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2022 Annual Report

A note from John Dahm
Accra President and CEO

In 2022, Accra continued to work toward our mission of improving lives by providing individualized homecare services and support to people living at home by providing quality homecare to clients throughout Minnesota.

Despite facing continued challenges in the homecare industry, including increased workforce pressures, regulatory changes, and rising costs, Accra achieved remarkable results. Our revenues increased by 7.4% to $341.7 million. I am thrilled to share that in 2022, Accra continued to achieve a positive Return on Mission (ROM) of 0.91%, consistent with last year.

This positive Return on Mission was made possible through various strategic initiatives:

We expanded our operations to reach even more individuals, aligning with our mission.

By optimizing our administrative and overhead expenses, we reduced indirect costs, allowing us to allocate more resources directly to our clients’ care.

Through a targeted effort to manage overtime and implement compliance measures, we successfully curbed direct costs, ensuring efficient service delivery.

We proactively pursued Federal COVID relief funds, which played a crucial role in offsetting the additional costs incurred by regulatory changes.

Legislative changes
During the 2023 Minnesota legislative session, our public affairs team successfully advocated for an increase in the PCA-Choice wage to $19 per hour, starting January 1, 2024. This wage increase is a significant step forward, and we remain committed to providing fair compensation for our caregivers.

Our public affairs team also successfully advocated for an increase in the PCA reimbursement rate to offset the increase in caregiver wages. Unfortunately, the reimbursement rate did not increase at the same rate as PCA-Choice wages, so our operating margins will be even tighter in the future.

Looking Ahead
The evolving landscape of healthcare continues to inspire us to seek external collaborations. We are actively pursuing partnerships that align with our vision of creating an ecosystem focused on delivering personalized care in the home, tailored to the unique needs of those underserved by the current healthcare system.

Additionally, we are preparing for executive team transitions in the coming years and have expanded our leadership team to include a group of talented senior directors who will help guide us through this period of change.

I am proud to report that Accra is well-positioned to continue fulfilling our mission in the years ahead. I am profoundly grateful for the unwavering dedication of our employees and caregivers whose passion and commitment drive our success. Together, we are positively impacting the lives of our clients and communities across Minnesota.

Administrative and support employees
PCA Clients Served
Minnesotans served
Direct Care staff employed
Highlights from 2022 to present
In 2022, Accra celebrated its 30th Anniversary!

Celebrating 30 Years of Service

To recognize the occasion, Accra talked with employees, clients, caregivers and responsible parties about the impact that Accra has made on the people and communities it has served. Thank you to all the clients who have trusted Accra with their homecare services and the employees who have made these services possible for three decades!

Preparing for the CFSS Transition in Minnesota

CFSS expected to launch in 2024

CFSS is a new self-directed homecare option being developed by the State of Minnesota to replace the current PCA Choice program and the state-funded Consumer Support Grant (CSG) benefit, which is expected to launch in 2024. CFSS will offer those who need home services more choice, control and flexibility with their services and supports required to live and work in their community.

Accra was approved as a Community First Services & Supports (CFSS) consultation services provider by the State of Minnesota. We have developed a business plan around the transition to CFSS and will communicate with our current and prospective clients about the changes as they are announced by DHS.

Taking Payroll on the Go

Accra Mobile

When DHS announced in May 2022 that Electronic Visit Verification (EVV) would be required in Minnesota for FMS providers, Accra needed to add a reliable system.

In June 2023, Accra started rolling out its own mobile electronic time capture platform known as Accra Mobile. Data from the mobile application flows seamlessly into the Accra Access portal. Responsible parties can approve or reject time shifts created by caregivers, view weekly summaries of time and see the status of the time shift data as it moves through processing and payment.

Advancing Accessibility Through Accra Access Online Portal

Accra Access debuted in Q1

This new online client portal provides responsible parties with real-time visibility of budget balances and usage details for each client and their associated services. It also allows each program to publish announcements and general resources that are accessible to responsible parties in a self-service capacity.

Users have access to key published report data, such as monthly statements like utilization letters and spending summaries. Accra team members can also send notifications to alert responsible parties of client specific requirements or concerns.

As of September 2023, 5,100 clients across various programs have adopted the system. More adoptions are expected as new functionalities in development are added, such as a new job board feature.

Mental Health Services

Providing in-person therapy

Accra now provides in-person therapy at our Minneapolis, Duluth, Hibbing and Virginia clinics, and we offer virtual therapy via telehealth to clients throughout Minnesota.

Accra also provides adult rehabilitative mental health services (ARMHS) throughout the seven-county Twin Cities metro area and St. Louis County. ARMHS help clients manage the symptoms of mental illness, develop independent living skills and lead a more fulfilling life at home.

