Outcome Measures for State Flex Program Financial and Operational Improvement Interventions

Document Type

Policy Brief

Publication Date



MRHRC, rural, financial, outcome measures, State Flex Programs, hospitals, Critical Access Hospitals


This brief provides a detailed look at outcome measurement issues for State Flex Program (SFP) interventions conducted under Program Area 2: Financial and Operational Improvement (FOI), a mandatory area of SFP activity. It presents a set of short- and intermediate-term FOI measures for common categories of FOI interventions. Given that SFPs tend to focus primarily on output and long-term, high-level outcome measures, these short- and intermediate-term outcome measures provide a bridge between project activities and long-term outcomes within the course of the funding cycle. The brief describes a set of common FOI interventions as well as the theory of change and a set of short- and intermediate term measures for each intervention. Efforts to document the impact of SFP initiatives on Critical Access Hospital (CAH) performance would be supported by: • Implementing collaborative learning initiatives to provide a unified, structured framework to coordinate SFP FOI activities across the Flex Program funding cycle. • Reducing the emphasis on outputs and increasing the emphasis on short-, intermediate-, and long-term outcome measures. • Structuring SFP requests for proposals to request that contractors identify short-, intermediate-, and long-term outcome measures; baseline data; actionable outcome targets; and a realistic timeline to reach performance targets as part of their work products.

A companion brief (https://www.flexmonitoring.org/publication/monitoring-state-flex-program-financial-and-operational-improvement-activities) provides an inventory of all SFP FOI initiatives and a more detailed analysis of the interventions undertaken by a subset of 14 SFPs.

FMI: John Gale, john.gale@maine.edu


rural health, financial management, outcome measurement, hospitals,


This report was completed by the Flex Monitoring Team with funding from the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS), under PHS Grant No. U27RH01080. The information, conclusions, and opinions expressed in this document are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Funding Organization

HRSA-Federal Office of Rural Health Policy

Grant Number

PHS Grant No. U27RH01080