Wintergreen_MS_Flex_20260727 (2).pdf

Response to IFB RFx No. 3160008132 FLEX FY26: Financial and Operational Improvement for Mississippi's Critical Access Hospitals

Mississippi Office of Rural Health Review Team:

Wintergreen appreciates the opportunity to submit this response to the Mississippi State Department of Health for FLEX FY26: Financial and Operational Improvement for Mississippi's Critical Access Hospitals.

Wintergreen is a Maine-based rural healthcare consulting firm focused on helping rural hospitals and clinics make practical, measurable, and sustainable improvements in financial performance, operations, quality, and community value. Our work reflects the rural values of collaboration, simplicity, and practicality.

Of note, Wintergreen is already serving Mississippi's rural healthcare system as the Mississippi Small Rural Hospital Improvement Program (SHIP) grant vendor. This Flex application therefore is a deliberate continuation and expansion of Wintergreen's current Mississippi rural hospital work, carried forward with the Mississippi Rural Health Association (MRHA) and the Mississippi Rural Hospital Alliance (MS Rural Hospital Alliance) as proposed subcontractors and statewide partners. Through the SHIP work, Wintergreen has built a practical platform for rural hospital communication, engagement, education, and technical assistance in Mississippi. This Flex proposal builds on that platform so Mississippi's CAHs receive braided, coordinated support rather than fragmented grant activity.

The two-year contract period (September 1, 2026 through August 31, 2028) provides an important opportunity to move beyond assessment into sustained implementation. Wintergreen's proposed approach is designed specifically around the IFB's required deliverables. The work will be supported by quarterly reporting to the Mississippi Office of Rural Health Flex Coordinator, timely submission of deliverables, and a final comprehensive report.

We understand that Mississippi's CAHs face a difficult operating environment marked by low volumes, workforce constraints, payer and reimbursement complexity, revenue cycle pressure, cash-flow stress, and the need to protect local access to essential services. Our proposed model is intentionally implementation-oriented. We will use the statewide assessments to identify the most vulnerable hospitals and the highest-value interventions, then connect statewide education with hospital-specific technical assistance, market intelligence, chargemaster improvement, and sustainability planning. Wintergreen looks forward to continuing its partnership with the Mississippi Office of Rural Health, Mississippi Rural Health Association, Mississippi Rural Hospital Alliance and the Mississippi's CAHs to strengthen rural hospital financial sustainability and preserve access to care across Mississippi.

Respectfully submitted, Jonathan Pantenburg President, Wintergreen

Wintergreen Mississippi Flex Response

Scope of Services Response

3.1 Prior Experience

Collectively, Wintergreen advisors have been in business providing healthcare consulting services for more than eighteen years, exceeding the IFB's minimum requirement of fifteen years of experience providing goods and services similar in requirements and scale to those described in this IFB. Our firm has provided financial, operational, and strategic consulting services to Critical Access Hospitals, rural hospitals, rural health clinics, and healthcare organizations throughout the United States since its founding. Wintergreen's principals and consultants have individually accumulated decades of additional healthcare executive and advisory experience prior to joining the firm.

Wintergreen's current role as Mississippi's SHIP grant vendor demonstrates recent, directly relevant experience providing statewide rural hospital improvement services in Mississippi. Through the SHIP engagement, Wintergreen is already working within Mississippi's rural hospital environment, coordinating with the Mississippi Rural Health Association and Mississippi Rural Hospital Alliance, and delivering technical assistance to Mississippi's small rural hospitals. This Flex application continues that partnership and extends it to the CAH-specific financial and operational improvement scope described in this IFB.

3.2 Required Certifications, Accreditations, and Licenses

Wintergreen is registered to do business with the State of Mississippi as required by the IFB. We will provide notarized copies of all valid licenses and certificates required for performance of the work no later than ten days after receiving the Notice of Intent to Award and will provide current notarized copies within twenty-four hours of demand at any time during the contract term, as required by Section 3.2 of the IFB.

3.3 Financial Stability or Solvency

Wintergreen is a private for-profit corporation and not required to receive an annual financial audit.

The firm is financially solvent and demonstrates strong financial performance, with the resources and stability to meet its contractual obligations. Sound fiscal management, consistent operating results, and a strong balance sheet ensure the firm's ability to deliver high-quality services throughout the duration of client engagements.

3.4 Ability to Perform

Wintergreen has the necessary facilities, ability, and financial resources to provide the services specified in this IFB. Wintergreen's qualifications include:

• The ability, capacity, skill, and financial resources to perform the work required. Wintergreen maintains a team of experienced rural healthcare consultants with direct CAH executive, financial, operational, and advisory experience. Wintergreen's current Mississippi SHIP engagement demonstrates active capacity to deliver statewide rural hospital improvement services.

