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 central and 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, SD, and the Presentation Sisters of Aberdeen, SD.

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


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 540 organizations through donations, sponsorships and key partnerships.

540 community partners

$5.8 million in donations and sponsorships

Avera also partners with:

  • Red Cross to save lives through smoke detectors ($10,000)
  • Fellowship of Christian Athletes (FCA) to expand programming to female athletes, plus training to help coaches be positive leaders and role models ($30,000)
  • Aberdeen Ride Line to support public transportation in the city of Aberdeen, including rides to health care appointments ($13,000)

Native American Initiatives

The Avera American Indian Health Initiative started in 2013 in response to a growing number of requests from tribal organizations for help in addressing the Native American health care needs in South Dakota.

South Dakota is home to nine federally recognized tribes – nearly 100,000 Native Americans who experience challenges such as a lower life expectancy, unemployment and poverty.

Avera’s American Indian Health Initiative is committed to building relationships with regional tribes and the Indian Health Service to find cost–effective health care solutions that impact the health status of native peoples and their communities.

Additionally, Avera has collaborated in acquiring federal grant funding to improve access to care, including a children’s telehealth network on the Pine Ridge Indian Reservation and a Purchased Referred Care Network among regional tribes.

Avera recently collaborated with the Yankon Sioux Tribe to open a dialysis unit in Wagner, SD, making it the only tribally owned and operated dialysis service unit in the region.

Through meeting with Indian Health Service, the Great Plains Tribal Chairmen’s Health Board and the National Indian Health Board, Avera is gaining a better understanding of the complexities of the Indian health delivery system in our region. We look forward to additional collaborations on health care solutions for Indian people.

JR LaPlante
Director of Tribal Relations

Employee Engagement Survey

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

91-95%* of employees report satisfaction in three main categories: job engagement, organization engagement and overall satisfaction

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

93%* are proud to be part of Avera

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

Ten key drivers of overall employee satisfaction

  • Administrator trust
  • Management of the facility
  • Fairness of promotions
  • Job opportunities
  • Communication
  • Understanding needs
  • Representing issues to administration
  • Employee recognition
  • Keeping good employees
  • Manager trust

Disabilities Rights Conference

The history of living with a disability in the United States has been one of separation, exclusion and even discrimination regarding basic rights such as education, work, housing, and routine daily activities. Legislation and greater awareness have brought great improvements, yet gaps still exist.

Avera, the U.S. Attorney’s Office of South Dakota and LifeScape sought to bring together a group of people concerned for justice and equal access to all members of our society, including people with disabilities.

Deb Fischer-Clemens
Senior Vice President, Public Policy
Avera Health

On Oct. 21, 2015, nearly 200 people gathered to hear inspiring speakers, participate in panel discussions and form action plans. Among speakers were:

  • Heather Abbott, survivor of the Boston Marathon bombing of 2013
  • Corey and Jenny Briest of Yankton, SD. Corey is an Iraqi war veteran who was severely injured by a roadside bomb in Baghdad.
  • Mario Arnauz Bonds, singer, songwriter and author of “Without Sight, But Full of Vision”


Nationwide, health care providers experience unprecedented levels of burnout, impacting providers, their families and the quality of health care as a whole. Avera’s LIGHT program is setting best practices as it serves physicians and advanced practice providers.

What LIGHT offers

  • 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 serve others
  • Proactive ideas to help prevent compassion fatigue and burnout

Avera Medical Group LIGHT Program

LIGHT (Live, Improve, Grow, Heal, Treat),
is a preventive, proactive approach to
well-being for physicians, nurse
practitioners and physician assistants.

