Live Better. Live Balanced. Avera

Avera’s health ministry is focused on helping people feel better and live healthier so they can experience all the good gifts that life has to offer. Caring for the whole person – body, mind and spirit – is central to the Avera mission. We’re privileged to not only deliver the highest quality expertise and technology, but also to make an emotional and spiritual connection with patients and their families.

Avera is a regional health system comprised of more than 330 locations in 100 communities throughout eastern South Dakota and areas of four surrounding states. Avera serves a population of nearly 1 million throughout a geographical footprint of 72,000 square miles and 86 counties.

Avera is the health ministry of the Benedictine Sisters of Yankton, S.D., and the Presentation Sisters of Aberdeen, S.D.

As a health ministry rooted in the Gospel, Avera’s mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

  • Expert health care in 60 medical specialties
  • Quality at national-benchmark levels
  • Superior customer service
  • A wide range of locally available care


Catholic Identity Matrix

The Catholic Identity Matrix (CIM) is a mission assessment and enhancement process offered by the Veritas Institute at the University of St. Thomas for use by Catholic health care organizations.

The CIM has been carried out at Avera McKennan, Avera St. Luke’s, Avera Queen of Peace and Avera Sacred Heart hospitals. In 2012, Avera was the first health care organization to pilot CIM with clinics and physicians through Avera Medical Group. Next, Avera has asked the Veritas Institute to develop a version for central services.

When the Sisters came to South Dakota over a century ago, they were guided by a set of concrete values as a ministry of the Catholic church. Today, CIM helps us ensure that despite the pressures of a changing society, we uphold those same values as we serve people most in need.

J. Michael Stebbins, PhD
Executive Vice President of Mission
Avera Health

Mission Leadership Development

Each year, Avera leaders join on a regular basis to explore topics surrounding leadership in a mission-based organization.

This not only helps leaders understand their role in supporting the mission, it helps them deepen their own spirituality and make connections with peers. Leaders in turn are asked to “cascade” concepts to employees.

Leaders in Ministry

Leaders in Ministry, a nine-month theological and spiritual formation program for Avera leaders, has completed its 10th year. Monthly sessions are held at the Broom Tree Retreat Center near Irene, S.D.

Since its inception, 151 Avera leaders have participated in Leaders in Ministry

In the past year, 19 leaders completed the program.

Employee Engagement Survey Results

In March, employees system-wide had opportunity to share their feedback through the Employee Engagement Survey.

91-94%* of employees report satisfaction in three main categories: job engagement, organization engagement, overall satisfaction

98%* understand how their job supports the organization’s mission

93%* are proud to be a part of Avera

*Percentage of employees who answered “agree or strongly agree” or “satisfied or strongly satisfied”

Five key drivers of overall employee satisfaction

  • Administrative trust
  • Management of the facility
  • Employee recognition
  • Communication
  • Understanding needs

Employee Health Insurance Subsidy

Avera values access to reliable, meaningful and affordable health insurance coverage not only for the patients we serve, but also for our employees.

Out-of-pocket medical assistance for unique or catastrophic financial situations that employees may face

25% premium discount for employees meeting income guidelines

Case management services to assist employees or their family members experiencing complex illness or injuries in navigating the health care system and their benefits

Avera Medical Group Mission

In December 2014 a mission leader was hired to focus on mission integration efforts with Avera Medical Group leaders, providers and clinic staff. Efforts are being focused around engaging each clinic in Avera’s mission and values, and ensuring that all employees come to a deeper understanding of how their work contributes to and supports our mission. This is being accomplished through site visits, and meetings with clinic leaders, providers and clinic staff.

Avera Medical Group mission activities

  • Mission formation sessions are held at the beginning of every meeting of the service lines
  • Mission Advisory Council continues to send out quarterly “mission reminders” to all clinic staff
  • Mission formation sessions are planned for each clinic.

Avera Medical Group LIGHT Program

LIGHT (Live, Improve, Grow, Heal, Treat),
is a well-being program for physicians,
physician assistants, and nurse
practitioners. Avera’s LIGHT program
represents a new level of care and action
to optimize personal development and
professional performance.

What LIGHT offers providers

  • Strategies for sustaining a fulfilling career from onboarding to retirement
  • Resources to help providers renew their enthusiasm for their practice or overcome burnout
  • A continuum of care to help providers care for themselves, so they can reach out and serve others
  • Proactive ideas to help prevent compassion fatigue and burnout
  • Training program for providers and leaders to become Peer Strategy Coaches

Charity Care and Community Benefit

As a health care ministry, Avera provides care to all who come to us, regardless of their ability to pay.

Avera’s mission also involves making a positive impact upon the communities we serve, often accomplished through providing community benefits.

