Document Type

Policy Brief

Publication Date



Cutler, Population Health and Health Policy


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.


The Flex Monitoring Team is a consortium of the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine. With funding from the federal Office of Rural Health Policy (PHS Grant No. U27RH01080), the Flex Monitoring Team is cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program). The monitoring project is assessing the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals (CAHs); and engaging rural communities in health care system development.

Funding Organization or Grant

Funding from the federal Office of Rural Health Policy (PHS Grant No. U27RH01080)