• The ability to perform the work promptly and within the time specified without delay or interference.

Wintergreen's proposed team is available for immediate deployment upon contract execution.

• Character, integrity, reputation, judgment, experience, and efficiency. Wintergreen has never had a contract terminated for cause or default. Wintergreen's principals have served as rural hospital executives (CFO, COO, CNO) and have provided consulting services to rural hospitals, state offices of rural health, and federal grant programs across multiple states.

• Quality of performance of previous contracts or services. Wintergreen's current Mississippi SHIP grant performance demonstrates quality delivery of statewide rural hospital improvement services.

Wintergreen has also provided similar services under Flex and other federal rural health programs in other states.

3.5 Insurance

Wintergreen will ensure that professional staff and other decision-making staff carry professional liability insurance in an amount commensurate with the professional responsibilities and liabilities under the terms of this IFB. Wintergreen will obtain, pay for, and keep in force during the contract period general liability insurance against bodily injury or death in an amount commensurate with the responsibilities and liabilities under the terms of this IFB. Insurance carriers will be licensed or hold a Certificate of Authority from the Mississippi Department of Insurance. We will provide certificates of insurance upon request.

4.1 Scope of Services To Be Performed

Wintergreen will perform the services required under Program Area 2: Financial and Operational Improvement. The proposed work focuses on improving Critical Access Hospital financial stability, operations, and efficiency by identifying CAHs with greater needs and implementing practical interventions to address those needs. We will employ a statewide needs assessment process to guide the project and will integrate education, technical assistance, chargemaster review, market share and outmigration analysis, action planning, sustainability planning, and implementation support.

Our approach is especially well suited to Mississippi because it builds directly on Wintergreen's role as Mississippi's SHIP grant vendor and on Wintergreen's ongoing relationship with statewide rural hospital partners. For this Flex response, Wintergreen proposes the Mississippi Rural Health Association and the Mississippi Rural Hospital Alliance as subcontractors. These subcontractors will help support outreach, meeting coordination, statewide partner alignment, CAH engagement, and sustainability of implementation activity, while Wintergreen remains responsible for all contract performance, deliverables, quality assurance, and reporting to Mississippi Department of Health (MSDH).

Deliverable 1. Statewide Needs Assessment

Wintergreen will complete one statewide needs assessment during each of the two contract years to identify, during that 24-mont program period, at least twelve (12) vulnerable hospitals as priority candidates to receive chargemaster reviews, receive action plans, and identify CAHs that will most benefit from additional financial resources and training. The first assessment will be the organizing foundation for the full Flex project because it will establish baseline conditions, identify priority needs, and match CAHs to the interventions most likely to produce measurable improvement. The second assessment, conducted during the second half of the proposed 2-year contract period, will evaluate progress, update vulnerability indicators, identify emerging needs, and inform sustainability planning and any necessary course corrections.

The assessment(s) will combine quantitative data analysis and stakeholder input. Quantitative sources may include Medicare cost reports, CAHMPAS and Flex Monitoring Team measures where applicable, hospital-submitted financial and utilization information, revenue cycle indicators, service-line information, payer mix information, public data, and data available through MSDH. Qualitative input will be obtained through structured conversations with MSDH, Mississippi Rural Health Association, Mississippi Rural Hospital Alliance, CAH leaders, CFOs, revenue cycle leaders, and other stakeholders approved by MSDH.

Each assessment will evaluate operating and total margin, cash-flow pressure where available, cost structure, revenue cycle performance, payer mix, reimbursement dependency, outpatient and ancillary utilization, market leakage indicators, service-line opportunity, chargemaster and charge capture risk, clinic integration, and readiness for implementation support. Wintergreen will prepare a statewide summary report, a prioritization methodology, and a list of at least twelve vulnerable CAHs recommended for action planning and additional support.

Table 1. Statewide Assessment Methodology Summary

Component Wintergreen Approach Output

Data inventory Identify state, federal, public, and hospital-submitted data relevant to CAH vulnerability and performance.

Approved data request and data inventory.

Financial review Assess margin, cash-flow pressure, payer mix, cost structure, revenue cycle risk, and reimbursement indicators.

Financial vulnerability findings.

Operational review Review service-line, clinic, utilization, chargemaster, and operational opportunity indicators.

Operational opportunity themes.

Stakeholder input Gather structured input through MSDH-approved engagement with hospitals and statewide partners.

Qualitative findings and implementation considerations.