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
  • Research
  • Financial and in-kind contributions
  • Community-building activities

By the numbers...

Charity care/financial assistance
Unpaid costs of government programs
Additional community benefits

Key Partnerships

Through 140 partners, Avera allocates a total of $1.1 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 ($35,000) – Every week, this hunger relief organization provides temporary food assistance to approximately 21,000 individuals and families. The BackPack Program gives food every weekend to more than 5,000 school children who otherwise might go hungry. This sponsorship helped in the construction of new food banks in Sioux Falls and Pierre.
  • Charis Ministries ($7,000) – With vehicles marked “Project Car,” volunteers help individuals with transportation needs get to medical appointments.
  • Holy Innocence Ministry ($5,000) – This program operated through the St. Vincent de Paul Society of Sioux Falls assists needy families with diapers for their children, promoting better health and hygiene.


Avera Medical Group

More than 800 physicians and allied health professionals collaborate to deliver comprehensive, seamless care, with ease of referral to specialists in more than 60 specialty areas.

Bar graph of providers by year
Bar graph of clinics by year

Number of clinic visits: 1,722,046

A System of Strength

Avera’s value of stewardship of our resources shines in our financial strength.

Gross patient and resident revenue in 2015
Net profit margin for investment in future services, technology and capital projects

Bond Rating

A1 by Moody’s
AA- by Standard and Poor’s.

Community Partnerships

Avera recognizes that no one can do it alone. To help extend our mission into the communities we serve, Avera collaborates with approximately 700 organizations through donations, sponsorships and key partnerships.

700 community partners

$5.3 million in donations and sponsorships

“Through Stage Science, we hope to give young people a glimpse of what’s possible, and possibly inspire some to enter the STEM fields of science, technology, engineering and mathematics,” said Gareth Davies, PhD, Chief Scientific Officer with Avera Institute for Human Genetics.

Avera Centralization

Rather than similar departments doing similar work at six regional centers, Avera is centralizing key services to gain efficiencies through standardization, and ultimately improve patient care and outcomes. This journey will continue for years to come.

Departments that have become centralized

  • Risk Management and General Counsel
  • Transcription
  • Information Technology
  • Marketing
  • Human Resources
  • Construction Management Services
  • Centralized Business Office

Employees use
their best strengths
and abilities, where they
are already located. While
jobs might change,
no jobs are lost in
the process.

Human Resources Centralization

Avera began bringing HR departments from all entities under one department two years ago. HR staff specialize in three key areas, serving the entire Avera system to solidify Avera’s standing as an employer of choice:

  • Talent Management: Hiring, recruiting, onboarding, performance management, employee health
  • Total Rewards: Compensation, benefits, awards and recognition
  • Leadership and Organizational Development: Leadership and staff development and educational events

Also part of this team are HR officers – the “go-to” people at individual Avera locations who operationalize these three areas.

Over the past year, Avera Human Resources:

  • Received and processed 41,400 job applications
  • Hired 5,400 people
  • Continued to serve 16,122 Avera employees and 2,687 volunteers


Marketing Centralization

One year ago, Marketing at Avera centralized, bringing together 56 staff under one team—Avera Marketing. First year accomplishments include:

  • Avera KnowledgeNet: Avera’s first system-wide intranet—more than 1,466,000 visits
  • We magazine: Avera’s new quarterly magazine for employees and their families
  • Community Partnership Program: Coordinates all donations and sponsorships across Avera. More than 700 community partners.
  • AMG Newsletter: Avera’s physician and provider newsletter—1,365 subscribers
  • SHE magazine: Avera produces an extra issue of SHE magazine for Mother’s Day
  • Avera Cancer Institute:
    • “The Girls Will Thank You” breast cancer campaign—12 percent increase in mammogram appointments
    • “Cancer Care Done Differently,” emphasizing Avera’s interconnectedness, cutting-edge science and holistic care for the body and soul
    • “Butt Seriously,” raising awareness of colorectal cancer and the importance of regular screenings—15 percent more colonoscopies than predicted in April 2015.
    • Avera Cancer Institute magazine.
  • “Live Better. Live Balanced:” Avera is starting a conversation in our communities to inspire a grassroots movement to position good health as leading to greater joy through a new narrative that’s simple, positive and emotional.
    • Balance community newsletter – Provided to 250,000 households
    • Live Better. Live Balanced. advertising campaign

Avera eCARE

With more than 20 years experience in providing virtual care, Avera has developed world-class expertise in partnering with hospitals to provide increased access to specialists. Avera eCARE™ uses interactive video and technology to connect with outlying sites through a “virtual hospital” in Sioux Falls.

