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.

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PHYSICAL LOCATION/MAILING ADDRESS:
Bloom Health Network LLC (d/b/a Bloom Healthcare)
10900 W 44th Ave., Suite 200
Wheat Ridge, CO 80033
Franke P. Elliott
President, Bloom Health Network LLC
felliott@bloomhealthcare.com

JOINT VENTURES BETWEEN OR AMONG THE ACO AND ANY OF ITS ACO PARTIPANT 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.

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 ACOs. 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 ACOs at the CMS Website