Increasing PCA Wages

A caregiver helps a senior client take her medications.

During the 2023 Minnesota Legislative session, Accra joined with several community partners, including the Minnesota Home Care Association, The Arc MN, and SEIU to advocate for an increase in the base hourly wage for PCAs and for an increase in the corresponding reimbursement rate for providers.

The new two-year CBA increases base wages for PCAs in the PCA Choice program to $19/hour effective Jan. 1, 2024, and $20/hour effective Jan. 1, 2025. Concurrently, the corresponding reimbursement rate paid to all providers increases by 21.3% effective Jan. 1, 2024, and an additional 4.3% effective Jan. 1, 2025.  While Accra applauds the increase in the base wage rate for PCAs, we also recognize that the reimbursement rate is not keeping pace with the increases in base wages required of Choice providers.

Broadening Legislative and Public Affairs Efforts

Accra successfully engaged in the 2023 Minnesota legislative session by:

  • Participating in several one-on-one private meetings with committee leadership and staff in both the House and the Senate, 
  • Providing key testimony in several legislative hearings, 
  • Engaging in discussions with key staff in the Governor’s office, 
  • Maintaining regular communications with DHS staff, 
  • Collaborating with several valued community partners including SEIU, and 
  • Facilitating action by Accra clients resulting in over 200 contacts with more than 65 Legislators. 

All of this action results in Accra creating a new level of visibility and respect within the Legislature and the Governor’s office, and it allows Accra to initiate and nurture valued relationships that will continue to reap rewards into the future. 

Furthering Our Diversity, Equity and Inclusion Efforts

In 2022 and 2023, the impact of DEI at Accra broadened and accelerated, with survey data finding that 96% of employees feel that Accra is committed to DEI. Accra’s 2023 DEI theme is Develop, Engage, Integrate. To achieve this, four employee panels were held, which highlighted the diverse lived experiences of Accra staff, in addition to regular bulletins, support groups and book club meetings. To foster continuous education, Accra created quarterly DEI learning courses that help employees build DEI awareness and gain the knowledge and skills to embrace differences, challenge biases and foster an inclusive workplace. Accra’s goal is to cultivate a workplace where diversity thrives and an environment in which empathy, respect and openness are ingrained in everything that it does.

Appointing a Chief Technology Officer

Tim Jones headshot

In January 2023, Timothy Jones was promoted to Chief Technology Officer.

In his new role, Jones focuses on developing and executing technology strategy, including leveraging technology to improve Accra’s services, enhance efficiency and increase the organization’s return on mission. For three years, he has overseen significant growth within Accra’s IT team and the formation of a development team, which created the Accra Access portal and Accra Mobile application. With over three decades of IT experience, Jones will continue to drive innovation and digital transformation at Accra, as well as bolster security and maintain compliance with government regulations.

With Chief Operating Officer Sue Morgan announcing her plans to retire at the end of 2023, the Accra executive team has been engaged in succession planning.

In response, Accra announced the promotion of several Directors to Senior Director positions. These promotions, which include reassignment of Sue’s current assignments among these individuals, are as follows:

  • Peter Noss to Senior Integration Director
  • Rochelle Wodarz to Senior Program Director of PCA/CFSS and Compliance
  • Tyler Langenfeld to Senior Program Director of Strategic Development
  • Valerie Patino to Senior Program Director of FMS and Mental Health
  • Hannah Rutt to Senior HR Director

The Executive Leadership team will continue to provide counsel, guidance, and direction to the Senior Leadership Team as Accra advances its vision of building the ecosystem that delivers personalized care in the home to better meet the needs of those served by the current health care system.

Our Programs
  • Personal Care Assistance (PCA) Choice

    Self-directed Personal Care Assistance (PCA) Choice services are available to children and adults with disabilities, chronic diseases, behavioral diagnoses and mental illnesses who need assistance with personal care in their homes or in the community. PCA caregivers help with “activities of daily living,” such as dressing, grooming, eating, bathing, transfers, mobility, positioning and toileting, as well as light housekeeping, laundry and meal preparation. The PCA Choice option gives clients a greater level of responsibility in managing their care, while Accra helps handle the employment and management-related functions of the PCA.

  • Financial Management Services (FMS)

    Accra’s Financial Management Services support individuals with long-term care needs or disabilities to easily hire and employ caregivers under the consumer-directed community supports (CDCS) program or the Consumer Support Grant (CSG). In each of these programs, Accra helps participants directly employ caregivers and purchase other supports that they need for living in the community. Accra helps participants determine how their program budget is used, receive approval from their county case manager, hire their own employees and choose their own service vendors. Accra then handles all required employer and employee paperwork, payroll, vendor payments, reimbursements, claims processing, tax filings and workers’ compensation on behalf of the individual.

