Voluntary Alignment Acknowledgement

Dear Medicare Beneficiary,

Medicare has started an initiative where health care providers who share a common set of goals aimed at improving patient care can work together more effectively. This initiative brings together health care professionals in an Accountable Care Organization (ACO), to work together with Medicare to give you more coordinated care and services.

Your Southwestern Health Resources provider is voluntarily taking part in this new initiative by joining Southwestern Health Resources Accountable Care Network because we think it will help us provide better quality care for our patients.

If you are reviewing this letter and form, it is because your doctor or other health care professional thinks that you might benefit from care coordination and preventive services offered by Southwestern Health Resources Accountable Care Network.

You can use this form to confirm that your Southwestern Health Resources provider is the main doctor or other health care professional you see or the main place you go for routine care, to help determine if Southwestern Health Resources Accountable Care Network should help coordinate your care. Routine care can include regular care and check-ups you get from a doctor or other health care professional and care for other chronic health problems, such as asthma, diabetes, and hypertension. Please click here to complete the form at your earliest convenience.

Alternatively, instead of completing this form, you can also log into Medicare.gov and select your main doctor or other health care professional in order to determine whether Southwestern Health Resources Accountable Care Network should help with coordinating your care. If you make a selection on this form and make a different selection through Medicare.gov, Medicare will prioritize the most recently submitted selection.  

Your benefits will NOT change, and you can visit any doctor, other health care professional, or hospital.

Whether or not you complete this form or select a doctor or other health care professional through Medicare.gov, you remain eligible to receive the same Medicare benefits and you still have the right to use any doctor, other health care professional, or hospital that accepts Medicare, at any time. If you have questions, feel free to ask your doctor or other health care professional, call Southwestern Health Resources Accountable Care Network at 682-236-2121, or call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about ACOs. TTY users should call 1-877-486-2048.

Completing this form or selecting a doctor or other health care professional through Medicare.gov is your choice AND you can change your mind.

If you choose to complete this form or select a doctor or other health care professional through Medicare.gov you should do so yourself. No one else should complete this for you.

No one is allowed to attempt to influence your choice to complete this form or select a doctor or other health care professional through Medicare.gov by offering or withholding anything in exchange for you to complete or not complete the form or to make a selection online. If you feel pressured to sign or not sign this form or to make a selection online, please call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

 Please call 682-236-2121 or update your online selection if you change your mind later about whether you consider your Southwestern Health Resources provider to be the main doctor or other health care professional you see or the main place you go for routine care.

Sincerely,

Southwestern Health Resources