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. As we deliver the highest quality expertise and technology, we seek to make an emotional and spiritual connection with patients and their families.

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

Avera is a regional health system comprised of 340 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.

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

Mission

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 350 organizations through donations, sponsorships and key partnerships.

350 community partners

$5.6 million in donations and sponsorships

Avera also partners with:

  • Presentation College in Aberdeen and Mount Marty College in Yankton to sponsor simulation labs to support future health care workers
  • NAMI of South Dakota to train people who facilitate meetings for individuals and families impacted by mental illness
  • Aberdeen Ride Line to support public transportation in the city of Aberdeen, including rides to health care appointments

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.

Native Americans 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 Indian Health Service (IHS) to find cost-effective health care solutions that impact the health status of native peoples and their communities.

Telemedicine Outreach

Avera has received the opportunity to receive up to $100 million over five years in contractual funding from IHS to provide telemedicine services to approximately 130,000 American Indians in the Upper Midwest.

Two telemedicine programs are being implemented, including Avera eCARE™ Emergency and Specialty Clinics. Through eCARE Emergency, local ER staff can request immediate face-to-face consults in cases that involve serious issues such as heart attack, stroke or trauma. Specialty Clinics offer local appointments in medical specialties such as behavioral health, cardiology, obstetrics, kidney care, pain management and more.

Telemedicine is helping to ease the challenge of health care delivery to reservations. Many of the people who will be served either must travel hundreds of miles for specialty care, or they forego care altogether.

Improving health care for American Indians is a complex problem that will take multiple partnerships over the long term. However Avera welcomes this opportunity to be part of the solution.

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.

89-94%* of employees report satisfaction in three main categories: job engagement, organization engagement and overall satisfaction

97%* understand how their job supports the organization’s mission

91%* 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
  • Employee recognition
  • Communication
  • Job opportunities
  • Fairness of promotions
  • Understanding needs
  • Keeping staff
  • Representing issues to administration
  • Manager trust

Child Sexual Abuse Awareness Conference

Child sexual abuse is one of the most devastating criminal activities we face. In South Dakota, it’s estimated that child sexual abuse impacts 4,000 children every year. That could be only a fraction, because abuse is often hidden for years and some victims never tell.

Avera, the U.S. Attorney’s Office of South Dakota and Children’s Home Society sought to bring together a group of people concerned for stopping the horrors that children experience in the form of sexual abuse, with a goal of having a lasting impact in our community, region and state.

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

Over 350 people gathered Aug. 18-19, 2016, to hear speakers, participate in discussions and form action plans. This was the third 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. Among speakers were:

  • Matthew Sandusky, Founder and Executive Director of Peaceful Hearts Foundation, and a victim of childhood sexual abuse at the hands of his adopted father, Jerry Sandusky.
  • Erin Merryn, childhood sexual abuse survivor, and now author and advocate for the abused.
  • Robert Anda, MD, co-founder of the Adverse Childhood Experiences – or ACE Study – with the Centers for Disease Control and Prevention (CDC).

LIGHT

Dr. Tad Jacobs, Avera Medical Group Chief Medical Officer, and Mary Wolf, Director of the LIGHT program, left, accept the Achievement Citation from Sr. Carol Keehan, CHA President and Chief Executive Sponsor, and Dr. Rod Hochman, CHA Board of Trustees Chair.

On June 12, 2017, the Catholic Health Association presented Avera Medical Group’s LIGHT program with its Achievement Citation, an award presented once each year to innovative programming that changes lives.

The well-being of Avera’s physicians, physician assistants and nurse practitioners is a vital part of our health system. To address the many challenges providers face, Avera began the LIGHT program in 2014.

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 provides approaches and tools for physicians and advanced practice providers so that they can maintain a healthy balance while serving patients.

Those who take part in it can find useful means to combat physician burnout and stay on a path of service to others. LIGHT services touch people throughout their careers, from residency to retirement:

  • Executive and peer coaching
  • A couple's retreat
  • A women’s retreat
  • A Fulfilling Retirement: One Last Prep for Leaders in Medicine
  • No-agenda socials for providers and spouses
  • Schwartz Rounds, a gathering to process social and emotional aspects of being health care providers
  • Continuing medical education credits for completion of courses on well-being strategies
  • LIGHT lunches

We are very proud that Avera is a pioneer in developing the LIGHT program. In receiving the CHA distinction, we hope to raise awareness and provide ideas that other health systems can apply in their own settings.