Prioritization Identify at least twelve (12) vulnerable CAHs and recommend matching interventions.

Prioritized CAH list and intervention recommendations.

Progress assessment (Assessment 2)

Reassess vulnerability indicators, evaluate progress, and update recommendations.

Updated vulnerability findings and sustainability recommendations.

Deliverable 2. Revenue Cycle Management Roundtable Meetings and Educational Sessions

Wintergreen will conduct two (2) meetings per year of roundtable meetings and educational sessions to assist hospital CFOs with improving the financial processes needed to manage facility functions. One (1) session must be held live, in-person, in a central Mississippi location. Twenty-eight (28) CAHs are available to participate. Wintergreen proposes two annual roundtable sessions per year, for a total of four sessions across the 2-year contract period, consistent with the IFB bid form.

The CFO roundtables will be designed in coordination with MSDH and informed by the statewide needs assessment findings. Topics may include CAH financial dashboards, revenue cycle performance, cash-flow management, payer-mix strategy, cost-structure review, Medicare cost report considerations, chargemaster governance, denial prevention, service-line economics, market opportunity, and sustainability planning. Each session will include practical tools, examples, and implementation guidance.

Wintergreen will leverage its Mississippi SHIP grant-vendor infrastructure and the support of the Mississippi Rural Health Association and Mississippi Rural Hospital Alliance, subject to MSDH approval, to support communication and participation. This coordination will help ensure that Flex education complements, rather than duplicates, other Mississippi rural hospital education and technical assistance activity.

Table 2. Revenue Cycle Management Roundtable Proposed Model (Two-year Period)

Roundtable Proposed Focus Area Format

Roundtable 1 Statewide financial vulnerability themes, CAH financial dashboards, and revenue cycle priorities.

Virtual or in person, as approved by

MSDH.

Roundtable 2 Cash-flow management, payer mix, reimbursement strategy, and Medicare cost report considerations.

Virtual.

Roundtable 3 Chargemaster governance, denial prevention, charge capture, and coding-to-billing controls.

Live, in person in central Mississippi.

Roundtable 4 Service-line economics, CAH market opportunities, outmigration findings, and sustainability planning.

Virtual or hybrid.

Deliverable 3. Market Share and Outmigration Assessments for Individual CAHs

During the two-year contract period, Wintergreen will help at least six (6) selected CAHs identify market opportunities for new patient services and opportunities to improve existing service lines through market share and outmigration assessments. CAH selection will be coordinated with MSDH and based on the statewide needs assessment, hospital readiness, data availability, and the likelihood that market analysis will lead to feasible financial and operational action.

The market studies will be built around ZIP code-based primary and secondary service-area analysis.

Wintergreen will not default to county-only market definitions because rural hospital markets often cross county lines, and county-based markets may include areas that do not actually draw to the hospital while excluding ZIP codes that do draw to the hospital. A rural hospital market study published in Health Services Research supports defining rural hospital market areas using ZIP code of patient origin rather than relying only on county boundaries. Wintergreen will therefore define each CAH's primary market as the group of ZIP codes or ZIP Code Tabulation Areas that produce the largest share of the CAH's relevant utilization, typically the ZIPs accounting for approximately 60 to 70 percent of inpatient, outpatient, emergency, clinic, or priority service-line activity. The secondary market will generally include the next tier of ZIPs, typically the next 15 to 25 percent of relevant activity, adjusted for adjacency, travel time, strategic importance, minimum volume, and local leadership input.

Wintergreen will combine publicly available utilization data with hospital-provided proprietary data. The public-data layer may include CMS Hospital Service Area data, which contains Medicare Provider Number, ZIP Code of Residence, Total Days of Care, Total Charges, and Total Cases for hospital and ZIP combinations. Wintergreen may also use CMS Medicare inpatient geography and service data, which provides Original Medicare Part A inpatient discharges by geography and MS-DRG, and CMS Medicare outpatient hospital provider-and-service data, which reports OPPS outpatient services by provider CCN and APC with beneficiary counts, services, charges, allowed amounts, and payments. The CMS outpatient data dictionary confirms provider, rurality, APC, beneficiary, charge, allowed-amount, and payment fields that can support benchmarking and service-line review.

Because public Medicare data alone cannot describe the complete, current, all-payer market, Wintergreen will request hospital-supplied proprietary data for each participating CAH. The request will include at least 24 to 36 months of patient-origin data by ZIP code, inpatient discharges, outpatient encounters, emergency department visits, swing-bed activity if applicable, rural health clinic activity if available, ancillary volume, priority service-line detail, payer class, provider or referrer where available, transfer or referral destination where available, and gross or net revenue indicators where appropriate. Public data will create the external baseline and benchmarking framework; hospital data will provide the current, all-payer, operationally specific picture that CAH leaders need for implementation.

