At the TASC 90 / FORHP webinar on February 19, Nevada presented alongside us to walk through a real Flex-funded initiative implemented with their Critical Access Hospitals.
The session focused on practical lessons and replicable approaches grounded in documented results.
For many state Flex programs, the central challenge right now is execution. Funding must translate into measurable financial sustainability, and outcomes must be clearly documented for stewardship and reporting. Nevada offered a practical example of how to do both.
Start Small. Prove Impact. Expand Thoughtfully.
The initiative began with one hospital. There was understandable uncertainty about how much impact could be generated in a very small Critical Access Hospital. After early results demonstrated meaningful financial lift, Nevada expanded the work to four hospitals and is now adding a fifth.
One example shared during the webinar involved a 4-bed CAH with an average daily census of 0.12. A $25,000 Flex-funded engagement generated an estimated $640,000 in 12-month revenue lift, representing approximately a 25.6× return.
In a rural setting, that level of impact supports staffing stability, preserves access, and strengthens long-term viability. The size of the hospital did not limit the significance of the outcome.
Just as important as the financial results was the structure of the partnership. Nevada remained actively involved throughout the engagement. The state team participated in recurring working sessions, maintained visibility into progress, and helped address participation challenges when needed.
That shared ownership model among state, hospital, and partner improved engagement and follow-through.
Education, Structure, and Clear Expectations
The engagement was designed to support hospital teams, not overwhelm them. Weekly cadence, defined roles, and explicit participation expectations were established at kickoff.
Hospitals agreed to share data, validate findings, implement recommendations when feasible, and document barriers when they arose.
This upfront clarity reduced friction later. Everyone understood the time commitment, the accountability structure, and the expected outcomes.
Data stewardship was also built into the process from the beginning. Agreements specified what data would be shared, how it would be transmitted, and how outcomes would be reported back to support FORHP requirements.
By designing for reporting at the outset, Nevada ensured the state received the information needed to demonstrate impact.
Translating ROI Into Meaningful Impact
Return on investment was carefully measured and documented.The team tracked the progression from recommendation to implementation to financial outcome. They then translated those financial gains into operational implications that leadership and policymakers could understand.
Financial lift affects payroll stability. Payroll stability affects workforce retention. Workforce retention protects access for rural communities. Connecting those dots is essential when reporting the value of Flex-funded work
A Replicable Framework for State Flex Programs
Nevada’s experience can be organized into a simple sequence that other states can adapt. The work began by identifying a financial sustainability use case grounded in data and hospital input. Participation expectations and data-sharing requirements were defined before launch. Recurring working sessions included state involvement. Implementation was tracked, ROI was quantified, and outcomes were translated into stewardship reporting.
The guiding principle was shared ownership. When states remain engaged alongside hospitals and partners, engagement strengthens and documentation improves. The result is measurable financial stability that can be clearly communicated.
Next Steps for States Ready to Act
The webinar concluded with practical guidance for states interested in replication. Begin by identifying a near-term financial sustainability priority supported by data and hospital input. Draft participation and data-sharing expectations before kickoff. Establish a plan for reporting ROI and impact back to FORHP. Leverage TASC 90 for technical assistance on contracting, reporting, and peer learning.
These steps provide a path from funding to documented financial sustainability.
