Quality and performance improvement are fundamental components for provider participation in the Medicare program and this focus is well-represented under the Medicare Rural Health Flexibility Program (Flex Program). Grants to states under the Flex Program promote activities that support improvement in clinical quality and operational and financial performance. During the 2005 grant year, states proposed quality and performance improvement activities representing 30 percent of requested funding. This briefing paper provides an in-depth description of activities proposed by states during the 2005 grant year and provides Flex administrators and other stakeholders ideas to consider as they address their own state issues.

Key Findings:

• States proposed many activities recommended within the federal guidance, including widespread use of the balanced scorecard approach, participation in national quality improvement efforts, and development of relationships with state Quality Improvement Organizations and networks supporting quality and performance improvement efforts.
• State Flex Programs are furthering the ability of hospital administrators, quality managers, and others to participate in quality improvement activities and are undertaking activities to ensure the efficiency and financial stability of their business operations.
• States proposed needs assessments and planning activities to develop and finance future systems of existing HIT as well as pilot programs and upgraded systems to enhance links to other providers, improve availability of patient records, and improve patient safety.
• State Flex Programs have demonstrated a commitment to quality and performance improvement, with proposals spanning a range of clinical, operational, and financial themes.