Medicare Shared Savings Program

ACO Name and Location

Essentia Health
Previous Names: N/A
502 E Second Street
Duluth, Minnesota 55805

ACO Primary Contact

Primary Contact Name Christine Papineau
Primary Contact Phone Number (218) 576-0838
Primary Contact Email Address Christine.Papineau@EssentiaHealth.org

Organizational Information

ACO participants:

ACO Participants ACO Participant in Joint Venture (Enter Y or N)
Bridges Medical Center N
Innovis Health, LLC N
Brainerd Medical Center, Inc. N
Nat G. Polinsky Memorial Rehabilitation Center, Inc. N
St. Joseph''s Medical Center N
St. Mary''s Medical Center N
First Care Medical Services N
Graceville Health Center N
Northern Pines Medical Center N
The Duluth Clinic, Ltd. N
St. Marys Regional Health Center N
St. Mary''s Hospital of Superior N
Lakewood Health System N
SMDC Medical Center N
Pine Medical Center N
Essentia Health Virginia, LLC N

ACO governing body:

Member Member's Voting Power - Expressed as a percentage or number Membership Type ACO Participant Legal Business Name/DBA, if Applicable
Last Name First Name Title/Position
Blair Richard Director and Chairperson 1 Medicare Beneficiary NA
Boehlke-Bray Laura Director 1 ACO Participant The Duluth Clinic, Ltd
Raway Beverly Director 1 ACO Participant St. Mary's Medical Center
Haugen Joel Director 1 ACO Participant Innovis Health, LLC
Hofer Kathleen Director 1 ACO Participant St. Joseph's Medical Center
Russ Thomas Director 1 ACO Participant The Duluth Clinic, Ltd.
Leino Walter Director 1 Medicare Beneficiary NA
Seitz James Director 1 Medicare Beneficiary NA
Ager Dean Director 1 Community Member NA
Anderson James Director 1 Community Member NA
Dunham Linda Director 1 Community Member NA
Hodnik Alan Director 1 Community Member NA
Gaddie David Director 1 Community Member NA
Hassen Neal Director 1 Community Member NA
Trettel Claremarie Director 1 Community Member NA
Collard Lori Director and Vice Chairperson 1 Community Member NA
Herman David EX-OFFICIO 0 Other NA

Key ACO clinical and administrative leadership:

David Herman ACO Executive
Michael Van Scoy Medical Director
Christine Papineau Compliance Officer
Rajesh Prabhu Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee Name Committee Leader Name and Position
Quality Committee Rajesh Prabhu, Chair
Population Health Committee Michael Van Scoy, Chair
Clinical Practice Committee Peter Henry, Chair
Compliance Committee Julene Brown, Chair

Types of ACO participants, or combinations of participants, that formed the ACO:

  • Critical Access Hospital (CAH) billing under Method II
  • ACO professionals in a group practice arrangement
  • Hospital employing ACO professionals
  • Rural Health Clinic (RHC)

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Second Agreement Period
    • Performance Year 2017, $2,837,135
    • Performance Year 2016, $0
  • First Agreement Period
    • Performance Year 2015, $0
    • Performance Year 2014, $0
    • Performance Year 2013, $0

Shared Savings Distribution

  • Second Agreement Period
    • Performance Year 2017
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 40%
      • Proportion of distribution to ACO participants: 40%
    • Performance Year 2016
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
  • First Agreement Period
    • Performance Year 2015
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
    • Performance Year 2014
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
    • Performance Year 2013
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A

Quality Performance Results

2017 Quality Performance Results:

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 84.11 80.60
ACO-2 CAHPS: How Well Your Providers Communicate 92.31 93.13
ACO-3 CAHPS: Patients' Rating of Provider 91.99 92.31
ACO-4 CAHPS: Access to Specialists 81.73 83.32
ACO-5 CAHPS: Health Promotion and Education 66.97 62.30
ACO-6 CAHPS: Shared Decision Making 75.42 75.85
ACO-7 CAHPS: Health Status/Functional Status 73.39 73.05
ACO-34 CAHPS: Stewardship of Patient Resources 21.77 25.68
ACO-8 Risk Standardized, All Condition Readmission 14.71 15.01
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) 17.41 18.46
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 49.60 53.95
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 79.48 79.16
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 61.95 61.74
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.85 1.93
ACO-11 Use of Certified EHR Technology 100.00 98.48
ACO-12 Medication Reconciliation 99.36 75.32
ACO-13 Falls: Screening for Future Fall Risk 98.27 74.38
ACO-44 Imaging Studies for Low Back Pain 57.41 67.32
ACO-14 Preventive Care and Screening: Influenza Immunization 69.35 72.52
ACO-15 Pneumonia Vaccination Status for Older Adults 93.39 72.92
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 73.78 70.69
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 99.50 90.48
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 90.94 61.98
ACO-19 Colorectal Cancer Screening 79.18 64.58
ACO-20 Breast Cancer Screening 79.44 70.05
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 83.76 79.89
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 10.25 16.74
ACO-41 Diabetes: Eye Exam   60.66 50.37
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 77.54 71.47
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 95.75 86.86

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples.

Note: In the Quality Performance Results file(s) above, search for “Essentia Health” to view the quality performance results. This ACO can also be found by using the ACO ID A01714 in the public use files on data.cms.gov.

Payment Rule Waivers

Yes, our ACO does use the SNF 3-Day Rule Waiver.