Tad Jacobs, DO
Chief Medical Officer
Avera Medical Group

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, community blood bank, and more
  • Research
  • Financial and in-kind contributions
  • Community-building activities

By the numbers...

Charity care/financial assistance
$22,580,311
Unpaid costs of government programs
$37,021,418
Additional community benefit
$35,505,210
Total charity care and community benefit
$95,106,939

Key Partnerships

Through 130 partners, Avera allocates a total of $1.5 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.

Examples

  • Delta Dental of South Dakota Foundation provides dental work for underserved youth in communities throughout the region.
  • The Family Visitation Center offers a safe, neutral setting for parent/child visits when there are issues of custody or other family dynamics.
  • Boys and Girls Club of the Aberdeen Area has opened a state-of-the-art facility as a safe place where youth can learn and grow.
  • The Compass Center of Sioux Falls offers crisis intervention, advocacy, counseling and prevention services to those impacted by domestic violence, sexual assault and stalking.

Growth

Avera Medical Group

More than 900 physicians and allied health professionals collaborate to deliver comprehensive, seamless care, with ease of referral to specialists in more than 60 specialty areas.

Providers:
Bar graph of providers by year

In 2017, Avera Medical Group welcomed:

  • Avera Medical Group Orthopedics and Sports Medicine in Sioux Falls, SD
  • Avera Medical Group Dermatology in Pierre, SD
  • Avera Medical Group Family Medicine at the Avera Fox Run Medical Plaza in Yankton, SD
  • Avera Medical Group Hospitalists in Mitchell, SD
  • Granite Falls Health Clinic in Granite Falls, MN, which signed a professional service agreement (PSA) to become an Avera affiliate

Number of clinic visits: 1,744,050

System Growth

Avera’s growth as a health system is driven by our value of faithful stewardship of our resources. Forming partnerships with local hospitals and long-term care centers helps Avera deliver high quality care near home.

Inpatient hospital days in 2017
191,111
Outpatient visits in 2017
1,149,215

Hospital discharges:

40,925

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.

Recent examples:

  • Avera Sacred Heart Hospital purchased Yankton’s Lewis and Clark Specialty Hospital, giving it the name Avera Surgical Hospital on the Avera Fox Run Health Campus.
  • 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 renewed its lease with the community of Milbank, SD, for an additional 22 years, beginning in November 2016.
  • Avera signed a Partner in Health agreement with New Life Treatment Center in Woodstock, MN.

Avera@Home

Home care is about receiving quality health care in the comfort of your home. After a hospitalization or health event, Avera@Home is prepared to have the conversation at the hospital bedside or around the kitchen table to discuss next steps with patients and their families.

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. It starts with a “kitchen table” conversation to help patients and their families set and realize very individualized goals.

Avera@Home offers assistance through:

  • Hospice
  • Home health
  • Home medical equipment

These services are offered in the home or at a care facility seven days a week. Avera@Home offers care for the body, mind and spirit encompassing a complete team of qualified physicians, professional nurses, social workers, clergy and volunteers.

Avera Cancer Institute

Avera has a 30-year history as a leader in innovative cancer care. Avera Cancer Institute is one name and one unified program of care.

6 regional centers

40 outreach sites

The Helmsley Center in Pierre

In April 2017, Avera St. Mary’s Hospital broke ground on the new Helmsley Center, located on its campus in Pierre, SD.

The Helmsley Center is being constructed thanks to a generous donation of up to $10 million from The Leona M. and Harry B. Helmsley Charitable Trust to ensure the people of central South Dakota no longer have to travel more than 100 miles for some cancer treatments, specifically radiation therapy. When completed in the fall of 2018, the building will be home to the Avera Cancer Institute in Pierre.

