PROBLEM
Voluntary alignment lets Medicare patients choose their main doctor, but fewer than 1 in 400 (0.25%) MSSP beneficiaries use this option today—leaving half of all FFS beneficiaries not connected to an ACO.
Expanding Access to Accountable Care for Medicare Beneficiaries
The Coalition for Accountable Care Access (CACA) brings together ACOs, provider organizations, and policy leaders to advocate for Signed Voluntary Alignment (SVA) in the Medicare Shared Savings Program (MSSP) and future ACO models.
Your voice matters in this critical planning process. By advocating to make voluntary alignment accessible through simple paper or electronic forms—as successfully demonstrated in ACO REACH—MSSP and future ACO models will be able to expand access to coordinated, high-quality care for millions of beneficiaries and generate meaningful cost-savings for our healthcare system.
UPDATES:
On February 27, 2026, nearly 30 accountable care organizations (ACOs) that care for millions of Medicare beneficiaries across the country sent a letter to CMS calling for reforms.
On March 10, 2026, the National Association of ACOs (NAACOS)—representing 120 ACO organizations—sent a letter to CMS requesting to adopt signed-voluntary alignment to expand beneficiary participation in ACO models.
The Opportunity
Millions of seniors still lack access to the coordinated, high-quality care that ACOs provide
SOLUTION
The ACO REACH Model offers a proven alternative—over 100,000 beneficiaries have chosen their doctor through simple paper or electronic forms, nearly 20× the MSSP rate.
IMPACT
Adopting ACO REACH’s alignment process in MSSP could connect 560,000 more seniors to care and save Medicare $140 million annually.
ACO REACH has demonstrated a streamlined, auditable, and scalable voluntary alignment process that can be replicated within MSSP and future ACO programs.
The Policy Ask
We’re calling on CMS to:
- Adopt Signed Voluntary Alignment (SVA) from ACO REACH into MSSP and future ACO models
- Leverage the efficiencies and learnings the SVA process in ACO REACH by allowing paper and electronic attestation forms
- Institutionalize flexibility and consistency across future ACO models
Signed by ~30 ACOs representing millions of Medicare beneficiaries nationwide