Bob Sutton has 25+ years of professional leadership experience, most recently as Avera Executive Vice President of Human Resources. He has been with Avera since 2013 and has served in roles that include Regional President and CEO of Avera St. Mary’s Hospital in Pierre and Senior Vice President of Community Relations.
Sutton was selected through a rigorous, national search process. “His visionary leadership skills will continue Avera’s growth and strategic development as one of the nation’s most sophisticated health systems delivering rural health care,” said Sr. Mary Kay Panowicz of the Avera System Members.
“Mission is the
core of our organization, and I aspire to lead with vision and courage as we set a clear direction for growth and future strengthening of our organization,”
Through his 44-year career with Avera, John Porter has been pivotal in the formation of the Avera system, its tremendous growth over the past four decades, and the development of innovative programs.
Porter has built upon the Avera system from its traditional hospital/nursing home-centered context to becoming a fully integrated care continuum that includes a full range of hospitals, clinics, long-term care centers, retirement communities, home care, hospice, sports and fitness centers, home medical equipment outlets, health insurance, telehealth and more.
He has championed Avera’s model of partnerships, allowing Avera to excel at delivering quality care, close to home across the Upper Midwest.
“During his extraordinary tenure, John has been a faithful steward and keeper of our mission, allowing it to flourish so that the health ministry of Avera could be shared by 18,000 employees,” Sr. Panowicz said.
Amy Elliott is a prominent and respected maternal and pediatric researcher. Her areas of scholarly interest include health disparities, population health, fetal alcohol spectrum, fetal and infant mortality, early childhood development and maternal-child health. This work complements and will be an extension of research taking place through the Avera Research Institute.
This team’s research will answer meaningful questions to promote child health for many generations, while impacting the lives of participating families today.
- The Environmental Influences on Child Health Outcomes (ECHO) study aims to better understand the effects of various environmental child health and development factors. Local work will emphasize asthma and neurodevelopment outcomes including autism, ADHD and fetal alcohol spectrum disorders.
- The Infant Care Practices Study is a clinical trial testing a curriculum that incorporates traditional messages with American Academy of Pediatrics recommendations to promote a safe sleep environment for American Indian infants.
Our research team lives out the Avera mission by working to understand factors that determine the health of a certain population, and how to improve it. Our studies will help answer crucial questions about the effects that physical, chemical, biological, social and behavioral environments have on the health of children.Amy Elliott, PhD
90-95%* of employees report satisfaction in three main categories: job engagement, organization engagement and overall satisfaction
96%* understand how their job supports the organization’s mission
92%* are proud to be part of Avera
*Percentage of employees who answered “agree or strongly agree” or “satisfied or very satisfied”
Employee Recruitment and Retention
Avera’s most valued resource is our people. The talent and knowledge employees bring to our health ministry are gifts that make a difference in the lives and health of people that we serve.
In the past year, Avera Human Resources implemented the “Purpose. Impact. You.” campaign and Retention Engine tools to help Avera leaders create a dynamic employee experience. Avera set a goal to increase first year retention by 10 percent, and exceeded that goal with a 16.27 percent change from the previous year.
Avera’s new employee well-being program, LiveNOW, was created by Avera, for Avera. A strategic partnership between Avera Human Resources and Avera Health Plans, LiveNOW is designed to connect employees with resources that can help them continue or start a healthier lifestyle.
If this were a new influenza strain or other communicable disease, these numbers would capture our immediate attention. Avera and the U.S. Attorney’s Office of South Dakota sought to bring together a group of people concerned for opioid addiction and misuse to not only discuss the problem but to arrive at possible solutions to protect individuals and families.Deb Fischer-Clemens
Senior Vice President, Public Policy
Over 400 people gathered Oct. 18, 2017, to attend “The Opioid Epidemic: A Wicked Problem of the Worst Kind.” This was the fourth annual conference sponsored by Avera and the U.S. Attorney’s Office, along with other community sponsors, to explore issues of justice, well-being and safety in our state and region.
Keynote speaker was Stacey Hail, MD, FACMT, of Dallas, Texas, a forensic and medical expert witness who analyzes overdose cases from all over the country. Other speakers included Lt. Gov. Matt Michels; Kim Malsam-Rysdon, Secretary for the South Dakota Department of Health; and panels of state and local experts.