LIGHT highlights and achievements

  • Awarded the Medicus Integra Award from the Coalition for Physician Wellbeing
  • Launched Executive Coaching program, through which a certified executive coach talks with providers on issues such as managing change, balancing commitments and leadership development
  • Trained Peer Strategy Coaches, allowing providers to reach out to their colleagues for help with strategies for a variety of professional and personal issues
  • Provided a retirement series for physicians and their spouses focusing on emotional aspects such as meaning, identity and relationships
  • Named a pilot site for the American Medical Association’s Steps Forward burnout inventory

Charity Care and Community Benefit

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

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

By the numbers...

Charity care/financial assistance
Unpaid costs of government programs
Additional Community benefit
Total charity care and community benefit

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.


  • Delta Dental of South Dakota Foundation ($20,000) provides dental work for underserved youth in communities throughout the region.
  • Safe Harbor in Aberdeen, SD, ($30,000) oversees parent-child visits when difficult custodial issues exist and serves as a domestic violence shelter for people in northeastern South Dakota.
  • The Banquet in Yankton, SD, ($5,000) and the Banquet in Sioux Falls, SD, ($5,000) serve regular meals to people in need in an atmosphere of respect and dignity.
  • City of Fort Pierre, SD, ($10,000) is developing a new neighborhood park in a growing part of the community. Avera funding goes toward needs such as benches, picnic tables, play equipment, trees and landscaping.


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

In 2016, Avera Medical Group welcomed:

  • Avera Medical Group Neurology in Sioux Falls, SD
  • Avera Medical Group Dermatology in Mitchell, SD
  • Avera Medical Group Plastic & Reconstructive Surgery in Sioux Falls, SD
  • Optometry as part of Avera Medical Group Ophthalmology in Sioux Falls
  • Avera Tyler physicians and advanced practice providers and Avera Medical Group Dental Care in Tyler, MN

Number of clinic visits: 1,726,129

System Growth

Avera’s growth as a health system is driven by our value of faithful stewardship of our resources. Welcoming additional partners helps Avera deliver high quality care near home.

System Growth

These partnerships benefit local communities in the form of long-term stability, greater access to updates in equipment and technology, and help with physician recruitment.

Inpatient hospital days in 2016
Outpatient visits in 2016

Hospital discharges:


  • Tyler Healthcare Center in Tyler, MN, formerly a managed facility, became an Avera-sponsored and owned facility, which is now Avera Tyler
  • Through an agreement reached with Merrill Pioneer Community Hospital Association, Avera will lease operations of the Rock Rapids community hospital and clinics beginning in May 2019
  • Avera entered into a new Partner in Health agreement with Community Memorial Hospital in Redfield, SD.
  • Avera renewed its lease with the community of Milbank, SD, for an additional 22 years, beginning in November 2016.

Careflight 30th Anniversary

No matter where patients experience critical injuries or illness throughout the Avera region, they deserve the same access to critical care. That’s why the Careflight team at Avera McKennan Hospital & University Health Center in Sioux Falls stands ready to transport patients to the level of care they need, as quickly as possible.

25,000 patients transported

On March 13, 2014, Mary Leedom was at the Broom Tree Retreat Center when she collapsed due to a major aneurysm rupture in her brain, in the midst of asking a question.

If I hadn’t had that speedy flight from Broom Tree to Avera McKennan, I wouldn’t be alive today. Although I had just a slim chance of recovery without severe deficits, I was able to go back to work after just two months. Without the expertise of the Careflight team and Avera medical staff, I wouldn’t be here.

Mary Leedom
Assistant Vice President, Perioperative Services
Avera McKennan Hospital & University Health Center

Avera Cancer Institute

Avera has a 30-year history as a leader in innovative cancer care. In the past, Avera delivered care through related, yet separate programs. Now, Avera Cancer Institute is one name and one unified program of care.

