Vermont State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

Vermont Flex continues to work with the Vermont Program for Quality in Health Care (VPQHC) as a subcontractor to manage a network of quality directors and staff from the state's eight critical access hospitals (CAHs) and one additional Small Rural Hospital Improvement Grant Program (SHIP)-eligible hospital. This Quality Network collaborates to increase reporting, processes and clinical outcomes in all four Medicare Beneficiary Quality Improvement Project (MBQIP) domains.

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: 

Since 2015, six out of eight CAH hospitals have begun reporting on all Emergency Department Transfer Communication (EDTC) measures. In Quater 1 of 2016, four CAHs were reporting all EDTC measures and one was only reporting some measures. In Quarter 2, those five were reporting all EDTC measures and in Quarter 3 a total of six of eight CAHs were reporting all EDTC measures. 

Program Area: Support for Financial and Operational Improvement: 

Each year Vermont convenes the Rural Health Summits in two to three rural or CAH communities. These summits include leadership from hospitals, federally qualified health centers (FQHCs), rural health clinics (RHCs), free clinics, long term care, home health, dental and mental health and other health care providers, as well as leaders from public health, housing, transportation, anti-poverty, community action, violence prevention and insurers. Topics include a review of hospitals' recent community health needs assessments and implementation plans, other key health-related issues in the community, rural health resources from the state and national partners and identification of opportunities for collaborative local or policy improvements.

During a 2015 Summit, Vermont identified a possible change in statute that would alleviate an issue of patients with mental health crises becoming backlogged in emergency departments because they could not be legally transferred to local mental health agencies or to the state psychiatric hospital where space was available.

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

In December 2016, Vermont Flex started conversations with the new state Emergency Medical Services (EMS) director about a possible pilot study on the potential impact of community paramedicine in one or more communities in Vermont. Flex would compare data on one to two months of EMS transports to Emergency Departments to identify the following:  

  • Frequency distribution of all visits
  • Billed claims on select avoidable visit types
  • EMS transport records/notes for those visits
  • EMS operator impressions of underlying issues for patients
  • Suggestions/plans of what can be done to prevent avoidable Emergency Department (ED) visits
  • Estimate costs savings if avoidable visits were prevented (one of these strategies might be using shared savings for community paramedicine or other local preventive care activities to prevent avoidable emergency transports, admissions and costs)

After some refinement, this study might be repeated in several other hospital service areas and if successful, could then be rolled to the full state.

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): 

CAH Quality Network: Vermont Flex continues to work with VPQHC to manage a quality network of quality directors and staff from the state's eight CAHs and one additional SHIP-eligible hospital. The Network meet periodically to share information about collecting and reporting MBQIP measures and other quality improvement issues. In November 2016, guest speaker Karla Weng, Senior Program Manager, from Rural Quality Improvement Technical Assistance (RQITA), Stratis Health, presented on all four MBQIP domains as well as trends in quality reporting.

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

Vermont continues to work with Flex and State Office of Rural Health (SORH) program staff from neighboring states on the New England Performance Improvement (NEPI) initiative through the New England Rural Health RoundTable. Through NEPI, rural hospital leaders and staff have access to a wide range of discounted or free online courses and webinars through the Institute for Healthcare Improvement (IHI), as well as certifications in Patient Safety, Healthcare Quality, Healthcare Risk Management, Infection and Disease Control and Trauma Nursing.

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

John Olson
State Office Director, Vermont
(802) 951-1259

Specialty Areas / Background Areas

  • Budgeting for multi-funded projects
  • Coalition building
  • Meeting/Process facilitation
  • Grant writing
  • Program development

State Office Director since March 2010


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.