Through the grant, services offered at tribal facilities include eCARE Emergency and eCARE Specialty Clinic. Without this service, many tribal members would have to travel hundreds of miles for this level of specialty care, or forego care altogether.
After this successful launch of eCARE Emergency and eCARE Specialty services to nearly 130,000 American Indians in the Upper Midwest, other IHS areas are currently working with Avera eCARE to expand the reach of telemedicine to reservation communities.
Avera’s American Indian Health Initiative is committed to building relationships with regional tribes and IHS to find cost-effective health care solutions that impact the health status of native peoples and their communities.
This includes the new Avera Health American Indian Scholarship Program Fund to enhance educational opportunities for American Indian medical students.
For a number of years, Avera has been seeking to live out this mission among members of our region’s American Indian communities. These efforts date back to informal donations of medical equipment and supplies.JR LaPlante
Avera formally began its Avera American Indian Health Initiative in 2013 in response to a growing number of requests from tribal organizations for help in addressing Native American health care needs.
Improving the health disparities of American Indians is a complex problem that will take multiple partnerships over the long term. Yet Avera has welcomed the opportunity to be part of the solution.
Avera Director of Tribal Relations
As a health care ministry, Avera provides care to all who come to us, regardless of their ability to pay.
Examples of community benefits
- Community health services and screenings
- Health professions education
- Subsidized services, including Careflight, emergency services, hospice care, behavioral health services, and more
- Financial and in-kind contributions
- Community-building activities
Through 130 partners, Avera allocates a total of $2 million in donations and sponsorships that qualify as community benefits – those programs or activities that provide treatment or promote health and healing as a response to identified community needs.
- Feeding South Dakota: Avera funding supports the Mobile Food Pantry, which allows fruit, vegetables, dairy products, baked goods, lean proteins as well as non-perishable food to more easily reach the most underserved counties of our state.
- The Banquet: Avera has pledged toward the construction of a new west side location for this ministry that provides meals to people living in poverty.
- Ronald McDonald House: Avera provides general support for this house for families of children who have serious illnesses.
- Aberdeen Ride Line: Avera provides funding for this program that provides transportation for the general public, people with disabilities and the elderly, including rides to and from doctor appointments.
- Marshall (MN) Fire Department: Avera provided matching funding which helped purchase two specialized washing machines to remove carcinogens and biohazards from firefighters’ wearable gear.
Growth in Orthopedics
All Avera orthopedics and sports medicine programs have come under a new name: Avera Orthopedics. Avera has the largest team of orthopedic physicians in the region, with 35 doctors in addition to 20 advanced practice providers. Avera’s orthopedic providers cover seven hospitals and 40+ outreach sites.
Avera’s team of orthopedic specialists provides a full range of musculoskeletal care including spine, fracture care, sports medicine, surgical joint replacement and repair, arthroscopy, physical medicine and rehabilitation, and podiatry. In Sioux Falls, Avera Orthopedics includes the region’s first orthopedic trauma group to cover the Emergency Department 24/7 for complex fractures.
LIGHT, Avera’s well-being program for physicians, physician assistants and nurse practitioners, offers opportunities to optimize personal development and professional performance. Key programs include peer and executive coaching, retreats, a retirement series, a spouse engagement group, Schwartz Rounds, LIGHT lunches and more.
In 2018, Avera Medical Group welcomed:
- Avera Medical Group Infectious Disease Specialists in Sioux Falls, SD
- Number of clinic visits:
- Inpatient hospital days in 2018
- Outpatient visits in 2018
Avera continually engages in dialogue and face-to-face meetings with communities that might benefit from affiliation with a health system. These partnerships take the form of a facility being owned, leased or managed by Avera, or another type of affiliation best suited for a particular situation.
Partnerships benefit local communities in the form of long-term stability, greater access to updates in equipment and technology, and help with physician recruitment.
- Tri Valley Health System of Cambridge, NE, voted to become an Affiliate Member of Avera Health, through which Avera provides a full range of consultation services and management support.
- Beginning in May 2019, Avera will lease operations of the Rock Rapids community hospital and clinics. Construction on a $28.9 million building to house Avera Merrill Pioneer Hospital is underway.