Avera Cancer Institute facility updates

  • The Don and Carmen Meyer Center of Excellence, opened in January 2016, is the new home of Avera Cancer Institute in Aberdeen
  • Avera Cancer Institute Marshall’s new building opened in early 2015, with enhanced space for chemotherapy and the addition of radiation therapy
  • New facilities mirror the design of the Prairie Center in Sioux Falls, with its Prairie Wind architectural theme and patient-friendly amenities

Avera Cancer Institute

6 regional centers

40 outreach sites

WIN Consortium

In November of 2015, Avera Cancer Institute became the fifth medical institution in the United States to join the Worldwide Innovative Networking (WIN) Consortium.

The WIN Consortium is a global network of leading academic, industry, insurance and non-profit research organizations working to make personalized cancer care a reality for patients worldwide.

Avera joins prestigious medical institutions including Memorial Sloan-Kettering Cancer Center in New York, New York University Langone Medical Center, University of Texas MD Anderson Cancer Center and University of California San Diego Moores Cancer Center.

Avera Cancer Institute joins others around the world in a shared goal: to translate personalized cancer medicine discoveries into standards of patient care.

Elekta Collaboration

Avera collaborates with Elekta to equip its locations with advanced cancer technology:

  • Cancer treatment technology: Linear accelerators, Gamma Knife® and brachytherapy
  • Treatment planning software
  • MOSAIQ® electronic medical record specially designed for cancer care

Gamma Knife

Treatment options for brain tumors have historically included surgery, external radiation and chemotherapy. Now these options are greatly expanded by the addition of Gamma Knife® at Avera Cancer Institute in Sioux Falls – the first technology of its kind in the Dakotas.

Rather than a surgical incision, Gamma Knife targets 192 small beams of radiation on the tumor with high precision. Gamma Knife is considered the gold standard for non-invasive treatment of brain disorders. Previously, receiving this level of care meant a trip to Omaha, NE, or Rochester, MN.

Linear Accelerators

Avera Cancer Institute locations equipped with Elekta technology include:

  • Elekta Versa HD™ in Sioux Falls
  • Elekta Infinity™ in Mitchell and Aberdeen, SD, and Marshall, MN.

Elekta equipment in Sioux Falls and Aberdeen was purchased thanks to generous funding from The Leona M. and Harry B. Helmsley Charitable Trust.

Electronic Medical Record

MOSAIQ® is Elekta’s electronic medical record specially designed for cancer care. It ties all Avera cancer registries together, so physicians can view outcomes or results real time across the system, and patients can experience seamless care.

Avera eCARE

Avera eCARE™ celebrated numerous milestones of growth in 2016:

  • Connection with its 1 millionth patient
  • Expansion to 12 states
  • Launch of eSchool Health in eight schools
  • Service to 10 percent of Critical Access Hospitals in nation

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
  • eSchool Health
  • Patients touched:

    1 million
  • Total sites served:

  • Health care dollars saved:

    $180 million
  • Geographical footprint:

    12 states


Avera is connecting with patients where they are, whether that’s at home, in a dorm room, at work or at the grocery store.

AveraNow started as a mobile video visit with an Avera provider through a smartphone, tablet or laptop. Now, AveraNow locations can be found in all seven Hy-Vee stores throughout Sioux Falls.

Hy-Vees are equipped with kiosks that allow a face-to-face virtual visit aided by exam equipment including a thermometer, blood pressure cuff, derm cam and otoscope.

Fast, convenient care

AveraNow treats minor illnesses such as colds, flu, fever, stomach ailments, sinus infections and more. Goals are to improve access to care at an affordable cost, and ultimately connect patients to an Avera provider for regular preventive visits.

AveraNow on Campus gives students at South Dakota State University access to top-quality care 24 hours a day, seven days a week, all with just a few clicks on a smartphone, tablet or desktop computer.

3,800 patients enrolled in AveraNow


In January 2016, DAKOTACARE was purchased by Avera, giving Avera the unique opportunity to serve the needs of South Dakotans with both a choice provider network through DAKOTACARE and a value network plan through Avera Health Plans.