  • 245D Waivered Services

    Accra is a Basic 245D licensed provider of Individualized Home Supports (IHS) without training, respite, homemaker, night supervision and Individual Community Living Support (ICLS) Services. In each service, the person or family selects a trusted, qualified worker suited for their homecare needs. Accra then assigns a 245D Accra Service Coordinator to work with the client and their county case manager to set up and administer Basic 245D Waivered Services while ensuring that all workers are properly trained.

    In 2022, Accra began offering Individualized Home Supports (IHS) with training, which is an Intensive 245D Service. IHS with Training provides support and training to adults who require assistance in at least one community living services category. These service categories include community participation, health and wellness, household management and adaptive skills. Accra matches each client with a fully trained and qualified IHS Designated Coordinator who helps them achieve their stated outcomes and goals. 

  • Home Health Care

    Home Health Care consists of medical and health-related services and assistance with day-to-day activities, including professional nursing services, home health aide services and rehabilitation services, which maintain the security and safety of people living at home. Accra primarily provides Home Health Care services to people requiring continuing care for chronic needs. (Home Health Care is only available in select locations.)

  • Individual Therapy & ARMHS

    Accra provides in-person therapy at our Minneapolis, Duluth, Hibbing and Virginia clinics, and we offer virtual therapy via telehealth to clients throughout Minnesota. Our licensed therapists provide individual therapy for a variety of mental health issues. Therapy services are available in either an office setting or by mobile health, depending on our client’s preference.

    Accra also provides adult rehabilitative mental health services (ARMHS) throughout the seven-county Twin Cities metro area and in St. Louis County. ARMHS help in areas such as medication education and monitoring; developing symptoms management skills; household management; and employment-related or community living transitions. Supervised by mental health professionals, ARMHS can be provided in an office setting or in a client’s home, based on client preference. Current office settings are available for adults in Minnetonka, Hibbing and Virginia.

  • Senior Assisted Living

    Accra High Street House in Lake City offers a quaint assisted living community with comfortable apartments. At High Street House, Accra partners with each resident to create a personalized plan tailored for their specific healthcare needs. 

  • Private Pay

    The Private Pay program allows people to buy homecare services with their private dollars when they are not covered by other payers. Individuals are responsible for finding their own employees, and once they do, Accra will assist them with employee paperwork, record-keeping and payroll duties. 

  • Community First Services and Supports (CFSS)

    Community First Services and Supports (CFSS) is a new self-directed option being developed by the State of Minnesota to offer those who require home services more choice, control and flexibility with the services and supports needed to live and work in the community. CFSS, when implemented, is intended to replace the current Personal Care Assistance (PCA) program and the state-funded Consumer Support Grant (CSG) benefit. 

    Accra will offer Consultation Services, a part of CFSS that will help all participants (or the participant’s representative or family member) make informed choices about CFSS. The consultation services provider will support participants by providing instruction on CFSS, the service delivery models and self-directing skills. The provider will also offer guidance in becoming a participant-employer, assist with developing the required service-delivery plan, and obtain approval of the plan when applicable.

    As one of the most experienced providers of PCA Choice and FMS in Minnesota, Accra will provide homecare services under both the CFSS agency and budget models. We will serve clients using whichever model they prefer when CFSS is implemented.

Leadership Team & Board of Directors

Executive Team

John Dahm, President and CEO

Susan Morgan, Chief Operating Officer

David Hancox, Chief Administrative Officer

LeAnn Frette, Chief Financial Officer

Amy Hilsgen, Chief Human Resources Officer

Tim Jones, Chief Technology Officer

Senior Leadership Team

Peter Noss, Senior Integration Director

Rochelle Wodarz, Senior Program Director of PCA/CFSS and Compliance

Tyler Langenfeld, Senior Program Director of Strategic Development

Valerie Patino, Senior Program Director of FMS and Mental Health

Hannah Rutt, Senior HR Director

Board of Directors

Chairperson: Mark Heston, Founder and CEO, Heston + Associates Consulting

John Dahm, President and CEO, Accra

Steve Suckow, ESOP Specialist, BMO Harris Bank

Monica Theisen, Senior Audit Manager, Eide Bailly LLP

Robin Brown, SVP, IT, Cirrus Aircraft

Mike Neill, CTO, C.H. Robinson

Bonnie Hays, Manager, Hennepin Health Plan

Christianna Finnern, Shareholder, Winthrop & Weinstine

Mike Holz, Vice President, SureScripts, LLC

Accra Financial Statements

Accra Income Statement for the years ended December 31, 2022 and 2021

Accra Balance Sheet — December 31, 2022 and 2021