Strategic Business Units
Through Strategic Business Units, Avera has a new strategic vision that allows Avera to operate more and more as one system and less as a grouping of regional centers. Avera’s nine Strategic Business Units include:
- Academic Medical Center and Research
- Community Hospitals
- Critical Access Hospitals (CAHs)
- Long-Term Care
- Avera Medical Group
- Insurance Division
- Post-Acute Care
- Avera eCARE
Avera’s Good2Great initiative has involved large, system-wide projects with a goal of finding cost savings or new revenue sources to help Avera successfully navigate through a changing environment and sustain the health ministry entrusted to us by the Sisters. Good 2Great has marked a major milestone of over $100 million in these projects implemented.
Compass of Care
The Compass of Care delivery model sets Avera@Home apart as a modern home care and hospice agency that provides a full continuum of care.
Avera@Home focuses on the patient’s goals and satisfaction. Experienced case managers lead the effort to provide the clinical excellence that patients need to successfully recover at home.
Avera@Home offers assistance through:
- Home health
- Care Transitions
- Home medical equipment
The Helmsley Center in Pierre
The Helmsley Center in Pierre, SD, which opened this fall, is home to the sixth Avera Cancer Institute location.
This center brings radiation oncology for the first time to Pierre as well as expanded medical oncology, diagnostics, infusion therapy and private infusion rooms, surgical oncology and ongoing support. Avera eCARE® telehealth connectivity also allows patients to have additional cancer services available.
At 57,000 square feet, the Helmsley Center reflects Avera’s goal to achieve the best possible care for patients in a patient-centered environment. Additional features include an oncology pharmacy, meditation room, food service area, healing garden and welcoming atrium.
The Helmsley Center was constructed thanks to a generous donation of $10 million from The Leona M. and Harry B. Helmsley Charitable Trust.
Upgrades to Elekta™ radiation treatment technology is now complete, ensuring greater continuity of care system wide. Elekta technology at Avera Cancer Institute locations include
- Elekta Versa HD™ in Sioux Falls
- Elekta Infinity™ in Aberdeen, Mitchell, Pierre and Yankton, SD, and Marshall, MN
Elekta equipment in Sioux Falls, Aberdeen and Pierre was purchased thanks to generous funding from The Leona M. and Harry B. Helmsley Charitable Trust.
Contrast-enhanced spectral mammography (CESM) is an important diagnostic tool that can deliver more definitive information when a screening mammogram shows abnormal findings. In addition to Sioux Falls, CESM has been added in Pierre and Aberdeen, SD, and Marshall, MN.
SPRING Clinical Trial
Through Avera’s membership in the Worldwide Innovative Networking (WIN) Consortium, the first patients in the world have had access to the SPRING trial. In the Survival Prolongation by Rationale Innovative Genomics Phase 1 trial, participating patients with metastatic non-small cell lung cancer are given a three-drug protocol including immunotherapy and targeted therapies.
Avera Cancer Institute Navigation Center
The navigation center receives calls from patients and their loved ones 24/7, answering questions, providing support or making appointments. The Navigation Center serves all those in our region regardless of where they get their care. Over the past year, the Navigation Center averaged 700 inbound and outbound calls per month for a total of over 8,500 calls.
30 years of the Avera Race
On May 12, 2018, the Avera Race Against Breast Cancer celebrated 30 years of saving lives. This year’s event involved 5,200 participants. Since the Race’s inception in 1988, it has raised $6.2 million to support programs such as the cancer resource library, wig program, survivorship care, patient navigation and more.
Avera eCARE® highlights of 2018:
- Celebrated 25 years of telemedicine care, which began with specialty consults in 1993
- Major exhibitor at the American Telemedicine Association (ATA) national conference, where Avera eCARE Chief Executive Officer Deanna Larson was named ATA Woman of the Year
- Built upon business-to-business marketing and sales, reaching out to health systems, hospitals, long-term care and senior living communities, schools, prisons and more
- Expanded Emergency and Specialty Clinic services to reservation communities across the Upper Midwest and in additional states through an ongoing collaboration with Indian Health Service
- Served more hospitals and emergency rooms with 24/7 real-time access to a Behavioral Health Assessment Center staffed by experienced psychiatry nurses at the eCARE hub in Sioux Falls, SD
- Earned The Joint Commission’s Gold Seal of Approval® for Ambulatory Health Care Accreditation by demonstrating continuous compliance with nationally recognized standards
- Growth from 14 states to 18 states and two new product lines, Hospitalist and Behavioral Health
Avera eCARE Product Lines:
- Behavioral Health
- Correctional Health
- School Health
- Senior Care
- Specialty Clinic
Patients touched:1.4 million
Total sites served:400+
Health care dollars saved:$200 million
Geographical footprint:18 states
This expansion involves basing a fixed-wing aircraft in Pierre in addition to Careflight locations in Aberdeen and Sioux Falls.