The outmigration and leakage analysis will be practical and service-line specific. Wintergreen will compare the CAH's patient-origin and utilization data against public Medicare patient-origin flows, regional referral patterns, Dartmouth Atlas ZIP-to-Hospital Service Area and Hospital Referral Region crosswalks, and available hospital referral or transfer information. The analysis will identify ZIP codes where local residents appear to leave the CAH service area for services that may be clinically, operationally, and financially appropriate for the CAH to retain or recapture. Leakage opportunities will be categorized by service line, estimated volume, revenue potential, clinical feasibility, operational requirements, and implementation complexity.

Each participating CAH will receive a concise but actionable market study report. The report will identify the primary and secondary service areas, public-data benchmarks, CAH proprietary utilization patterns, inpatient and outpatient service opportunities, outmigration and leakage issues, potential recapture opportunities, referral and access barriers, revenue cycle considerations, implementation requirements, and recommended next steps. Wintergreen will focus on opportunities that are realistic for CAHs, such as outpatient diagnostics, therapy, infusion, specialty clinics, swing-bed optimization, chronic care management, transitional care management, provider-based rural health clinic alignment, emergency department-related outpatient services, and other services that fit local market demand and operational capacity.

Table 3. Market Assessment Process, Data and Deliverable Summary

Market Assessment Step Approach and Potential Data Sources Output

CAH selection Confirm six participating CAHs with MSDH based on vulnerability, readiness, and implementation potential.

Approved participant list.

Data intake Request public and proprietary data, including patient-origin ZIPs, inpatient and outpatient utilization, ED visits, referrals, transfers, payer mix, and service-line detail.

CAH-specific data inventory and validation notes.

Service-area definition Define ZIP/ZCTA-based primary and secondary markets using patient-origin volume, adjacency, travel time, and leadership validation.

Primary and secondary market tables and maps, as feasible.

Public-data overlay Use CMS, Census ACS, CDC PLACES, HRSA AHRF, and Dartmouth Atlas data to benchmark utilization, demographics, health need, and referral geography.

External benchmark and community opportunity profile.

Leakage analysis Compare public origin-flow information with hospital-supplied all-payer utilization, referral, and transfer data.

Outmigration and leakage findings by ZIP and service line.

Opportunity analysis Identify feasible new services and existing service-line improvement opportunities.

Hospital-specific market study and opportunity profile.

Action planning Convert findings into practical priorities and sustainability plan components.

Hospital-specific implementation priorities and next steps.

Deliverable 4. Billing and Coding Course

Wintergreen will provide a billing and coding course open to all CAHs two (2) times per Flex fiscal year.

One (1) session will be held live, in-person, in a central Mississippi location. The courses will be practical, rural-specific, and designed for finance, revenue cycle, coding, HIM, clinic, and operational leaders. Topics will include documentation integrity, charge capture, coding accuracy, claim readiness, CAH billing considerations, Medicare and Medicaid billing rules, denial prevention, and internal audit processes.

Wintergreen will use training materials, examples, checklists, and implementation tools. Participant feedback and common questions will be used to refine follow-up sessions and identify areas requiring additional technical assistance. As with the CFO roundtables, Wintergreen will coordinate with MSDH and, if approved, leverage the Mississippi SHIP grant-vendor platform and subcontractor support from the Mississippi Rural Health Association and Mississippi Rural Hospital Alliance to support outreach and participation.

Table 4. Potential Billing and Coding Topic Areas (FLEX FY Years 1 and 2)

Offering Proposed Focus Format

Training 1 CAH billing and coding fundamentals, documentation integrity, charge capture, and denial prevention.

Virtual or in person, as approved by MSDH.

Training 2 Applied coding-to-billing controls, claim readiness, revenue leakage, and internal audit tools.

Virtual.

Training 3 Live Mississippi CAH billing and coding workshop with case examples and implementation planning.

Live, in person in central Mississippi.

Training 4 Follow-up course addressing participant questions, recurring risk areas, and implementation lessons.

Virtual or hybrid.

Deliverable 5. Chargemaster Reviews for CAHs

Wintergreen will conduct twelve (12) chargemaster reviews per year (two reviews per year for six CAHs) for a total of 24 assessments during the 24-month contract period, to help identify and correct errors in list of procedures and related codes/charges, and work with the CAHs as a cohort to implement changes. Facility level tracking with outcomes, baseline, and goals are required. Consistent with Amendment #2 and the Q&A Report, Wintergreen will conduct 24 total chargemaster reviews over the two-year contract period (12 per year).

