Medicare Shared Savings Program

ACO Name and Location

Essentia Health ACO Inc.
Previous Names: Essentia Health
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 [email protected]

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. Mary's Regional Health Center N
St. Mary's Hospital of Superior N
Essentia Health - Moose Lake 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
First Name Last Name Title/Position
Cathy Cantor, MD President 0% ACO Participant Representative St. Mary's Medical Center
Taylor Mertz, MD Member 10% ACO Participant Representative Innovis Health LLC
Jan Baldwin, MD Member 10% ACO Participant Representative Essentia Health Virginia LLC
Tanya Diegel, MD Member 10% ACO Participant Representative Innovis Health LLC
Sheila Hart Member 10% Medicare Beneficiary & Community Stakeholder N/A
Michael Sterns,MD Member 10% ACO Participant Representative St. Mary's Hospital Superior
Sarah Nelson, MD Member 10% ACO Participant Representative SMDC Medical Center
Michael Haarstad, MD Member 10% ACO Participant Representative SMDC Medical Center
Adam Riutta, MD Member 10% ACO Participant Representative St. Mary's Medical Center
Bruce Smith, MD Vice Chair 10% ACO Participant Representative SMDC Medical Center
Krista Skorupa, MD Chair 10% ACO Participant Representative SMDC Medical Center
Robert Green Treasurer 0% ACO Participant Representative St. Mary's Medical Center
Michael Watters Secretary 0% ACO Participant Representative St. Mary's Medical Center

Key ACO clinical and administrative leadership:

Dr. Cathy Cantor ACO Executive
Dr. Sarah Nelson Medical Director
Torri Schramm 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 Dr. Cathy Cantor, Chair
Clinical Practice Committee Dr. Gratia Pitcher, Chair
Compliance Committee Torri Schramm, 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 2023: $11,413,273
    • Performance Year 2022: $11,166,946
    • Performance Year 2021:$10,156,122
    • Performance Year 2020, $10,619,537
    • 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 2023
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesign care processes/resources: 40%
      • Proportion of distribution to ACO participants: 40% 
    • Performance Year 2022
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesign care processes/resources: 40%
      • Proportion of distribution to ACO participants: 40% 
    • Performance Year 2021
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesign care processes/resources: 40%
      • Proportion of distribution to ACO participants: 40%
    • Performance Year 2020
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesign care processes/resources: 40%
      • Proportion of distribution to ACO participants: 40%
    • 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

Note: Our ACO participated in multiple performance years during Calendar Year 2019. Shared savings/losses amount reporting for Performance year 2019 therefore represent net shared savings or losses across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.

Quality Performance Results

2023 Quality Performance Results:

Quality performance results are based on CMS Web Interface

Measure# CMS Web Interface - Measure Name Collection Type Rate ACO Mean
CAHPS-1 Getting Timely Care, Appointments, and Information CAHPS for MIPS Survey 79.12 83.68
CAHPS-2 How Well Providers Communicate CAHPS for MIPS Survey 93.60 93.69
CAHPS-3 Patient’s Rating of Provider CAHPS for MIPS Survey 92.12 92.14
CAHPS-4 Access to Specialists CAHPS for MIPS Survey 70.01 75.97
CAHPS-5 Health Promotion and Education CAHPS for MIPS Survey 69.46 63.93
CAHPS-6 Shared Decision Making CAHPS for MIPS Survey 57.26 61.60
CAHPS-7 Health Status and Functional Status CAHPS for MIPS Survey 73.81 74.12
CAHPS-8 Care Coordination CAHPS for MIPS Survey 84.91 85.77
CAHPS-9 Courteous and Helpful Office Staff CAHPS for MIPS Survey 92.41 92.31
CAHPS-11 Stewardship of Patient Resources CAHPS for MIPS Survey 25.11 26.69
001 Diabetes: Hemoglobin A1c (HbA1c) Poor Control1 CMS Web Interface 9.69 9.84
134 Preventative Care and Screening: Screening for Depression and Follow-up Plan CMS Web Interface 88.45 80.97
236 Controlling High Blood Pressure CMS Web Interface 85.62 77.80
318 Falls: Screening for Future Fall Risk  CMS Web Interface 98.03 89.42
110 Preventative Care and Screening: Influenza Immunization CMS Web Interface 65.90 70.76
226 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention CMS Web Interface 72.41 79.29
113 Colorectal Cancer Screening CMS Web Interface 85.04 77.14
112 Breast Cancer Screening CMS Web Interface 85.47 80.36
438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease2 CMS Web Interface 89.43 87.05
370 Depression Remission at Twelve Months2 CMS Web Interface 24.55 16.58
321 CAHPS for MIPS CMS Web Interface 5.11 6.25
479 Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups1 Administrative Claims 0.1443

0.1553
484 Clinician and Clinician Group Risk-Standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions Administrative Claims N/A

35.39
For Previous Years' Financial and Quality Performance Results, please visit data.cms.gov
  • [1] A lower performance rate corresponds to higher quality.
  • [2] For PY 2023, the CMS Web Interface measures Quality ID #438 and Quality ID #370 do not have benchmarks, and therefore, were not scored. 

Payment Rule Waivers

  • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR 425.612.
  • Waiver for Payment for Telehealth Services:
    o Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.
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