Medicare Shared Savings Program

ACO Name and Location

Essentia Health
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 Yes or No)
Bridges Medical Center No
Innovis Health, LLC No
Brainerd Medical Center, Inc. No
Nat G. Polinsky Memorial Rehabilitation Center, Inc. No
St. Joseph''s Medical Center No
St. Mary''s Medical Center No
First Care Medical Services No
Graceville Health Center No
Northern Pines Medical Center No
Deer River Healthcare Center, Inc. No
The Duluth Clinic, Ltd. No
St. Marys Regional Health Center No
St. Mary''s Hospital of Superior No
Lakewood Health System No
SMDC Medical Center No
Pine Medical Center No

ACO governing body:

Member Last Name Member First Name Member Title/Position Member's Voting Power Membership Type ACO Participant TIN Legal Business Name/DBA, if Applicable
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
Julene Brown 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:

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

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Second Agreement Period
    • 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 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

2016 Quality Performance Results:

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 80.31 80.51
ACO-2 CAHPS: How Well Your Providers Communicate 92.64 93.01
ACO-3 CAHPS: Patients' Rating of Provider 91.94 92.25
ACO-4 CAHPS: Access to Specialists 80.31 83.49
ACO-5 CAHPS: Health Promotion and Education 65.59 60.32
ACO-6 CAHPS: Shared Decision Making 73.38 75.40
ACO-7 CAHPS: Health Status/Functional Status 73.13 72.30
ACO-34 CAHPS: Stewardship of Patient Resources 20.75 26.97
ACO-8 Risk-Standardized, All Condition Readmission 14.17 14.70
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) 16.33 18.17
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 49.72 53.20
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 70.13 75.23
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 58.19 59.81
ACO-9 Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) 7.22 9.27
ACO-10 Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 ) 12.71 14.53
ACO-11 Percent of PCPs who Successfully Meet Meaningful Use Requirements 96.01 82.72
ACO-39 Documentation of Current Medications in the Medical Record 94.74 87.54
ACO-13 Falls: Screening for Future Fall Risk 97.85 64.04
ACO-14 Preventive Care and Screening: Influenza Immunization 55.56 68.32
ACO-15 Pneumonia Vaccination Status for Older Adults 90.48 69.21
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 70.63 74.45
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 99.51 90.98
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 92.6 53.63
ACO-19 Colorectal Cancer Screening 73.19 61.52
ACO-20 Breast Cancer Screening 77.74 67.61
ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented 38.62 76.79
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 87.03 77.72
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 11.86 18.24
ACO-41 Diabetes: Eye Exam   52.57 44.94
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 82.52 70.69
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 92.55 85.05
ACO-31 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 95.13 88.67
ACO-33 Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy – for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) 86.17 79.67

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.

The approved list of SNF affiliates:

  • Ecumen (dba: Lakeshore/Duluth)
  • Ecumen (dba: Emmanuel Nursing Home/Detroit Lakes)
  • Graceville Health Center (dba: Essentia Health Grace Home/Graceville)
  • Benedictine Health Center (Duluth)
  • American Lutheran Homes, Inc (dba: Bethany on University/Fargo)
  • Bethany on 42nd (Fargo)
  • St Mary's Regional Health Center (dba: Essentia Health Oak Crossing/Detroit Lakes)
  • The Evangelical Lutheran Good Samaritan Society (dba: Good Samaritan Society of Pine River/Pine River)
  • The Evangelical Lutheran Good Samaritan Society (dba: Good Samaritan Society-Bethany/Brainerd)
  • Lakewood Health System (Staples)
  • First Care Medical Services (dba: Essentia Health First Care Living Center/Fosston)