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 Jessica Martensen
Primary Contact Phone Number 218-786-6611
Primary Contact Email Address Jessica.Martensen@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
Polinsky Medical Rehabilitation Center 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
Deer River Healthcare Center, Inc. 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 N/A
Albrecht Chuck Member 1 Community Stakeholder Representative N/A
Anderson James Member 1 Community Stakeholder Representative N/A
Gaddie David Chair 1 Community Stakeholder Representative N/A
Gefroh Ellison Stefanie Member 1 ACO Participant Representative Innovis Health, LLC
Goldfarb George Member 1 Community Stakeholder Representative n/A
Herman David Ex-Officio Member 0 ACO Participant Representative The Duluth Clinic, Ltd.
Hodnik Al Member 1 Community Stakeholder Representative N/A
Hofer Kathleen Member 1 Community Stakeholder Representative N/A
Leino Walt Member 1 Medicare Beneficiary Representative N/A
Lewandowski Laurie Member 1 Medicare Beneficiary Representative N/A
Maug Kevin Member 1 Community Stakeholder Representative N/A
Raway Beverly Member 1 Community Stakeholder Representative N/A
Rudd Jane Member 1 ACO Participant Representative The Duluth Clinic, Ltd.
Russ Thomas Member 1 ACO Participant Representative The Duluth Clinic, Ltd.
Stokes Kimberly Member 1 Community Stakeholder Representative N/A
Trettel Claire Marie Member 1 Community Stakeholder Representative N/A

Key ACO clinical and administrative leadership:

David Herman ACO Executive
Michael Van Scoy Medical Director
Julene Brown Compliance Officer
Jessica Martensen 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

  • Third Agreement Period
    • Performance Year 2019 & 2019A, $9,542,017
  • 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

  • Third Agreement Period
    • Performance Year 2019 & 2019A
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 40%
      • Proportion of distribution to ACO participants: 40%
  • 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

2019 Quality Performance Results:

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 80.84 85.86
ACO-2 CAHPS: How Well Your Providers Communicate 92.24 94.11
ACO-3 CAHPS: Patients' Rating of Provider 89.65 92.69
ACO-4 CAHPS: Access to Specialists 77.02 81.54
ACO-5 CAHPS: Health Promotion and Education 65.69 60.44
ACO-6 CAHPS: Shared Decision Making 57.32 62.78
ACO-7 CAHPS: Health Status/Functional Status 74.11 73.79
ACO-34 CAHPS: Stewardship of Patient Resources 21.12 26.17
ACO-45 CAHPS: Courteous and Helpful Office Staff 92.79 92.84
ACO-46 CAHPS: Care Coordination 85.58 86.89
ACO-8 Risk Standardized, All Condition Readmission 14.38 14.86
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 56.37 58.15
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91) 1.73 1.87
ACO-13 Falls: Screening for Future Fall Risk 97.47 84.04
ACO-14 Preventive Care and Screening: Influenza Immunization 72.77 74.77
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 77.27 78.04
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 91.87 70.40
ACO-19 Colorectal Cancer Screening 82.28 70.76
ACO-20 Breast Cancer Screening 83.89 73.84
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 84.51 82.17
ACO-27 Diabetes: Hemoglobin A1c Poor Control (>9%) 11.44 13.88
ACO-28 Controlling High Blood Pressure 87.27 75.04

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

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 A1066 in the public use files on data.cms.gov.

Payment Rule Waivers

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

Preferred Network

The preferred network is a partnership between Essentia Health and multiple skilled-nursing facilities (SNFs), home health agencies (HHAs), hospice care, durable medical equipment (DME) and infusion care with the goal of providing high quality and timely care.

Having a variety of Preferred Network partnerships ensures Essentia Health patients have a continuum of quality care from high-value providers throughout the continuum of care.

For more information, please contact:

Primary Contact Name Jessica Martensen
Primary Contact Phone Number 218-786-6611
Primary Contact Email Address Jessica.Martensen@EssentiaHealth.org