North Highland partnered with a state health agency to strengthen Critical Access Hospitals through the federally funded Medicare Rural Hospital Flexibility (Flex) Program. Over eight years, we developed a sustainable support infrastructure that enhanced clinical quality, strengthened financial performance, and built lasting improvement capabilities across rural healthcare systems serving remote communities.
The Challenge: Sustaining Rural Healthcare Access
Rural communities depend on Critical Access Hospitals for healthcare access, yet these small facilities face relentless pressure. A state health agency's Office of Rural Health confronted a challenge: how to help hospitals with 25 or fewer beds survive mounting financial strain, workforce shortages, and evolving federal quality standards while serving the state's most geographically isolated communities.
The stakes were high. Without sustained support, these healthcare lifelines risked closure, leaving vulnerable populations without access to emergency care, primary services, or specialty treatments. The agency needed a partner to deliver customized technical assistance across three federally mandated pillars—Quality Improvement, Operational and Financial Performance, and Population Health—while helping hospitals maintain program eligibility and secure continued federal funding.
Our Approach
North Highland built a sustainable transformation engine through a repeatable three-phase methodology customized to each hospital's reality.
- Discovery and Planning established the foundation. Teams aligned objectives with federal requirements, secured commitment through Memorandums of Understanding, and gathered peer benchmark data nationwide. Every hospital started with clear expectations and measurable goals grounded in comparable facility performance.
- Assessment brought clarity to complexity. Comprehensive site visits with senior management documented financial and quality practices in detail. Gap analyses compared each hospital against peer benchmarks, revealing specific improvement opportunities backed by data and best practices rather than generic recommendations.
- Delivery transformed insights into lasting capability. Customized CEO reports gave each hospital actionable roadmaps for improvement. Training webinars and site-specific sessions addressed unique challenges across all program pillars. Annual two-day virtual or in-person conferences connected hospitals with national experts and peer networks. All materials lived on a jointly administered website, creating an enduring knowledge base accessible beyond initial delivery.
What set this engagement apart was continuity through change. As leadership transitioned within the Office of Rural Health, North Highland ensured seamless knowledge transfer to new directors and coordinators. Subject matter experts and specialist subcontractors brought insights from successful programs in other states, enriching strategy and accelerating results.
Value Delivered
- Clinical excellence became the standard. Hospitals achieved 80.7% overall hospital ratings, crushing the 76.0% national average of peer-state benchmarks. Patient satisfaction soared to 79.3% willingness to recommend compared to the 73.8% benchmark. Clinical quality indicators reached exceptional levels: 100% antibiotic stewardship implementation versus 91.3%, and a remarkable 0.0 healthcare-associated infection rate compared to the 0.7 national benchmark.
- Financial performance transformed. Participating hospitals delivered 33.16% growth in three-year operating revenue, outpacing national benchmarks. Strong margins emerged across the board—6.20% total margin and 4.82% operating margins substantially exceeding most comparable states and securing these hospitals' futures.
- Program effectiveness earned validation from those who matter most. Hospital administrators rated North Highland's support highly for quality improvement initiatives, operational and financial sustainability, and ensuring high-quality rural healthcare delivery.
- Infrastructure for sustained success took root. North Highland helped shape a Critical Access Hospital Quality Collaborative focused on priority areas identified through comprehensive program evaluation. Hospitals gained quality improvement toolkits, data-driven decision resources, and peer networks supporting ongoing collaboration beyond the engagement.
By consistently meeting federal funding guidelines, participating hospitals secured continued access to resources for quality, financial, and population health initiatives. Rural communities-maintained access to essential healthcare services, and hospitals built the capabilities to sustain improvement independently—the true measure of transformation success.
Is your rural healthcare system ready to achieve exceptional clinical quality while strengthening financial sustainability? Let's discuss how North Highland can help you transform rural health systems and secure rural communities' healthcare access for the long term.