Through Avera Health Plans and
DAKOTACARE, Avera is now the second
largest health insurer in South
Dakota, covering 154,000 lives

DAKOTACARE by the numbers

  • 30 years of committed service to South Dakota
  • Nearly 1,000 employer groups covered
  • 0:36 average wait time for customer service calls
  • 99% claims processing in 30 days
  • 99% claims financial and processing accuracy


Avera launched a newly designed web site in June 2016 with an emphasis on user friendliness and easy navigation.

The new focuses on health services at the system level, and then directs web visitors to Avera locations and providers that offer those services, plus important patient and visitor information.

Features of

  • A responsive design, whether the visitor is using a desktop computer, tablet or mobile phone
  • Navigation that makes it easy for consumers to complete common tasks: Find a physician, find a health plan, find a location, find a job or view baby pictures
  • Search Engine Optimization strategies to result in better results for Internet searches
  • Consumer-centered content that’s short and to the point

Yearly visits: 4.1 million

Antibiotic Stewardship

Overuse of antimicrobials, for example antibiotics and antiseptics, creates “superbugs” that become resistant and are difficult to treat, putting people at risk for serious and even life-threatening infections.

Avera physicians, pharmacy and laboratory experts created a system-wide antimicrobial stewardship program that includes:

  • Consistent dosing policies for antimicrobials
  • Daily conference calls to discuss challenging cases
  • Treatment protocols for common infectious diseases

Each year, Avera tracks antibiograms, a summary of laboratory tests checking for the susceptibility of given bacterial species to various antibiotics. Trends indicate if certain bacteria are becoming less susceptible to common antimicrobials so providers can take action and limit their use.

Avera Twin Register

In May, the Avera Institute for Human Genetics launched the first and only twin register in South Dakota – the Avera Twin Register, as a result of its experience and association with the Netherlands Twin Register at Vrije Universiteit in Amsterdam.

The power of twins research is unparalleled when it comes to learning how much of a certain trait or disease is related to genetics and how much of it is related to environment – the age-old nature-versus-nurture debate.

Studying twin DNA gives Avera researchers opportunity to better understand how genes influence human traits and diseases, which may allow for more accurate diagnosis, the development of better treatments and possibly the prevention of diseases.

Avera scientists are working with other top scientists to transform the future of science, and the future of medicine.

Fred Slunecka
Chief Operating Officer, Avera Health

Bricks and Mortar

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

Projects at Avera facilities that were underway or completed in 2016:

  • Avera Medical Group Family Health Center and Emergency Department, Sioux Falls: $25 million
  • Grasslands Health Campus and new Avera Medical Group Mitchell clinic: $19.4 million
  • Milbank Area Hospital Avera new health care campus: $20 million
  • Coach Don & Carmen Meyer Center of Excellence, home to Avera Cancer Institute Aberdeen: $13.7 million
  • Avera Sr. James Care Center expanded facility at Avera Sacred Heart Majestic Bluffs campus, Yankton: $10 million
  • Neonatal Intensive Care Unit at Avera McKennan Hospital & University Health Center: $7 million
  • Avera De Smet Memorial Hospital, new hospital addition and renovation: $4.8 million
  • Behavioral Health Senior Unit and Extended Care Unit at Avera Prince of Peace campus, Sioux Falls: $3.2 million


Seeing Sepsis

Sepsis accounts for one in five hospital deaths nationwide and kills 258,000 Americans annually. A quality project at Avera is saving lives, reducing sepsis mortality by 45 percent to an average mortality rate of 8.8 percent – well below the national average of about 14 percent.

Seeing Sepsis:

  • Nurse-driven screening protocol that’s hardwired to the electronic medical record
  • Evidence-based order sets, listing antibiotics in order of which to give first
  • Trigger tool for transfer to ICU or tertiary care center
  • Education for staff, including a common language for providers and easy-to-follow infographic
  • Measurement and feedback

Avera Medical Group Quality

In spring 2015, the Centers for Medicare & Medicaid Services released proposed rules for implementing the landmark Medicare Authorization and CHIP Reauthorization Act (MACRA) legislation.  MACRA represents a significant step forward in advancing the triple aim of improving patient quality, patient experience and cost efficiency, and Avera Medical Group is well-positioned in these areas.