Avera is concerned about every single resident within our service area. When a critical illness or injury occurs, the sooner a patient can receive specialty critical care services, the better outcomes he or she will experience.Doug Ekeren,
Avera Emergency Medicine Service Line
More than just a fast way to get patients to the hospital, Careflight is an extension of a hospital critical care unit and Emergency Department. Careflight helicopter (rotor-wing) and fixed-wing aircraft are designed as airborne ICUs, staffed by professionals highly trained in critical care.
The expanded Careflight fleet consists of:
- New PC-12 fixed wing planes in Sioux Falls and Pierre, with a new hangar in Pierre
- A new rotor wing H145 in Sioux Falls
- Avera’s existing EC 145 helicopter is now in Aberdeen
Careflight was the first helicopter transport program in South Dakota. In its 30-year history, Careflight has transported 25,000 patients.
The Innovation Institute helps take ideas to the marketplace by
- Evaluating the potential of ideas
- Developing prototypes
- Obtaining patents
- Matching potential products with willing investors
Avera providers, clinicians and employees experience the real-world challenges of caring for patients every day. Their ideas submitted to the Avera InnovationLab might one day revolutionize how health care is administered throughout the world.
More than 240 ideas have been submitted into the pipeline, with several under consideration for product development and two in the commercialization stage.
Nationwide, one example of ideas coming out of the Innovation Institute is an elevated arm sling developed by a California surgeon. This novel sling is just one product that completed the Innovation Institute’s product development cycle and is now hitting store shelves.
Avera PACE, a regional group-purchasing organization, is now showcasing some of the products and services developed through the Innovation Institute.
The National Committee for Quality Assurance (NCQA) announced that Avera Health Plans increased their score this year from 3.5 to 4, out of a possible 5. The ratings measure health plans based on their combined HEDIS®, CAHPS® and NCQA Accreditation standards scores maintaining our 5-star rating with the Federal Insurance Marketplace (healthcare.gov).
These scores are only possible thanks to the efforts of the staff who do great work on behalf of our members every day. Our results demonstrate our continued success and commitment to serving individuals and families in South Dakota.Debra Muller,
CEO, Avera Health Plans
For the past three years, Avera Health Plans has successfully engaged with individual policyholders by providing bi-annual focus groups in Aberdeen and Sioux Falls. Results and changes were incorporated to respond to our member’s needs – creating a high retention percentage each year due to the satisfaction of coverage and consistent pricing.
Employer Group Coverage Growth
With a 37.6 percent increase in the number of employers from 2017, Avera Health Plans is experiencing a boom with our fully insured employer group insurance plans. Of these employers, 10 are large businesses with more than 50 employees and the rest are small businesses with 50 or fewer employees. Avera Health Plans and DAKOTACARE together serve over 130,000 members across the United States through employer-provided plans, individual and Medicare Supplement policies.
Avera on Louise Health Campus
At 69th and Louise, Avera’s new surgical hospital and medical office building will specialize in orthopedics and gastroenterology – two specialties in which Avera is seeing growth. The hospital and medical office building will open in the fall of 2019.
Avera Addiction Care Center
The new Avera Addiction Care Center at Avera on Louise is expected to open in mid 2019. Plans include a residential building with 32 private rooms and a main building for treatment activities. With Avera’s 60-year history as the regional leader in mental health care, this is an important piece in our continuum of care.
Avera Human Performance Center
A new 60,000-square-foot complex at Avera on Louise will house seven volleyball courts and designated areas for physical therapy and Athletic Republic acceleration. It is designed help us better serve athletes of all ages and ability levels and will promote overall health, wellness and balance throughout a lifetime. A December 2019 opening is planned.
On the Avera McKennan main campus, several updates are underway that together total $41 million. This includes a new 24-bed inpatient rehab unit on the fifth floor of the Prairie Center; an expanded and enhanced 28-bed intensive care unit; and expanded surgical space.