The chargemaster process will begin with an MSDH-approved data request and facility kickoff.

Wintergreen will request relevant chargemaster files, service-line information, procedure and code data, selected claims or utilization reports where available, payer considerations where appropriate, and policies or processes related to chargemaster maintenance. Wintergreen will evaluate procedure/code/charge alignment, potential duplications, omissions, outdated codes, inconsistent pricing structures, charge capture risk, revenue leakage, and governance gaps.

Each review will produce a baseline finding set and immediate correction opportunities. Wintergreen will meet virtually with each participating hospital to validate recommendations and develop a hospital-specific action plan. Follow-up implementation support will assess progress, identify remaining issues, and document outcomes. The cohort model will allow hospitals to learn from common themes while preserving the confidentiality of hospital-specific information. Over the two-year contract period, Wintergreen will complete 24 chargemaster reviews for up to 12 different CAHs (six per year), building a growing cohort of hospitals implementing improved chargemaster governance and charge capture practices.

Table 5. Chargemaster Review Summary of Hospital-specific Work Steps

Phase Wintergreen Approach Output

Selection and kickoff Confirm participating CAHs with MSDH and conduct kickoff meetings.

Facility participation plan and data request.

Review Analyze chargemaster data and related billing and coding controls for each selected CAH.

Baseline chargemaster review reports and issue logs.

Action planning Review findings and set facility-specific goals and corrective actions.

Facility-level action plan and tracking tool.

Cohort implementation

Support reviewed CAHs as a cohort to implement common improvement strategies.

Cohort technical assistance and implementation support.

Outcome tracking Reassess progress through implementation check-ins and document remaining gaps and outcomes.

Outcome tracking summary and final findings.

Reporting Requirements

Wintergreen will submit quarterly updates via email to the Mississippi Office of Rural Health's FLEX Coordinator. Each quarterly report will include a detailed update on activities performed, a report on overall operations, successes, project delays, and any proposed changes in the scope of work. Wintergreen will use the template provided by the Mississippi Office of Rural Health. Wintergreen will comply with the reporting periods and due dates stated in the IFB:

Table 6. Project Timeline and Reporting Summary

Reporting Period Due Date Report Focus

September 1 - November 30 December 7 Startup activities, needs assessment progress, hospital engagement, initial education planning, subcontractor coordination, and early findings.

December 1 - February 28 March 8 Needs assessment completion, CAH prioritization, roundtable/training delivery, selected CAH engagement, and implementation progress.

March 1 - May 31 June 7 Market analysis progress, chargemaster review implementation, education activity, action planning, and emerging outcomes.

June 1 - August 31 August 31 Final implementation, outcome tracking, sustainability planning, final findings, and closeout.

Wintergreen will ensure that the Mississippi Office of Rural Health's FLEX Coordinator and Director are included on ALL communications between the contractor, hospitals, and the Stakeholder Committee, including all emails, conference calls, and video calls about the activities, as required by the IFB.

4.2 Contractor Responsibilities

Wintergreen will assign Jonathan Pantenburg as the Contractor Account Representative to work directly with the Contracting Agency Representative. Wintergreen will ensure that all personnel performing project activities comply with applicable state facility requirements, including:

• Wearing visible ID when working on state property or participating in state-sponsored events.

• Adhering to non-smoking policies and the prohibition of illegal substances.

• Following sign-in and sign-out procedures at state facilities.

• Exercising precautions for the protection of persons and property.

• Abiding by all state and agency policies.

Wintergreen acknowledges responsibility for any damages caused by its personnel. Wintergreen will perform all services in accordance with customary and reasonable industry standards; applicable federal, state, and local laws; applicable healthcare regulations; and the methods and procedures required by MSDH. Wintergreen will be responsible for the supervision, direction, and quality of its personnel and subcontractors, if approved by MSDH.

Wintergreen will administer and maintain all employment and payroll records, payroll processing, and payment of payroll checks and taxes as required by state, federal, and local laws. Wintergreen will make all unemployment compensation contributions as required. Wintergreen will perform background checks and/or drug screening prior to placement if requested by MSDH. Wintergreen will replace immediately, at no additional expense to MSDH, any employee not performing satisfactorily.

