May 7, 2024

The world’s largest virtual health network quietly has grown into 42 states from a fairly nondescript workplace in northeast Sioux Falls.

Avel eCare, the renamed former Avera eCare, became a partner of Aquiline Capital Partners, a private investment firm based in New York and London, in 2021.

“In that period, we’ve grown from covering 23 states in 2021. … We’ve had a nice expansion of geography, and at the same time, our recurring revenue streams have increased over 35 percent, so we continue to see really good growth,” CEO Doug Duskin said.

Avel offers a unique telemedicine platform that includes a combination of advanced technology and a network of virtual health care providers, including physicians, nurses and clinicians representing 15 distinct specialties.

The business partners with hospitals, health systems, government entities, schools, senior care communities, and law enforcement and EMS agencies around the country.

This week brings the official opening of the newly renovated headquarters at 4510 N. Lewis Ave. Avel eCare has grown to 377 employees and direct contractors, with about 75 percent of the team based in the Sioux Falls market.

“We’re really excited that we’ve invested in this space,” Duskin said. “I think that speaks loudly to the community and our employee base that we’re willing to invest a good bit into our headquarters. We’re not moving them. We’re here, and we’re invested to prove it and continue to support the growth in this community.”

Duskin, who is based in Atlanta, estimates he spends a week each month in Sioux Falls. Chief operating officer Jay Weems and chief medical officer Kelly Rhone are based in Sioux Falls.

The renovated office is designed to lift up the technology and innovation that’s occurring at Avel eCare, he said.

“We really are more of a tech company, and the business didn’t view itself as that,” he said. “We have viewed ourselves as a network of doctors, and that’s been shifted. The new building highlights that. It’s a front-and-center view of our innovation lab and technology.”

It also creates “a more inviting and welcoming experience for our employee base,” he said. “That’s more and more important to have the right meeting rooms, training rooms, the brightness of the office. If you’re going to spend as much time as our people spend in the building, it needs to be a welcoming space. We revamped it all to create a welcoming environment that we can grow into as we expand in the market.”

Avel eCare still supports virtual health across Avera’s footprint. Duskin called the health system “one of our largest and more important customers.”

In the past year, the clinician-to-clinician telemedicine platform expanded into a dozen new states with multiple acquisitions, including Texas-based hospitalist provider Fident Health and Nightwatch, a provider of remote pharmacy services to hospitals, clinics and nursing homes throughout the Midwest and mid-Atlantic regions.

More recently, Avel announced earlier this month the acquisition of Horizon Virtual, a Minnesota-based virtual hospitalist services provider.

“We continue to target growth for our organization,” Duskin said, adding that it’s a different approach from being part of a health system and existing largely to serve its needs.

“As an independent organization, it’s about growth and continuing to serve your community and staying true to the mission.”

In 2023, Avel also launched partnerships with multiple state and local government agencies, driven by two recently created service lines: crisis care and emergency medicine services.

Crisis care supports law enforcement in de-escalating a mental health crisis by providing on-demand access to behavioral health professionals from the field.

“There’s great expansion in that area as the effort around decriminalizing behavioral health,” Duskin said. “If you can take someone in a brief mental health crisis and avoid incarcerating them … the outcomes are much better, as well as it provides relief to the police and sheriff’s departments.”

South Dakota also has been a leader in bringing telemedicine to emergency medical services, he said. With state funding, Avel’s ER physicians and nurses are able to assist ambulance services and support EMTs and paramedics.

“So many of our EMTs are volunteers, and even if they’re not, in some of the cases they see having an ER doctor in the ambulance with them provides stronger care upfront. We’re able to triage the patient and communicate with the hospital that will be admitting in the ER, and the results so far have been extremely positive,” Duskin said, noting that Nebraska and Minnesota also are adding the service.

“We’ve seen great expansion of the program. “

Avel eCare is hiring multiple roles to support its growth and is “constantly looking for bench strength,” Duskin said. “So we’re looking for clinicians … that want to pull one or two shifts every week on a PRN basis.”

Medical professionals who left the field during the pandemic also now are returning and finding appeal working in virtual health, he said.

“They didn’t want to stop caring for patients, and this provides that environment, and we’re seeing that in some of the applicants today.”