Avera has developed the largest and most robust telehealth service in the United States and world that serves a rural area:

  • eICU® CARE
  • eEmergency
  • eConsult
  • ePharmacy
  • eLongTermCare
  • eCorrectional Health
  • Patients touched:

    178,000 Past Year
    805,000 Since inception
  • Total sites served:

    235 Since inception
  • Health care dollars saved:

    30 million Past Year
    171 million Since inception
  • Square miles covered:

    545,000 Since inception across eight states


Do you need to see a doctor for an ache or pain? There’s an app for that. AveraNow is a new mobile video visit that can take place over a smartphone, tablet or computer.

Advantages of AveraNow

  • Available 24/7 for patients as young as age 2 into adulthood
  • A real-time, two-way video visit with an Avera provider
  • Evidence-based protocols ensure high quality care

Why AveraNow?

AveraNow is one more option as part of Avera’s growing direct-to-consumer, easy access points of care.

  • Home health technologies like AveraNow are predicted to increase from 14.3 million worldwide in 2014 to 78.5 million by 2020 (Tractica)
  • Telemedicine delivers quality outcomes comparable to in-person visits
  • Patients report a 96 percent satisfaction with this mode of health care delivery
  • Telehealth is one of the most cost-effective ways to see a doctor. While an emergency room visit costs, on average, $1,500 to $3,000, an AveraNow visit is $49.

Avera Health Plans

Avera Health Plans offers affordable, trusted coverage for employers, families, individuals and seniors. Members have access to a provider network that includes more than 4,300 health care professionals and 92 hospitals.

During open enrollment for
the Health Insurance Marketplace,
Avera had
66% renewed members and 34 percent were new
individual policy holders.

We continue to cover the majority of policyholders who are enrolled through the Marketplace.

As of the end of FY 2015 88,204 carry the Avera Health Plans member ID card.


Now beginning its third year, Avera@Home is delivering high quality, patient-centered home care and hospice services, maintaining a focus upon outcomes, a consistent patient experience and performance expectations. After leaving the home health market several years ago, home health services were started up again in Sioux Falls. In Marshall, Avera re-entered the home care market, and began hospice services for the first time.

Also starting July 1, Avera Home Medical Equipment locations became part of Avera@Home, aligning equipment resources to holistically serve patients in their home.

  • 16 home health and hospice locations
  • 15 home medical equipment locations
    • 370 employees
    • 1,234 patients served in 2015

Avera Research Institute

Avera Research Institute engages in medical research that contributes to scientific knowledge, and clinical trials that give patients access to cutting-edge treatment approaches.

To support Avera’s clinical applications of personalized medicine using genetic science, the Avera Research Institute conducts research on the benefits of pharmacogenomic testing.

Clinical Trials
and Registries

100 active studies over the past year in
oncology, diabetes, pain
management and mental health Benefiting more
than 800 patients

Avera Institute for Human Genetics

The Avera Institute for Human Genetics is a CLIA-certified molecular genetics laboratory capable of performing high throughput genetics analysis for both research efforts and clinical application of personalized medicine. Current areas of focus include the following:

  • Genetic sequencing to match the right drugs to patients for pain management, behavioral health and other conditions
  • DNA analysis as part of the world’s largest twin study, shedding new light on the influence of heredity and a wide range of illnesses, including cardiovascular disease, pediatric bipolar disorder, ADHD and depression

Bricks and Mortar

Avera’s operating margin allows investments for future services, technology and capital projects.

Projects at Avera-owned facilities that were underway or completed in 2015:

  • Avera Prince of Peace Retirement Community construction and remodel, Sioux Falls: $25 million
  • Grasslands Campus and new Avera Medical Group Mitchell clinic: $19.4 million
  • Coach Don & Carmen Meyer Center of Excellence, home to Avera Cancer Institute Aberdeen: $13.7 million
  • Avera Medical Group 69th and Cliff new clinic, Sioux Falls: $11.75 million
  • Neonatal Intensive Care Unit at Avera McKennan Hospital & University Health Center: $7 million
  • Avera De Smet Memorial Hospital, new hospital addition and renovation: $3.2 million
  • Avera Sacred Heart Hospital, Yankton, fourth floor remodel and update: $3.15 million
  • Avera St. Mary’s Hospital, Pierre, OB remodel and new surgical clinic: $1.6 million


Ebola Response

In the late summer and fall of 2014, confirmed cases of Ebola in the United States heightened awareness and preparedness among hospitals worldwide, and Avera was no exception. Guided by the expertise of Avera infectious disease specialists, Avera activated a response plan specific to Ebola, which mirrored how any infectious outbreak would be handled.

