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 Jennifer O'Brien
Primary Contact Phone Number (218) 786-6611
Primary Contact Email Address Jennifer.OBrien@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
Ager Dean Member 1 Medicare Beneficiary Representative NA
Albrecht Chuck Member 1 Community Stakeholder Representative NA
Anderson James Member 1 Community Stakeholder Representative NA
Boehlke-Bray Laura Member 1 ACO Participant Representative The Duluth Clinic, Ltd.
Dunham Linda Vice Chair 1 Medicare Beneficiary Representative NA
Gaddie David Chair 1 Community Stakeholder Representative NA
Haugen Joel Member 1 ACO Participant Representative Innovis Health, LLC
Herman David Ex-Officio Member 0 ACO Participant Representative The Duluth Clinic, Ltd.
Hodnik Al Member 1 Community Stakeholder Representative NA
Hofer Kathleen Member 1 Community Stakeholder Representative NA
Leino Walt Member 1 Medicare Beneficiary Representative NA
Maug Kevin Member 1 Community Stakeholder Representative NA
Raway Beverly Member 1 Community Stakeholder Representative NA
Russ Thomas Member 1 ACO Participant Representative The Duluth Clinic, Ltd.
Stokes Kimberly Member 1 Community Stakeholder Representative NA
Trettel Claire Marie Member 1 Community Stakeholder Representative NA

Key ACO clinical and administrative leadership:

David Herman ACO Executive
Michael Van Scoy Medical Director
Jennifer O'Brien Compliance Officer
Jennifer O'Brien Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee Name Committee Leader Name and Position
Quality Committee Dan Collins, 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 2018, $0
    • 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 2018
      • 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 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

2018 Quality Performance Results:

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 81.98 86.14
ACO-2 CAHPS: How Well Your Providers Communicate 91.94 93.93
ACO-3 CAHPS: Patients' Rating of Provider 90.89 92.45
ACO-4 CAHPS: Access to Specialists 79.73 81.50
ACO-5 CAHPS: Health Promotion and Education 66.34 59.26
ACO-6 CAHPS: Shared Decision Making 58.19 61.94
ACO-7 CAHPS: Health Status/Functional Status 72.86 73.35
ACO-34 CAHPS: Stewardship of Patient Resources 21.98 26.26
ACO-8 Risk Standardized, All Condition Readmission 15.12 14.98
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) 17.52 18.59
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 36.73 37.01
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 72.63 76.75
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 58.49 59.00
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 2.03 1.98
ACO-11 Use of Certified EHR Technology 100.00 97.66
ACO-12 Medication Reconciliation 98.93 85.91
ACO-13 Falls: Screening for Future Fall Risk 98.28 79.73
ACO-44 Imaging Studies for Low Back Pain 61.72 64.36
ACO-14 Preventive Care and Screening: Influenza Immunization 67.43 72.71
ACO-15 Pneumonia Vaccination Status for Older Adults 91.45 75.97
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 85.41 76.83
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 51.85 72.81
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 93.42 66.74
ACO-19 Colorectal Cancer Screening 86.04 68.27
ACO-20 Breast Cancer Screening 80.50 71.96
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 85.05 81.47

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.