Living out our mission means thoughtfully planning for the future. We must think strategically and invest in ways that will fulfill our mission and best serve our growing city in the years to come.David Flicek
President and CEO,
Avera McKennan Hospital & University Health Center
Alumend, Avera’s wholly owned applied research and development company, is an anchor tenant of the future USD Discovery District, an 80-acre planned corporate and academic research park in northwest Sioux Falls
The Discovery District will provide access to research facilities and infrastructure for research business development and foster collaboration for the commercialization of new technologies.
Alumend LLC will establish its corporate office and research laboratory in the new district. Alumend scientists have developed Natural Vascular Scaffolding (NVS) therapy, a novel drug/device combination for the treatment of peripheral vascular disease (PVD). They will continue their research and development of other uses of the NVS chemistry with potential applications in cancer, orthopedics, cosmetics at the Discovery District.
Through our work with Alumend, Avera has been a proud participant in South Dakota’s biotech industry for the past two decades. Alumend furthers the Avera mission to make a positive impact upon lives by developing applications where there are currently unmet clinical needs.Ryan Hansen,
Avera Research Institute
Top projects underway or completed in 2018
- Avera on Louise Health Campus in Sioux Falls: $133 million
- The Helmsley Center at Avera St. Mary’s Hospital in Pierre: $30 million
- Avera Rock Rapids new hospital and clinic in Rock Rapids, IA: $22 million
- Avera McKennan Hospital & University Health Center new ICU in Sioux Falls: $11 million
- Avera Medical Group Lakes Regional Family Medicine in Spirit Lake, IA: $8 million
- Avera McKennan new rehabilitation unit: $6.3 million
- Avera Marshall Regional Medical Center Emergency Department in Marshall, MN: $6 million
- Avera Medical Group Brookings clinic renovation in Brookings: $4.5 million
- Avera Holy Family Hospital Emergency Department in Estherville, IA: $4.1 million
- Avera Palm Place office space renovation in Sioux Falls: $2 million
- Avera McKennan kitchen addition/remodel in Sioux Falls: $2 million
Avera facilities have used electronic medical records (EMR) for several years to enhance patient safety and streamline care between locations. The latest project is upgrading Avera’s entire platform to MEDITECH Expanse – a major endeavor to create a single EMR.
Over the past three years, the One AveraChart project has been designing, building and integrating one EMR to achieve greater patient safety, patient satisfaction, user satisfaction and operational efficiency.
Previous EMR platforms were tailored for individual regions and locations. Like never before, MEDITECH Expanse brings the system together as One Avera, and supports efforts toward system-wide Service Lines and centralization.
Benefits to providers and patients:
- Patient-centric registration
- Smart insurance look-up
- Better patient engagement through the online AveraChart portal
- Performance on the newest technology, such as iPhones and tablets
- Greater availability of patient education that’s tailored to a patient’s specific diagnosis
- Faster and more convenient
MEDITECH Expanse will help Avera deliver an even higher level of quality and safety, which is based on the right person receiving the right information at the right time for the right patient.
Avera Medical Group quality projects assist Avera as we take pioneering steps toward the shift to value-based payments. In addition, these efforts ensure that Avera continues to advance the triple aim of improving patient quality, patient experience and cost efficiency.
Give It A Shot
Avera’s Primary Care Service Line teamed with Avera Marketing to launch the “Give It A Shot” campaign. Diseases are becoming rare due to vaccinations. However, until we eliminate disease, it is important for individuals to stay up-to-date on all of their shots.
This campaign sought to educate patients on how immunizations protect them, their families, and society as a whole. The campaign also raised awareness that vaccinations are safe, having gone through many steps with the CDC and FDA to ensure safety. A toolkit included key messages about immunizations, an immunization checklist, an informational web landing page, clinic posters, and a list of frequently asked questions.
Diabetes Self-Management and Support
Avera Medical Group Quality recognized the growing need for additional support of the diabetic population, and launched a program to improve the health of patients with diabetes by encouraging self-management and patient engagement. Newly diagnosed patients or those whose diabetes is poorly controlled are referred for diabetes management education visits, where they learn how to improve their overall knowledge of diabetes, improve their diet, increase physical activity, understand blood sugar testing and monitor use and more.
In a pilot of this program in O’Neill, Creighton and Hartington, NE, 83 percent of participating patients saw a decrease in their A1C testing, and 69 percent of uncontrolled diabetics became controlled.