Financial Analysis and Sustainability Planning

General Requirements

Wintergreen meets the general requirements described in the IFB. Wintergreen has extensive experience working with Critical Access Hospitals and rural healthcare settings. The firm has knowledge of Medicare and Medicaid regulations specific to CAHs, including reimbursement, cost reporting, rural health clinic integration, revenue cycle processes, and operational issues affecting rural hospitals. Wintergreen consultants have a proven record of improving operational metrics and financial performance in healthcare institutions and have served as rural hospital executives, CFOs, COOs, nursing leaders, clinic leaders, and healthcare advisors.

Wintergreen's model is tailored to each CAH's unique circumstances. The statewide needs assessments will identify statewide patterns and hospital-specific vulnerabilities, while the market share/outmigration assessments, chargemaster reviews, action plans, and sustainability plans will be adapted to each participating CAH. Wintergreen also has significant capacity to deliver training materials and facilitate workshops for hospital staff, including statewide education, CFO roundtables, billing and coding courses, cohort implementation support, and hospital-specific technical assistance.

Wintergreen's ongoing role as Mississippi's SHIP grant vendor strengthens its ability to meet these general requirements. Through the SHIP engagement, Wintergreen is already working within Mississippi's rural hospital environment. This Flex application continues that partnership and adds the Mississippi Rural Health Association and Mississippi Rural Hospital Alliance as proposed subcontractors to support statewide engagement, communication, and implementation alignment.

Table 7. Wintergreen Responses and Qualifications

General Requirement Wintergreen Response

Experience with CAHs and rural healthcare settings

Wintergreen consultants have direct CAH executive, finance, operations, clinic, quality, and advisory experience across rural healthcare markets. Wintergreen has been in business more than 18 years, exceeding the 15-year minimum.

Knowledge of Medicare and Medicaid regulations specific to CAHs

The team has experience with CAH reimbursement, Medicare cost reports, rural health clinic strategy, payer mix, revenue cycle, and compliant financial improvement.

Proven record of improving operational and financial performance

Wintergreen's work emphasizes cost structure, revenue cycle, service-line economics, market opportunity, action planning, and implementation support.

Tailored strategies Each CAH receiving deeper assistance will receive hospital-specific findings, goals, action items, and sustainability plan elements.

Training and workshop capacity Wintergreen will deliver CFO roundtables, billing and coding training, cohort implementation support, and hospital-specific technical assistance.

Mississippi partnership structure Wintergreen is Mississippi's SHIP grant vendor and proposes Mississippi Rural Health Association and Mississippi Rural Hospital Alliance as subcontractors for Flex engagement support.

Quality Assurance

Wintergreen will maintain a documented quality assurance plan throughout the engagement. The plan will address timeliness of deliverables, accuracy of analysis and recommendations, responsiveness to MSDH and CAH needs, consistency of reporting, subcontractor coordination, and continuous improvement.

The quality assurance process will include senior review of deliverables before submission, work plan monitoring against milestones and due dates, solicitation of CAH staff feedback after major trainings and technical assistance activities, facility-level tracking of baselines and goals, and service adjustment based on feedback and performance information. Wintergreen will actively solicit CAH staff feedback and integrate that feedback into topic selection, technical assistance methods, and service adjustments.

Wintergreen will maintain a documented quality-control program and complaint records that are open to inspection by MSDH, consistent with the contract requirements.

Table 8. Quality Assurance Approach and Deliverables

Quality Assurance Element Method Evidence

Senior review Wintergreen principal review of reports, tools, and training materials before submission.

Reviewed deliverables.

Work plan monitoring Regular comparison of progress against milestones, reporting deadlines, and deliverable requirements.

Project tracker and monthly progress reports.

Subcontractor oversight Written coordination expectations, activity tracking, and review of subcontractor-supported outreach or meeting tasks.

Subcontractor activity summaries and meeting records.

CAH feedback Post-training feedback, structured debriefs, and implementation conversations.

Feedback summaries and documented service adjustments.

Facility-level tracking Baselines, goals, action items, status, and outcomes for selected CAHs.

CAH tracking tools and quarterly report content.

Final evaluation Closeout review of activities, findings, recommendations, measures taken, and outcomes.

Final comprehensive report.

Contract Compliance and Documentation

Wintergreen acknowledges and agrees to comply with the provisions of the Contract for Professional Services, including but not limited to:

• Record Retention: Wintergreen will retain all records related to this agreement for at least three years after final payment and all pending matters are closed, and for at least six years for records containing or associated with protected health information (PHI). Wintergreen will provide unimpeded, prompt access to books, documents, papers, and records for audit purposes upon reasonable advance written notice during normal business hours.

• HIPAA Compliance: All activities regarding the exchange of information and data will be performed in accordance with applicable Business Associate Agreements (BAA), Data Use Agreements (DUA), and HIPAA regulations.

