Avera formed in 2000 when the Presentation and the Benedictine health systems merged. Today, the Sioux Falls, S.D.-based system’s 72,000-square-mile footprint covers the whole of South Dakota, as well as parts of Minnesota, Iowa, Nebraska and North Dakota. It has 22,100 employees and physicians, operating more than 300 locations and serving 100 communities.
In conversation with Becker’s, Mr. Dover shared how within Avera’s footprint, its “secret sauce” is applied in expanding its physician and provider enterprise and leveraging technology and care management.
“The long and short of [it] is we are seeing 6% growth in our total clinic volume, compounded annually over the last year, two years, and now going into this, our third year,” he said.
As a result of the growth, Avera is able to invest hundreds of millions in the Sioux Falls market, building a six-story tower addition to Avera McKennan Hospital & University Health Center and a three-story building on the Avera on Louise Health Campus.
The system has also made a commitment to switch to Epic, an initiative that Mr. Dover indicates is another transformative investment over the next two years.
“All of this is resulting in us now being the dominant market share,” he said. “We have about a 45% market share across our footprint as well as 53% inpatient market share in our Sioux Falls market, and we have essentiality in most of the places we are at. But all of this is due to our commitment to rural healthcare and keeping care local, and making sure that our provider enterprise is the center of everything that we do.”
Mr. Dover noted that the biggest challenge Avera faces in maintaining access and care quality in rural areas is ensuring a robust workforce to care for patients.
“If you’re able to have those human resources available locally, people will stay local for their care,” he said. “People don’t like driving 3 1/2 hours to Sioux Falls in the middle of winter to get their care. And so we know if we can provide care locally, we know that’s the secret sauce.”
To address this, he said Avera owns an extensive transportation system — air medical airplanes and medical helicopters — and offers extensive telemedicine services.
“We send a pediatric cardiologist out to Pierre, S.D., twice a month to do clinics — put them on an airplane,” he said. “We have an airplane that we run physicians out everywhere. We have helicopters that we scoop patients up and bring them in to get their heart cath, if they have a heart attack. So our door-to-wire times meet national standards.
“But the real blessing is to keep the care local. We have an extensive telehealth network. And, I mean, it’s extensive. We were using telemedicine well before the pandemic, and we found that in many cases, our physicians on-site in the region are OK keeping a patient if they know someone’s got their back and they can do the consult.”
He cited obstetrics as a particular area of success in terms of telemedicine.
At Avera St. Benedict in Parkston, S.D., family medicine physicians are board-certified in family medicine and have obstetrics privileges. However, telemedicine may be used in certain situations, he said, such as when the obstetrics patient is in the emergency room and the family medicine physician is trying to assess whether a transfer is needed. Physicians in Sioux Falls are on call to help with those decisions and provide an immediate virtual consultation.
Another part of keeping care local is Avera’s partnerships with academic organizations in the region to get top talent. Roughly 80% of the health system’s front-line workforce are born, raised and trained in the area.
Avera also partners with the Sioux Falls School District on Avera Academy, a program for high school seniors to help them explore a career in healthcare.
“What we found is, in summary, the secret sauce is to keep care local,” Mr. Dover said. “If you keep care local, the hospital does well, the clinic does well, and it becomes a wonderful place that people want to then actually relocate to — to be part of an active, vibrant medical community, knowing that they have connectivity to a broader ecosystem.”