Avera’s Population Health initiative is working to give physicians and care teams enhanced tools and resources to help identify which patients can benefit from more proactive intervention, whether that’s encouraging a patient to access wellness visits and screenings to keep them healthy or to wrap them in additional care that will keep their conditions from progressing.
Avera’s population health efforts are focused on three important groups of patients, where our efforts can make the most impact:
- Those with chronic and/or high cost health care needs
- Accountable Care Organization patients attributed to Avera
- Avera Health Plans and DAKOTACARE members, including Avera employees on the employee plan
Accountable Care Organizations (ACOs) are designed to help health systems move toward coordinated, team-based care that’s efficient and high quality.
Avera now has three ACOs through the Medicare Shared Savings program that include about 40,000 Medicare patients and covering all Avera locations.
Patients in an ACO benefit from patient-centered, team-based care that focuses on quality, cost reduction, patient experience, and care navigation. An ACO encourages patients to have greater participation in their care, improving outcomes. Physicians benefit as well, with the opportunity for shared savings.
Stronger relationships between physicians, within and across specialties, result in better transitions of care, improving outcomes and creating a better care experience for patients.
Best Practice Success Stories
Avera’s Responsible Prescribing initiative, developed collaboratively by the Primary Care, Emergency Medicine and Behavioral Health Service Lines, developed resources and tools to help raise awareness about the threat of opioid misuse, coordinate action and collect strong data.
These tools included a controlled substance patient agreement, promotion of electronic prescribing, alternative pain management treatments, new pain management patient education and more.
Since August 2017, Avera Medical Group has reduced total opioid prescriptions by 25 percent.
One major way Avera can ensure ongoing quality of care is by standardizing equipment, software, best practices and care standards.
- The OB-GYN Service Line has implemented PeriWatch, a new fetal heart monitoring system that offers features and analytics that can help labor and delivery providers identify potential problems and reduce adverse outcomes.
- The Cardiology Service Line has taken steps to standardize all EKG software across Avera sites, for consistent readings every time. Epiphany will be implemented in 54 facilities.
- In an effort to enhance laboratory efficiencies and promote a better patient experience, the Laboratory Service Line and strategic partner Beckman Coulter Diagnostics completed their installation and standardization of testing platforms in 26 hospitals and clinic laboratories.
How GeneFolio Benefits Care
- Health Care’s Most Wired Advanced – Avera Health
- Premier Hospital Improvement Innovation Network (HIIN) Award for Excellence in Patient Safety
- Avera St. Luke’s Hospital in Aberdeen, SD
- Avera Sacred Heart Hospital in Yankton, SD
- Minnesota Hospital Association Innovation of the Year in Patient Care Award – Avera Marshall Regional Medical Center for the Zero Suicide project
- Top 20 Rural Community Hospitals
- Avera Queen of Peace Hospital, Mitchell, SD
- Avera St. Luke’s Hospital, Aberdeen, SD
- Avera St. Mary’s Hospital, Pierre, SD
- Top 20 and Top 100 Critical Access Hospitals
- Avera Hand County Memorial Hospital, Miller, SD
- Avera Holy Family Hospital, Estherville, IA
- Floyd Valley Healthcare – Avera, Le Mars, IA
- Top 100 Critical Access Hospitals
- Milbank Area Hospital Avera, Milbank, SD
- Avera St. Anthony’s Hospital, O’Neill, NE
- Becker's Hospital Review 100 Great Community Hospitals
- Avera Queen of Peace Hospital, Mitchell, SD
- Centers for Medicare & Medicaid Services (CMS) 5-star ratings:
- Avera Heart Hospital, Sioux Falls, SD
- Avera Queen of Peace Hospital, Mitchell, SD
- Avera Mother Joseph Manor, Aberdeen, SD
- American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke Silver Plus Quality Achievement Award – Avera St. Luke’s Hospital, Aberdeen, SD
- Hurst Gold Standard Of Nursing Award
- Avera Queen of Peace Hospital, Mitchell, SD
- Avera Heart Hospital, Sioux Falls, SD
- Avera Sacred Heart Hospital, Yankton, SD
- Blue Distinction Center for Maternity Care by Wellmark Blue Cross and Blue Shield
- Avera McKennan Hospital & University Health Center (+ under the Specialty Care program)
- Avera Sacred Heart Hospital
- Avera Queen of Peace Hospital
- Avera St. Mary’s Hospital