Avera Medical Group is once again in the forefront of technology with 99 percent of our eligible providers achieving Meaningful Use levels.

Practicing Excellence

Practicing Excellence was a year-long pilot to improve patient satisfaction scores. In surveys of 7,000 Avera patients, scores among participating providers were higher than non-participating providers in 11 out of 15 categories.

Clinic teams meet once a week in 15-minute huddles to view short videos about how to improve the patient experience.

Practicing Excellence helps physicians be better physicians through seeing things from the patient’s perspective. It’s designed to help physicians get to the next level.

Mikel Holland, MD
Avera Medical Group Pierre

Avera Coordinated Care

Avera Coordinated Care is a team approach to help patients improve their health and quality of life. Coordinated Care is a step toward Population Health, a concept through which health organizations will be responsible for the health outcomes of a group of people, rather than simply treating disease.

Coordinated Care helps people who have significant barriers to improved health, such as multiple diagnoses, catastrophic illness, health literacy issues, or financial challenges. It’s designed to curb health care costs through prevention and earlier treatment of disease at the clinic level, rather than in the hospital or emergency room.

Growth of Coordinated Care

  • 13 teams supporting 40 clinics and sites
  • 1,350 patients actively enrolled in South Dakota, Nebraska, Iowa and Minnesota

Improved outcomes

  • 32 percent improvement in hospital admissions and readmissions
  • 18 percent improvement in emergency room utilization
  • Primary care physician visits up 17 percent
  • 100 percent improvement in mammography, Pap tests, colorectal screening and advance directives

Service Line Development

Through Avera’s Service Line concept, physicians from across the system are engaging in rich conversations and collaboration in order to identify best practices that result in consistent care, which in turn builds quality and reduces cost.

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


The Radiology Service Line is developing consistent CT protocols and updated equipment, ensuring quality imaging and low radiation dose through a new collaboration with Siemens. Over the past year, 13 state-of-the-art Siemens CT units were purchased for Avera facilities.*

While this initiative will save $7 million over the next seven years, it goes beyond the ability to acquire powerful technology at an affordable price. It’s also about efficiency and workflow, reduced variation in care, and a system-wide view to ensure that all sites are connected and unified in the delivery of CT services.

Ultimately, our goal is providing efficient and safe imaging services for optimal diagnosis and treatment that enhances health, wellness and quality of life for the patients we serve.

*CT units in Creighton, Neb.; Gettysburg, S.D.; Redfield, S.D.; and Wessington Springs, S.D., were provided through generous funding from The Leona M. and Harry B. Helmsley Charitable Trust.



Dialysis is a life-saving treatment for people with end-stage kidney disease, and Avera has opened several new outpatient dialysis centers in recent years, from Sioux Falls to Mitchell to Wagner, S.D. The Nephrology Service Line has worked to build an improved patient experience through consistent equipment, care processes and facility design.

Just a few examples:

  • The latest dialysis technology
  • Chairs with heat and massage based on patient choice
  • A home-like design and atmosphere
  • Consistent staff training centered on evidence-based practices for a better patient experience and reduced errors

Patients can see the difference when they come through the door. They can see that everything is intentionally placed for them.

Beth Plahn
Director, Avera Dialysis

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.  Nearly 8 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., as well as enrolling in the Hospital Engagement Network. These programs include measurement of performance in patient safety, evidence-based care, patient and family engagement, appropriate hospital use, mortality, cost and efficiency, and community health.

The quality strategy emphasizes 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, C. difficile prevention, length of stay, Entereg utilization and ongoing sepsis mortality reduction.

For a complete report on Quality Measures, go to