This is the latest in a series of projects to bring state-of-the-art cancer centers to communities including:

  • The Don and Carmen Meyer Center of Excellence, opened in January 2016, home of Avera Cancer Institute in Aberdeen
  • Avera Cancer Institute in Marshall, opened in early 2015, offers enhanced space for chemotherapy and the addition of radiation therapy

New facilities mirror the design of the Prairie Center in Sioux Falls, completed in 2010, with its Prairie Wind architectural theme and patient-friendly amenities.

Linear Accelerators

Avera Cancer Institute in Yankton is currently upgrading to the Elekta Infinity™. When this project is complete, all Avera Cancer Institute regional cancer centers will have Elekta radiation treatment machines, ensuring greater continuity of care across the system.

Elekta technology at Avera Cancer Institute locations include

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

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

AveraChartCancer

Avera cancer patients now have their own online portal to their electronic medical record (EMR). Through AveraChartCancer, patients can message caregivers, and view medication information, lab and test results, clinical instructions, future appointments and diagnostic details.

Single Cancer Database

The One Avera Oncology MOSAIQ database holds all patient charts and information in one, centrally accessible EMR across the entire Avera system. This helps ensure timely, efficient and effective information sharing and communications, and a smoother continuum of care.

Avera Cancer Institute Navigation Center

This specialized call center takes calls from patients and their loved ones 24/7, answering questions, providing support or making appointments, as well as from primary care providers who are looking for assistance for their patient. The Navigation Center serves all those in our region regardless of where they get their care. Over the past year, the Navigation Center averaged 490 inbound and outbound calls per month across 375 ZIP codes.

Avera eCARE

Avera is home to the most extensive telehealth service in the United States and world that serves rural health care.

Avera eCARE™ highlights of 2017:

  • Service to 13 percent of Critical Access Hospitals in the nation
  • Launched Behavioral Health program
  • Expanded direct-to-consumer services including Employee Assistance Program (EAP), health coaching, campus care, gestational diabetes, health plans and women’s health
  • Opened a new eCARE hub in San Antonio, TX
  • Received a multi-million dollar contract to provide Emergency and Specialty Clinic services to Indian Health Service sites in South Dakota, North Dakota, Nebraska and Montana

Avera eCARE product lines:

  • Emergency
  • Senior Care
  • Pharmacy
  • ICU
  • School Health
  • Correctional Health
  • Specialty Clinics
  • Patients touched:

    1,022,885
  • Total sites served:

    340
  • Health care dollars saved:

    $188 million
  • Geographical footprint:

    14 states

Balance Blog and Magazine

Avera Marketing has launched a new wellness site for health features, blogs and tips at Avera.org/balance.

We’re committed to helping people enjoy good health and well-being throughout all phases of life. Balance content is designed to be relevant to everyday life, and fun to read. It’s all about living better and living balanced.

Kendra Calhoun
Senior Vice President,
Avera Health Marketing

Content is written by Avera health experts and regular bloggers as well as Avera’s writing team. The Balance site is updated almost daily with new content, which is often shared on social media or digital advertising. Twice monthly e-newsletters linking to Balance stories are sent to more than 11,300 subscribers.

In May 2017, the Avera Marketing team published its first-ever Balance magazine, inserted in newspapers in Sioux Falls, Mitchell, Aberdeen, Yankton and Pierre, SD, and Marshall, MN. Mirroring women’s magazines typically seen on a newsstand shelf, Balance was planned by a cross-functional Avera Marketing team and created by Avera’s writers and designers.

Pharmacogenomics

Pharmacogenomics is the study of DNA to understand how an individual will metabolize certain medications. Avera has launched GeneFolio, an exciting new test that offers patients a more precise idea of which medications will work best for them.

GeneFolio tests multiple genes that impact medications in three main classes:

  • Pain
  • Depression and other psychotropic disorders
  • Statins for cholesterol and certain types of blood thinners

Three out of four people have genetic variations that determine how their bodies process medication. That’s why prescribing the right medication is often a process of trial and error.

While GeneFolio doesn’t tell providers what to prescribe, it does give them an additional tool to prescribe the most effective medications, which can mean fewer side effects, faster recovery and lower costs.

