Bloom healthcare

ACO Reach

12600 W Colfax Ave. Suite B200
Lakewood, CO 80215

Bloom healthcare is excited to announce ACO REACH

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. Physician Housecalls, doing business as Bloom Healthcare, has formed its own ACO, called Bloom Health Network (also doing business as Bloom Healthcare). Bloom Healthcare is voluntarily taking part in this new initiative because we think it will help us provide better quality care for our patients.

Accountable care organization realizing equity, access and community health (aco reach) model

You can use the form below to confirm that Bloom Healthcare is the main doctor or other health care professional you see or the main place you receive routine care, to help determine if Bloom Healthcare 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.

Alternatively, instead of returning this form, you can also log into Medicare.gov and select your main doctor or other health care professional in order to determine whether Bloom Healthcare should help with coordinating your care (instructions how to do so HERE). If you make a selection on the form below and make a different selection through Medicare.gov, Medicare will prioritize the most recently submitted selection.

Get Started

Physical Location/Mailing Address:

Bloom Health Network LLC (d/b/a Bloom Healthcare)
12600 W Colfax Ave, Suite B-200
Lakewood, CO 80215
Franke P. Elliott
President, Bloom Health Network LLC
[email protected]

Joint ventures between or among the ACO and any of its ACO participant and preferred providers:

None to report at this time, please note Bloom Health Network LLC and Physician Housecalls LLC are both affiliates of Bloom Healthcare Inc.

Confirmation of main doctor or other healthcare professional form

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Note: Whether or not you complete this form or select Bloom Healthcare as your main doctor or other health care professional, 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. This form will simply help determine if Bloom Healthcare can help provide improved care and better service for you.

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Bloom Health Network LLC and Physician Housecalls LLC are both affiliates of Bloom Healthcare Inc.

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Selecting Bloom Healthcare or any other doctor or other health care professional by completing this form is your choice AND you can change your mind later. If you complete this form and select Bloom Healthcare (or any other doctor) as your main doctor or health care professional, you should do so yourself. No one else, other than a Power of Attorney or Legal Guardian, should complete this form for you.

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You can also do it online through www.MyMedicare.gov and we can provide you with instructions how to do so HERE. Whatever is easiest for you! If you make a selection on this form and make a different selection through MyMedicare.gov, Medicare will prioritize the selection you make through MyMedicare.gov. No one is allowed to attempt to influence your choice to complete this form or select a doctor or other health care professional through MyMedicare.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.

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If you have questions, feel free to call Bloom Healthcare at 720-923-1302. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about “DCEs”. TTY users should call 1-877-486-2048.

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If you change your mind later about whether you consider Bloom Healthcare to be the main doctor or other health care professional you see for routine care, you can call (303) 993-1330 or update your selection online, at anytime.

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Importante: esta informacion esta disponibles en espanol, solicitalo llamando al (720) 923-1302.

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You can also get more information about ACOs at the CMS Website

Bloom ACO Form

"*" indicates required fields

DISCLAIMER

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 or Bloom Healthcare at 720-923-1302, or call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about DCEs. TTY users should call 1-877-486-2048.

Completing the form below 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.

Importante: esta informacion esta disponibles en espanol, solicitalo llamando al (720) 923-1302.

You can also get more information about DCEs at the CMS Website

CONFIRM
By signing this form, I am confirming that my main doctor or other healthcare professional I receive routine medical care from is Physician Housecalls d/b/a BLOOM HEALTHCARE

Are you the patient?*

Yes

Are you the power of attorney or legal guardian?

Yes

Email address*

First Name*

First Name

Last Name*

Last Name

POA/Legal Guardian First Name

POA/Legal Guardian Last Name

Note: If the names listed above and in the attached letter are incorrect do not sign this form. If you would like to receive a new form with a different doctor, other healthcare professional, or practice listed, please call Bloom Healthcare at (720) 923-1302 to request a new form. Completing and returning this form is voluntary. It won’t affect your Medicare benefits.

Phone

This field is for validation purposes and should be left unchanged.