• Subcontracting: Wintergreen acknowledges that subcontracting requires the prior written consent of

MSDH.

• Requirements Contract: Wintergreen acknowledges that this is a requirements contract and that quantities are estimates only.

• Debarment: Wintergreen certifies that it is not currently excluded or debarred from future contract awards by any political subdivision or agency of any state, federal, local, or county government.

Implementation Timeline

The final timeline will be confirmed with MSDH during project kickoff. The following schedule assumes a September through August annual performance period aligned with the quarterly reporting schedule stated in the IFB. The two-year contract period allows Wintergreen to build on Year 1 foundations in Year 2, expanding the cohort of hospitals receiving deeper assistance and reinforcing sustainability.

Table 9. Year 1 Activities (September 2026 - August 2027)

Activity Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Kickoff and project charter X

Subcontractor coordination and workplan alignment X X

Data request and statewide needs assessment X X X

Identify vulnerable CAHs X X X

CFO roundtable sessions X X

Billing and coding trainings X X

Select CAHs for market/outmigration assessment X X

CAH market studies and outmigration assessments X X X X

Select CAHs for chargemaster reviews X X

Chargemaster reviews X X X

Chargemaster cohort implementation support X X X X X X

Outcome tracking for reviewed CAHs X X X X

Sustainability plans and action plan support X X X X X X X X

Quarterly reporting X X X X

Year 1 comprehensive report X X

Year 2 (September 2027 - August 2028)

Year 2 will follow a similar structure, building on Year 1 findings and expanding the chargemaster cohort.

Year 2 activities will include: one additional statewide needs assessments (progress updates), two additional CFO roundtable sessions, continued market share and outmigration assessments for additional or returning CAHs as directed by MSDH, two additional billing and coding training sessions, twelve additional chargemaster reviews for six CAHs, continued cohort implementation support, sustainability plan refinement, and a final two-year comprehensive report.

Project Team

Wintergreen's project team combines rural hospital executive leadership, CAH financial management, revenue cycle and cost report expertise, data analytics, clinic strategy, and clinical quality experience. The final team may be refined in consultation with MSDH, but the following individuals represent the proposed core team.

Table 10. Wintergreen Project Team

Team Member Proposed Role Relevant Experience

Jonathan Pantenburg, President Contractor Account Representative, project executive, financial and operational improvement lead

Jonathan has more than eighteen years of experience advising healthcare organizations on cost reduction, acquisitions, contracts, financial analysis, and operations.

He served as CFO and COO of Kahuku Medical Center, a 21-bed nonprofit Critical Access Hospital.

Rob Bloom, Principal CAH finance, CFO roundtables, revenue cycle, cash-flow strategy

Rob served as CFO for Carthage Area Hospital for more than a decade and has also served as Administrator of Primary Care Services and Interim Chief Financial Officer.

He has provided consultative services to rural hospitals.

Gregory Wolf, Principal Analytics, benchmarking, data systems, reporting infrastructure

Gregory has led development of healthcare analytics, benchmarking, and performance management tools for rural hospitals and primary care providers.

Zach Boser, Senior Consultant Cost report, reimbursement, service-line economics, valuation, and financial analysis

Zach has served as a rural hospital executive and healthcare advisor, with experience in Medicare cost report optimization, provider compensation valuation, practice acquisition analysis, and rural hospital financial improvement.

Nicole Thorell, Senior Consultant Quality, clinical operations, rural health clinic operations, implementation support

Nicole served as Chief Nursing Officer and Director of Risk and Quality at a CAH and oversaw nursing, outpatient specialty clinics, and four rural health clinics.

Proposed Subcontractors and Mississippi Partnership Alignment

Wintergreen's current role as Mississippi's SHIP grant vendor is central to this Flex proposal. SHIP and Flex are distinct programs, but they serve complementary rural hospital performance improvement objectives.

Mississippi will benefit from a coordinated approach in which the Flex project builds on the relationships, communication channels, and implementation discipline already established through Wintergreen's SHIP work.

Wintergreen proposes two Mississippi subcontractors for this Flex project: the Mississippi Rural Health Association and the Mississippi Rural Hospital Alliance. These organizations will support Mississippi hospital engagement, rural stakeholder communication, meeting coordination, education promotion, local context, and sustainability of improvement activity. Wintergreen will remain the prime contractor and will retain responsibility for all technical analysis, deliverables, reporting, quality assurance, project management, and contract compliance.

Wintergreen acknowledges that subcontracting requires the prior written consent of MSDH, as stated in Section 14 of the Contract for Professional Services. We will submit proposed subcontractor information for MSDH review and approval prior to engaging subcontractors. Subcontracts will be subject to the terms and conditions of the prime agreement and to any conditions of approval that MSDH may deem necessary.

