Implementation of the Flex Program's Innovative Models Program Area: Final Evaluation Report

Document Type

Briefing Paper

Publication Date



Rural, Flex Program, hospitals, innovation, Critical Access hospitals, MRHRC, rural hospitals, telehealth, care coordination, quality improvement


In the Fiscal Year 2015 Medicare Rural Hospital Flexibility Grant Guidance, the Federal Office of Rural Health Policy added a new, optional program area focused on rural health system innovations – Program Area 5: Integration of Innovative Health Care Models (Innovative Projects). This new program area allowed states to address needs not covered by the other core areas of the grant program and use Flex Program funding to undertake “innovative” projects with their Critical Access Hospital (CAH) partners to improve CAH quality, financial, operational, population health, and system delivery performance. The intent was to encourage states to test new approaches to supporting CAHs and rural communities that could provide best practice models for other State Flex Programs.

In 2017, researchers with the Flex Monitoring Team at the University of Southern Maine undertook a 15-month evaluation of the activities under Program Area 5, with a focus on projects involving telehealth, care coordination, and quality improvement. In our January 2018 briefing paper, An Interim Evaluation Report of the Innovative Projects Portfolio of the Medicare Flex Grant Program, we provided an overview of the Innovative Projects proposed by the 16 states, and a more detailed examination of seven states’ projects and their early implementation experience. This paper provides a more detailed discussion of implementation of the Innovative Projects by these seven states and the factors that affected their ability to successfully implement their projects. The final sections summarize evaluation findings, key lessons, and the broader implications for the Flex Program.


For more information on this study, please contact John Gale at

Funding Organization

Federal Office of Rural Health Policy