GeneFolio was featured on NBC Nightly News

Avera Health Plans and DAKOTACARE

In 2017, Avera Health Plans and DAKOTACARE seized opportunities to integrate to improve services and increase stewardship.

Avera Health Plans and
DAKOTACARE together
cover 141,000 lives.

  • Avera Health Plans, DAKOTACARE and Avera McKennan wellness services programs combined to offer one centralized wellness program for members. This team now provides members with a robust program including improved tools to manage health, such as health coaching, biometric screens and web portal access to health tracking tools.
  • Avera Health Plans and DAKOTACARE combined to launch an all-new Risk Adjustment department, bringing together the best practices from both organizations.

Avera on Louise

Avera Health has announced plans for a new health campus at 69th Street and Louise Avenue – the largest building project in Sioux Falls’ history.

The Avera on Louise Health Campus will be a walk-able, consumer-friendly campus constructed on 82 acres at a convenient, easy-to-access location in southwest Sioux Falls.

The first phase, a $133 million project, includes a surgical hospital and a connected medical office building, comprising 260,000 square feet. Opening of the campus is slated for early 2020.

The campus will specialize in orthopedics and sports medicine, gastroenterology, rheumatology and internal medicine. The surgical hospital will offer an immense range of innovative surgical procedures including robotic surgery, new technologies and amenities.

Health care of the future must be convenient and easily accessible, so Avera is revisioning what care we deliver where. This campus is part of a broad and unified development plan to meet the rapidly growing needs of Sioux Falls and the region.

David Flicek
President and CEO,
Avera McKennan Hospital & University Health Center

Alumend and Alucent

In May 2017, Avera Health announced an exciting development that will contribute toward South Dakota’s growing biotech industry.

The U.S. Food and Drug Administration (FDA) has approved Phase 1 first-in-man clinical trials of Natural Vascular Scaffolding (NVS) therapy, a novel drug/device combination for the treatment of peripheral vascular disease (PVD).

Over the past two decades, NVS has been developed in a Sioux Falls, SD, lab by Alumend, LLC, Avera’s research and development company. NVS will be tested and marketed through the name Alucent Medical, Inc., an owned subsidiary of Alumend.

NVS therapy, which marries balloon angioplasty with a pharmaceutical process, is the first combination product for vascular medicine to enter the U.S. FDA approval process.

NVS has the potential to leap-frog current treatments for peripheral vascular disease.

Myles Greenberg, MD
President and CEO of Alucent Medical

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 2017:

  • The Helmsley Center at Avera St. Mary’s Hospital in Pierre: $29 million
  • Avera Medical Group Family Health Center and Emergency Department, Sioux Falls: $25 million
  • Milbank Area Hospital Avera new health care campus: $20 million
  • Avera Medical Group Brookings clinic renovation: $4.3 million
  • Behavioral Health Senior Unit and Extended Care Unit at Avera Prince of Peace campus, Sioux Falls: $3.2 million
  • Avera McKennan Hospital & University Health Center laboratory update: $3 million
  • New Hope Dialysis Center in Wagner: $1.9 million
  • Finish of shell space for orthopedics on third floor of Avera Medical Group Family Health Center on Marion Road: $1.3 million

Quality

Responsible Prescribing

The Responsible Prescribing Campaign has positioned Avera as a leader in protecting patients from the dangers of opioid addiction while ensuring that patients with pain continue to receive comprehensive and compassionate treatment.

Responsible Prescribing Campaign

  • Staff education about opioid addiction
  • A controlled substance patient agreement to help patients and providers understand the dangers of opioid addiction and the responsibilities of both parties in managing opioids
  • A checklist for physicians to follow when prescribing opioids, which includes alternatives for pain management
  • A pain management educational brochure warning patients about the dangers of opioid addiction and outlining alternatives for pain management
  • Increased access to behavioral health support including an addiction specialist
  • Improved easy access to naloxone for patients at risk for overdose

Avera also made it easier for physicians to prescribe electronically and to access the Prescription Drug Monitoring Program (PDMP). Electronic prescribing reduces risk of medication errors and prescription alterations. Physicians use the PDMP to verify whether patients are receiving opioid medications from another physician, protecting patients from potential misuse.

