The Medicare Rural Hospital Flexibility (Flex) Program funds initiatives to improve the health of rural communities under Program Area 3: Population Health Improvement, in order to build the capacity of Critical Access Hospitals (CAHs) to achieve measurable improvements in the health outcomes of their communities. This brief: 

(a) provides an overview of the expectations for Program Area 3; 
(b) summarizes State Flex Program (SFP) initiatives under this Program Area; 
(c) describes promising population health strategies implemented by SFPs; and 
(d) discusses outcome measurement issues for population health, including providing an example a chain of short, intermediate, and long-term outcome measures for a potential population health activity. 

It also describes a pathway to connect Flex Program population health efforts to the U.S. Department of Health and Human Services’ Healthy Rural Hometown Initiative (HRHI), a five-year multi-program effort to address the factors driving rural disparities in heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Finally, the brief provides resources for outcome measurement in population health.

A companion brief, An Inventory of State Flex Program Population Health Initiatives for Fiscal Years 2019-2023, provides a detailed description of population health initiatives proposed by the 45 SFPs.