Washington State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

Support in this area includes:

  • Quality improvement (QI) leadership, training and technical assistance guided by critical access hospitals (CAH)
  • QI Directors Advisory Committee, in partnership with the Washington State Hospital Association (WSHA) and Qualis
  • QI training: basics for new directors, Medicare Beneficiary Quality Improvement Project (MBQIP) information, how to use the data being collected to identify what is important and what to do about it
  • Certified Professional in Healthcare Quality (CPHQ) study materials and exams for quality improvement staff at CAHs in conjunction with Quality Improvement Leadership forums put on in collaboration with WSHA
  • Supporting CAH participation in reporting MBQIP and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures to QualityNet and the Centers for Medicare & Medicaid Services (CMS) Abstraction and Reporting Tool (CART) through virtual and in-person technical assistance
  • Education and training webinars for Antibiotic Stewardship requirements through collaboration with the Healthcare Associated Infections Program at the Washington State Department of Health
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: 

Washington has contracted for the second year with a QI “hands-on” consultant whose background included working in a CAH extracting data and reporting measures. In the first year, the consultant designed a MBQIP workshop that was rolled out on each side of the state. As part of the workshop the consultant compiled a MBQIP Desk Manual, which included resources, explanations of accessing CART and tips to extracting data. The manual was so well-received that for FY2016 the consultant is updating the Manual and will be repeating the workshops for all new QI CAH staff and those that may have missed the first workshop. In addition, the consultant will be assessing the CAHs and their readiness to report to identify which CAHs will need more onsite technical assistance.

Program Area: Support for Financial and Operational Improvement: 

The Flex Program is providing funding for 12 financially distressed CAHs to obtain financial or operational assessments (i.e., chargemaster updates and billing compliance reviews, departmental efficiency assessments and possibly other topics). Washington Flex participates in a workgroup of 13 CAHS and two other state agencies, called the Washington Rural Health Access Preservation (WHRAP) group, to assist the CAHs that are on the brink of closure to prepare for value-based purchasing and alternative payment models.

The Washington Rural Health Collaborative developed a financial needs assessment tool that was presented to the WRHAP group for use among the CAHs. Plans are being developed for the state rural health association, Washington Rural Health Association (WRHA), to conduct a Chief Financial Officer (CFO) financial forum in 2017.

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

In 2017, Washington Flex will offer a four-module leadership/operational training workshop to rural emergency medical service (EMS) directors to strengthen quality and performance improvement competencies as well as leadership skills. The Flex Program will also announce a Population Health Request for Proposal (RFP) that CAHs can propose for potential funding for projects relating to population health improvement.

Please provide information about Collaboration/Shared Services (specifically connected to population health management): 

Washington Flex is supporting statewide development of a new Stroke Triage Tool initiated in each county through the EMS Regional Councils and local county stroke teams. This will include the development of revised county level protocols. The tool is being introduced in two launches on each side of the state, and will include EMS teams as well as other teams such as prevention, post-acute (home health, rehabilitation in a skilled nursing facility), primary care and other local community resources.

Washington supports the annual Northwest Rural Health Conference by providing program development as well as scholarships to local teams from the state's CAHs and EMS agencies to attend. For the first time last year, the state put rural EMS in the milieu with the CAHs and facilitated discussions about the coordination between settings and established more intentional partnerships between CAHs and EMS. This approach was well-received and assisted in setting a new record for conference attendance.  The Flex Program is currently planning the next regional conference for the end of February and will again offer EMS topics to the conference.

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

Washington Flex has partnered with the US Department of Agriculture (USDA) and Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy to provide a funding workshop that was performed on each side of the state, bringing together state and federal resources that provided an opportunity to support the CAHs in innovation planning.

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

Washington Flex actively participates in the Washington Rural Health Access Preservation workgroup which includes 13 CAHs, the Washington State Hospital Association, the Department of Health, the Health Care Authority and a national expert in value-based purchasing.

Washington Flex funds the Washington Rural Health Collaborative Network (WRHC) Leadership training for physicians and CFOs for value-based purchasing.

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 Flex Program funds Washington state networks, WRHC and Washington Rural Health Network (WRHN), in developing the use of the QHi reporting portal among their CAH members. This allows both QI and financial data to be entered and extracted, stimulating conversation around improvements as they compare their performance with other CAHs in their group. Many improvement projects have initiated from this comparison and conversation.

Washington Rural Health Collaborative: Twelve CAHs working on clinical quality improvement, financial improvement and accountable care organization (ACO) development. All but one CAH is on the west side of the state.

Northwest Rural Health Network: This network includes 14 CAHs and one rural sole community hospital. The network has worked primarily on health information technology (HIT) and care coordination. The network has a CFO group that meets regularly and are looking at developing an ACO. Specifically, the goals include:

    • Improve the quality and delivery of both behavioral and primary care health services in four rural counties in eastern Washington
    • Strengthen the rural health care system by establishing local public-private partnership organizations in four rural counties in eastern Washington
    • Expand impact with shared best practices and results

Public Hospital Joint Operating Board: This board is comprised of 18 hospitals that have an agreement to negotiate joint contracts with health insurers. This group is working on preparing for value-based contracting.

The Washington State Hospital Association (WSHA) provides an online monthly QI Leaders forum bringing in topics of relevance and speakers. This a well-attended forum of great value to CAH QI staff.

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

The Flex Program is working with their Quality Innovation Network (QIN), Association for Professionals in Infection Control and Epidemiology (APIC) and the Department of Health Healthcare Acquired Infection Section to develop a new Infection Preventionist (IP) training and professional development program designed specifically for CAHs. Collaborative work with Rural Quality Improvement Technical Assistance (RQITA) provides support for the Medicare Beneficiary Quality Improvement Project (MBQIP) and other QI activities. Washington Flex is currently in an eight-month long, in-depth TA program with RQITA to better serve the state's CAHs.

Within the Washington State Department of Health Office of Rural Health there is collaboration among the federal Small Rural Hospital Improvement Grant Program (SHIP), State Office of Rural Health (SORH), the Stroke Program, Workforce and J1 Visa program, EMS and Trauma services.

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

MBQIP reporting workshops are needed at a minimum on an annual basis. Quality Improvement staff in Washington CAHs have an incredibly high turnover. The majority of Washington CAHs want to complete the data reporting on time and accurately, but they just do not have the staff with the knowledge or ability to complete the reporting due to turnover. By having an annual workshop with subsequent follow-up, the Flex Program is able to ensure that new staff are trained and seasoned staff are receive a refresher and learn new reporting measures. This has proved to be successful in increasing the likelihood of accurate and timely reporting from the CAHs.

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

Pat Justis
State Office Director, Washington
(360) 236-2805

Specialty Areas / Background

Patient-Centered Medical Home Collaboratives both statewide and regional, expertise in quality improvement, primary care pratice transformation, patient safety, patient and employee experience.

State Office Director since August 2014

Lindy Vincent
Flex Coordinator, Washington

Flex Coordinator since March 2016

Danielle Kunkel
Flex Quality Improvement Coordinator, Washington
(360) 236-4863

Flex Quality Improvement Coordinator since August 2016

Bonnie Burlingham
State Office of Rural Health Grant Manager, Washington
(360) 236-2819

Specialty Areas / Background

  • Public and rural health
  • Rural health clinics (RHCs)
  • Strategic planning

Grant Manager since September 2013 

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.