Avera Medical Group Quality

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.

Zero Suicide Initiative

Avera Medical Group’s Behavioral Health Service Line has been working across service lines to implement best practices for suicide reduction including depression screenings in emergency services, primary care and OB/GYN.

The Zero Suicide Initiative also includes a pilot of telehealth consults to address questions that primary care providers may have about psychiatric drugs, use of the Columbia-Suicide Severity Rating Scale (C-SSRS) to assess suicidality, and staff training and education on suicide risk assessment and management.

Healthy Weight Initiative

Obesity is a growing epidemic, contributing to rising health care costs and declining quality of life. In South Dakota, 66 percent of adults and 33 percent of children are overweight or obese.

An Avera Medical Group obesity workgroup harnessed telemedicine to extend two Avera weight loss programs, including Balanced Weight Loss and Ideal Living within the AveraNow platform, both with a strong component of maintenance health coaching to help support long-term weight loss.

A combination of 158 face-to-face and AveraNow patients were enrolled over 18 months, losing an average of 7 to 29 pounds. This success has opened the door for these and similar programs to grow and serve rural areas as well.

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
  • Caring for an average of 1,500 patients in South Dakota, Nebraska, Iowa and Minnesota

Improved outcomes

  • 32 percent improvement in hospital admissions and readmissions
  • 19 percent increase in primary care visits at participating clinics
  • 10 percent average weight loss
  • 9 percent relative improvement in hypertension
  • 14 percent relative improvement in diabetic A1C results
  • Improved rates of colorectal screens, Pap tests and mammograms

ACOs

Accountable Care Organizations (ACOs) are designed to help health systems move toward coordinated, team-based care that’s efficient and high quality.

Avera has launched two ACOs through the Medicare Shared Savings Program that include about 20,000 Medicare patients.

Service Line Development

Through Avera’s Service Line concept, physicians from across the system collaborate 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

Preoperative Guidelines

The Primary Care Service Line Steering Committee approved new preoperative guidelines developed in collaboration with the General Surgery and Cardiology Service Lines, as well as anesthesia providers. The goal was to standardize best practices to ensure patients are appropriately and accurately cleared for surgery at the lowest possible cost.

In addition to collaborating with other Avera physicians, the Primary Care Service Line sought nationwide best practices from multiple sources to develop these guidelines.

 

Oncology

Avera recommends annual screening mammography beginning at age 40 and continuing as recommended by each patient’s provider.  The Primary Care Service Line, Avera Breast Leadership Council, and the Avera McKennan Breast Health Professional Advisory Board collaborated over the past several months to develop these guidelines, using many sources of evidence.

These physician groups also issued a position statement based on evidence from multiple randomized control trials, observational studies and National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET) modeling.

Oncology: Single Database

Emergency Medicine and Careflight

Quality Awards

  • Health Care’s Most Wired Advanced – Avera Health
  • Premier QUEST Citation of Merit – Avera McKennan Hospital & University Health Center, Avera St. Luke’s Hospital and Avera St. Mary’s Hospital
  • Becker’s 100 Hospitals & Health Systems with Great Women’s Health Programs – Avera McKennan
  • Top 20 Rural Community Hospitals – Avera Queen of Peace Hospital
  • National Research Corporation Excellence in Action for customer satisfaction scores in the top 10 percent – Avera Sr. James Care Center
  • Mission: Lifeline Gold Performance Achievement Award – Avera Heart Hospital
  • ACTION–Get With the Guidelines Platinum Performance Award – Avera Heart Hospital
  • Top 20 Critical Access Hospitals – Floyd Valley Healthcare and Avera Holy Family Hospital
  • National Rural Health Resource Center Innovation in Emergency Medical Service – Avera Holy Family Hospital
  • Top 20 Critical Access Hospitals in Patient Satisfaction – Avera Weskota Memorial Hospital
  • Minnesota Health Action Group Optimal Diabetes Care Award – Avera Medical Group Worthington, Pipestone and Marshall
  • Minnesota Health Action Group Optimal Vascular Care Award – Avera Medical Group Pipestone