Financial & Billing Matters | Tufts Health Together with Boston Children’s Accountable Care Organization (ACO)

Tufts Health Public Plans and Boston Children’s Accountable Care Organization have partnered to participate in the MassHealth Accountable Care Organization Program. Tufts Health Together with Boston Children’s ACO is a new MassHealth plan offered by Tufts Health Public Plans 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.

Tufts Health Public Plans 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 Tufts Health Together with Boston Children’s ACO or to check if your PCP is in the ACO, visit TuftsHealthTogether.com/BCACO or call 888-257-1985 (TTY: 888-391-5535), Monday through Friday, 8 a.m. to 5 p.m.

To learn more about MassHealth ACO enrollment options, visit masshealthchoices.com or call 1-800-841-2900 (TTY: 1-800-497-4648).

Frequently asked questions

Have my child’s MassHealth-covered benefits changed?
No, your child’s benefits will not change. Tufts Health Together with 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 need to do anything to enroll my child in Tufts Health Together with Boston Children’s ACO?

If you currently have a Boston Children’s affiliated primary care provider, whether at Boston Children’s Hospital or in the community, you should be automatically enrolled in the ACO for March 1, 2018. Please pay attention to your mail in November and December! MassHealth will be sending notices to patients about their health plan for March 2018. Make sure that your notice says you will be enrolled in Tufts Health Together with Boston Children’s ACO. If your letter has a different health plan name, or if you cannot find your letter, call MassHealth at 1-800-841-2900 (TTY: 1-800-497-4648).

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 Tufts Health Together with 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 Tufts Health Together. Your care will need to be provided by doctors and hospitals that accept Tufts Health Together coverage.

To check if your doctors are covered by Tufts Health Together with Boston Children’s ACO, visit this webpage or call 1-888-257-1985 (TTY: 1-888-391-5535).

My child is not enrolled in Tufts Health Together with 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 Tufts Health Together with 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 Tufts Health Together with Boston Children’s ACO?

For most patients, in order to continue to see your Boston Children’s PCP you must enroll in Tufts Health Together with Boston Children’s ACO. If you currently have a Boston Children’s PCP but do not see Tufts Health Together with Boston Children’s ACO on the letter you received from MassHealth, contact MassHealth by calling 1-800-841-2900 (TTY: 1-800-497-4648) to confirm your enrollment.

If you do not want to join Tufts Health Together with 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 1-800-841-2900 (TTY: 1-800-497-4648).

When are these changes happening?

If you’re happy with your new health plan, you will be automatically enrolled and your new coverage through Tufts Health Together with Boston Children’s ACO will take effect on March 1, 2018. You’ll have until May 31, 2018, to try out your new plan or to change plans for any reason. After June 1, you will only be able to change plans for certain reasons.

If you do not want to move into Tufts Health Together with Boston Children’s ACO, contact MassHealth through its webpage or call 1-800-841-2900 (TTY: 1-800-497-4648) before March 1, 2018.

How do I get more information?

For detailed plan and benefits information, or to check if your PCP is part of Tufts Health Together with Boston Children’s ACO, visit this webpage or call 888.257.1985 (TTY: 888.391.5535).

To learn more about MassHealth ACO enrollment options, visit this webpage or call 1-800-841-2900 (TTY: 1-800-497-4648).