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Accountable Care Organization | Overview

WellSense Health Plan and Boston Children’s Accountable Care Organization have partnered to participate in the MassHealth Accountable Care Organization Program. WellSense Boston Children’s ACO is a new MassHealth plan offered by WellSense Health Plan that provides quality health care for pediatric members. The participation of Boston Children’s Hospital and its affiliated specialists and primary care physicians, both in the hospital and in the community, in the MassHealth ACO program is an important part of our shared commitment to providing the best care possible to all of the children in the Commonwealth who need our services.

WellSense Health Plan and Boston Children’s ACO share the belief that every child deserves the chance for a healthy future. We focus on the preventive care and treatments that have long-term health benefits for our pediatric members. Together, we are committed to doing more and going further to keep your child healthy.

What is an ACO?

An ACO is a group of doctors, hospitals and other providers, led by a primary care provider (PCP), all working together to provide seamless, high-quality care. The mission of our ACO is to make sure our pediatric members get the care they need when sick and the support they need to stay healthy.

Health care as it should be: Focused on your child’s health

We know your family’s health care needs change. Keep your child healthy by starting with your primary care provider (PCP), who will guide you to the right care at the right time. Your PCP is on your side, helping your child get support to stay healthy and care when they’re sick.

Your PCP works closely with other ACO doctors to give you:

  • easy access to the right specialists at the right time
  • tools to better control illnesses like asthma and diabetes
  • programs and benefits that help you stay healthy

To learn more about WellSense Boston Children’s ACO or to check if your PCP is in the ACO, visit wellsense.org/bostonchildrens or call 888-566-0010 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m.

To learn more about MassHealth ACO enrollment options, visit masshealthchoices.com or call 800-841-2900 (TTY: 800-497-4648).

Frequently asked questions

Have my child’s MassHealth-covered benefits changed?

No, your child’s benefits will not change. WellSense Boston Children’s ACO offers all the covered benefits provided by MassHealth, plus additional discounts and rewards on things that keep you healthy. You can view the full list of benefits.

Do I have to change my child’s doctor(s)?

You do not need to change your primary care doctor, and all Boston Children’s specialists are covered through WellSense Boston Children’s ACO. However, if you see any specialists who do not practice at Boston Children’s, you will need to confirm if they are covered by WellSense Health Plan. Your care will need to be provided by doctors and hospitals that accept WellSense Health Plan.

To check if your doctors are covered by WellSense Boston Children’s ACO, visit this webpage or call 888-566-0010 (TTY: 711).

My child is not enrolled in WellSense Boston Children’s ACO, but sees a Boston Children’s specialist. Will this care continue to be covered by MassHealth?

For MassHealth patients not enrolled in WellSense Boston Children’s ACO, Boston Children’s will still be a critical provider of pediatric services in the region. We are working with other ACOs to ensure that patients who need to see a Boston Children’s provider will be able to seek care here. Please contact the ACO listed on the letter you received from MassHealth to confirm if your specialist is covered by your new health plan.

Can I keep my Boston Children’s primary care provider if I’m required to join a MassHealth ACO or MCO, but don’t want to enroll in WellSense Boston Children’s ACO?

For most patients, in order to continue to see your Boston Children’s PCP you must enroll in WellSense Boston Children’s ACO. If you currently have a Boston Children’s PCP but do not see WellSense Boston Children’s ACO on the letter you received from MassHealth, contact MassHealth by calling 800-841-2900 (TTY: 800-497-4648) to confirm your enrollment.

If you do not want to join WellSense Boston Children’s ACO, you will need to opt out with MassHealth and may need to change your primary care provider. To change your MassHealth ACO enrollment or to see your options, visit masshealthchoices.com or call 800-841-2900 (TTY: 800-497-4648).

How do I get more information?

For detailed plan and benefits information, or to check if your PCP is part of WellSense Boston Children’s ACO, visit this webpage or call 888-566-0010 (TTY: 711).

To learn more about MassHealth ACO enrollment options, visit this webpage or call 800-841-2900 (TTY: 800-497-4648).