Dear Beneficiary

Medicare has started an initiative to bring health care providers who share the common goal of improving patient care to 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. 

They are voluntarily participating in this new initiative by joining Pathways Health Partners because we think it will help us provide better quality care for our patients.

You are receiving this letter and form because your doctor or other health care professional thinks that you might benefit from the care coordination and preventive services offered by Pathways Health Partners.

Our goal is to ensure you receive the right care, at the right time, and at the right place. Your care should revolve around YOU! Not you revolving around the providers to get your care! WE accomplish this goal by providing you with:

• Easier, assisted appointment scheduling even with specialists
• 24/7 nurse line specifically for Pathways Health Partners’ beneficiaries
• Waiver of out-of-pocket copayments and deductibles for many services
• Enhancements to your current Medicare benefits

Pathways Health Partners is also dedicated to addressing and removing barriers to care often felt by those who experience health inequities. Health Inequity is when any group cannot access health care or does not experience the same results when accessing health care when compared to another group. If you are are experiencing health inequities, Pathways Health Partners also helps through:

• Connection to community resources such as food, financing support
• Resources for health coverage for you and your family members
• Transportation coordination for those without access to an automobile

Please use this form to confirm that your provider is your usual source of routine care, to help determine if Pathways Health Partners 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 filling out this form, you can also log into Medicare.gov and select your main doctor or other health care professional in order to determine whether Pathways Health Partners 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 Pathways Health Partners at 800-632-6228, 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.

You may choose to decline marketing activities related to ACO participation, including voluntary alignment, at your home or at the place where you receive care. 

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, apart from your personal representative or power of attorney.

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 800-632-6228 or update your online selection if you change your mind later about whether you consider your provider to your usual source of routine care.

Get more information about ACOs and the LEAD Model
CMS Website: http://cms.gov/priorities/innovation/innovation-models/lead

LEAD SVA Form Template (Effective September 15, 2026 for PY2027