This subcontractor structure strengthens the proposal in several ways. First, it uses trusted Mississippi rural health relationships to support CAH participation. Second, it allows education and technical assistance to be coordinated across rural hospital initiatives. Third, it helps avoid duplicative outreach, duplicative meetings, and disconnected grant messaging. Last, it creates a practical mechanism for sustaining improvements after the Flex project period ends.

Subject to MSDH approval, Wintergreen will coordinate with the Mississippi Rural Health Association and Mississippi Rural Hospital Alliance on communications, meeting logistics, rural hospital outreach, educational promotion, and alignment with statewide priorities. Wintergreen will ensure that all Flex communications include the Mississippi Office of Rural Health Flex Coordinator and Director, as required by the IFB.

Summary

Wintergreen's response is structured to conform to the IFB application fields, bid form, and scope requirements. The proposed annual budget is $115,000, allocated across the required bid form line items pursuant to the Mississippi OpenGov website; this amount incorporates a combined $25,000 allocation for the Mississippi Rural Health Association and Mississippi Rural Hospital Alliance as proposed subcontractors. The technical approach addresses the statewide needs assessments, CFO roundtables, CAH-specific market share and outmigration assessments, billing and coding courses, chargemaster reviews, reporting requirements, contractor responsibilities, financial analysis, sustainability planning, quality assurance, and documentation requirements.

The two-year contract period (September 1, 2026 through August 31, 2028) provides an important opportunity for sustained implementation. Year 1 will establish baselines, identify vulnerable CAHs, launch education and technical assistance, and begin chargemaster and market-study work. Year 2 will expand the cohort, reinforce improvements, refine sustainability plans, and document outcomes. This structure maximizes the likelihood that Flex-funded work will produce lasting financial and operational improvement for Mississippi's CAHs.

Most important, Wintergreen's proposal continues an existing Mississippi rural hospital partnership.

Wintergreen is already Mississippi's SHIP grant vendor, and this Flex application extends that work through Mississippi-based subcontractor participation and continued collaboration with statewide rural hospital stakeholders. This continuity gives MSDH a coordinated, efficient, and implementation-oriented pathway for strengthening the financial and operational performance of Mississippi's Critical Access Hospitals.

Budget and Bid Form

Table 11 below follows the line items, descriptions, quantities, and units of measure stated in the IFB and Mississippi OpenGov website. Wintergreen proposes a total annual budget of $115,000 for FLEX FY26 Financial and Operational Improvement for Mississippi's CAHs. We anticipate Year Two (FLEX FY 2027) to be the same annual budget amount. The combined, two-year budget is $230,000 as illustrated below:

Table 11. Combined Years 1 and 2 Budget per IFB Two-Year Budget Table Specifications

Item Description Quantity Unit of Measure Unit Cost Total

1 Statewide Needs Assessment 2 Assessment $10,000.00 $20,000.00

2 Revenue Cycle Management Roundtable 4 Roundtable Sessions $4,500.00 $18,000.00

3 Outmigration Assessment 6 Analysis $7,000.00 $42,000.00

4 Billing and coding trainings 4 Trainings $4,500.00 $18,000.00

5 Chargemaster reviews for CAHs (6 Hospitals) twice per year 24 Reviews $5,500.00 $132,000.00

TOTAL $230,000.00

The annual pricing above is designed to provide all required deliverables within the two-year IFB scope while strengthening the depth of CAH-specific technical assistance. The pricing also incorporates a combined $25,000 per year subcontractor allocation for the Mississippi Rural Health Association and the Mississippi Rural Hospital Alliance, subject to MSDH written approval as required by Section 14 of the Contract for Professional Services. The subcontractor allocation is included within the total annual bid and is not an additional charge.

Wintergreen's use of Mississippi-based subcontractors is central to the value of the proposed model.

Because Wintergreen is already Mississippi's SHIP grant vendor, this Flex project continues an established statewide rural hospital partnership while adding the Mississippi Rural Health Association and the Mississippi Rural Hospital Alliance as formal subcontracting partners for engagement, coordination, and sustainability support. This structure reduces duplication, supports consistent statewide communication, and increases the likelihood that Flex-funded work will translate into practical hospital action.

Wintergreen acknowledges that this is a requirements contract and that MSDH shall have no obligation if no services are required. Quantities reflect current expectations and the amount used may be less than or more than the estimate. Wintergreen understands and agrees that the quantity used shall not give rise to any claim for compensation other than the total of the unit prices for the quantity used.