Use of Voluntary Alignment in the Next Generation ACO Model

AJMC June 5, 2025
Tyler Boese, MS,Bryan E. Dowd, PhD,Roger D. Feldman, PhD,Kathleen Rowan, PhD,Woolton Lee, PhD,Devi Chelluri, MS,Susan Cahn, DrPH,Shriram Parashuram, PhD

Use of voluntary alignment attribution by Next Generation Accountable Care Organization (ACO) participants was limited. The authors highlight the reasons and describe organizational use cases via a mixed-methods approach.

ABSTRACT

Objectives: To describe adoption and use of voluntary alignment throughout the Next Generation Accountable Care Organization (NGACO) model from 2016 through 2021. Voluntary alignment allows Medicare beneficiaries to self-attribute to a particular medical provider or organization by signing a form or making a selection in the MyMedicare.gov portal.

Study Design: We performed mixed-methods analyses of cross-sectional survey, enrollment, and claims data and coding transcripts of interviews with NGACO leadership.

Methods: We statistically compared characteristics of NGACOs and beneficiaries that engaged in voluntary alignment compared to claims alignment. Additionally, we grouped...

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