; working with VA National Telemental Health HUB to expand their program into rural communities; and performing a rural veterans needs assessment to help agencies that serve veterans to be informed of the needs of the veterans across the state.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 1.3
Website Organization Website
Number of CAHs 13

Flex Program Staff

Liz Craker
Flex Coordinator, Utah
(801) 604-2856

Flex Coordinator since June 2022

Ashley Moretz
State Office Director, Utah
(801) 273-6605

State Office Director since February 2020

Mason Payne
Health Systems Specialist, Utah
(801) 638-9566

Health Systems Specialist since June 2021

Greg Rosenvall
Rural Hospital Development Director, Utah
(801) 793-0426

Specialty Areas / Background

Prior critical access hospital administrator (CAH) for 15 years


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, $1,560,000 (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.