Avera’s response plan

  • Travel screening questions of all patients at clinics and emergency rooms
  • All-staff training and education
  • Specialized training for direct caregivers
  • Personal Protective Equipment (PPE) in place for personnel that might face potential threats, with preparations made to dispatch PPE as needed to any clinic, site or facility
  • Plans to assess and isolate suspected Ebola patients in concert with South Dakota Department of Health and Centers for Disease Control and Prevention policy
  • Plans to transfer confirmed Ebola patients to a government-designated Ebola Treatment Facility

Fortunately, Avera was not presented with an actual case during this time of heightened awareness. Because disease outbreaks can occur unexpectedly at any time, Avera remains ready with our plan for Ebola or other infectious diseases.

Avera Medical Group Quality Metrics

In January 2015, the Centers for Medicare & Medicaid Services released goals to incorporate quality, cost and value into almost all payments in the coming years. CMS also created the HealthCare Payment Learning Action Network (HCPLAN), designed to promote these changes throughout all public and private insurers.

Avera Medical Group is an active member of the HCPLAN as well as a strong supporter of the national quality strategy.

Avera Medical Group quality achievements

  • Successfully submitted Physician Quality Reporting System data for more than 850 providers. Overall, Avera was above national averages for quality while remaining less expensive than expected.
  • Achieved 98 percent Stage 1 or Stage 2 Meaningful Use compliance compared to a national average of only 42 percent successful compliance with Stage 2.

Care Coordination

Avera Coordinated Care is a team approach that serves as an extension of the clinic care staff. The program helps connect patients with needed resources to help improve their quality of life.

Coordinated Care is specifically designed to help people who have significant barriers to improved health, such as multiple diagnoses, catastrophic illness, health literacy issues, or psychosocial issues such as lack of finances, depression, or lack of health insurance. There is no charge to patients for these services, but rather, Avera recoups the expenses through quality incentives earned through improved outcomes.

  • Eight teams across the Avera footprint, each comprised of an RN as team coordinator, a clinic care specialist, and a social worker
  • 1,010 patients active in the program

In 2015, Avera’s Coordinated Care program was recognized as among the top five of health organizations that participated in a Centers for Medicare & Medicaid Innovation (CMMI) Health Care Innovation Challenge Grant.

This is Teresa’s journey – we’re simply walking side by side with her. Anything she has accomplished she has done. We’re just there next to her to give her the support she needs and the inspiration that she truly gives back to us.

Kelli Rockafellow, Clinical Care Social Worker

Service Line Development

Physicians from across Avera are coming together like never before to develop clinical service lines that deliver quality care – consistently – across locations. Stronger relationships between physicians, within and across specialties, create better transitions of care. Many patients start their care at one location, and continue this journey at another.

This higher and more consistent level of quality is achieved in part through evidence-based, best-practice protocols. By taking a system-wide approach, these transitions happen more smoothly, improve outcomes and create a better care experience.

Best Practice Success Stories

Emergency Medicine

The Emergency Medicine Service Line continues to strive to improve the patient experience, quality of care delivered, and working environment for staff.

  • Standardization initiatives include carts, equipment, medications and patient flow processes so patients receive the same quality service, no matter where they present throughout the Avera system.
  • Careflight is developing a centralized communication/dispatch center and, ultimately, a unified aero medical program.
    • Implementing these changes is projected to increase revenue by $160,000 and produce savings of more than $380,000.


Avera collaborates with Elekta to equip its locations with advanced cancer treatment technology. This includes linear accelerators, gamma knife and brachytherapy, as well as advanced software for treatment planning, cancer registry and electronic patient records, tying the entire system together.

In addition to providing consistent, high quality care across all Avera Cancer Institute locations, this initiative will save Avera approximately $10 million over the next five years.

Quality Measurement

Providing customers with the highest quality care is a top priority for Avera. In addition to positive patient outcomes, quality outcomes are tied directly to the financial performance of the health system.

Each year, 7.75 percent of Medicare payments are at risk based on performance in the Centers for Medicare & Medicaid Services (CMS) reimbursement programs. These programs drive system quality strategy and include preventing patient harm and unnecessary readmissions.

Avera advances quality beyond the required Medicare programs by voluntarily participating in the QUEST program through Premier, Inc. This program applies more stringent measurement than that of CMS, and allows Avera to compare our performance to top performers in the nation.

Quality initiatives fall into the following domains: Patient safety, evidence-based care, patient and family engagement, appropriate hospital use, mortality, cost and efficiency, and community health.

This past year the quality strategy has emphasized using a system approach to opportunities that impact not only quality of patient care but also coding, documentation, and cost of care.

Advanced analytics are being incorporated to validate the scope of the problem followed by performance improvement efforts at a system level. These projects have included transfusion reduction, pneumonia, sepsis, discharge disposition, inpatient colon surgery, surgical site infection, and the relationship of OB inductions to C-section rates.

For a complete report on Quality Measures, go to