Wellforce Care Plan is a MassHealth Accountable Care Organization (ACO) Partnership Plan. It is made up of the Wellforce Care Plan ACO and Fallon Health. The Wellforce ACO is a group of hospitals and providers who have agreed to work closely together to take good care of you and your family. Fallon Health is a leading health care services company that has been caring for MassHealth members for more than 40 years.
As a member of the Wellforce Care Plan, all of your health care is managed by your PCP. Your PCP will work with Wellforce Care Plan’s group of doctors, hospitals and community health centers to provide you with great health care.
What is Wellforce Care Plan?
Wellforce Care Plan is made up of physicians and other health care providers from, or affiliated with:
- Circle Health
- Tufts Children's Hospital
- Hallmark Health
- Lowell Community Health Center
- Lowell General Hospital
- Lowell General Physician Hospital Organization
- New England Quality Care Alliance (NEQCA)
- Tufts Medical Center
What’s an Accountable Care Organization (ACO)?
An ACO is a group of providers who agree to work closely with patients and their families for all of their health care needs. Doctors and other health care providers choose to participate in an ACO because they are committed to providing patients with a better care experience. In an ACO, your PCP is responsible for coordinating your care and connecting you with available services and supports. This coordination will help you get the right care at the right time, in the right place.
How do I know if my primary care physician is part of Wellforce Care Plan?
To be sure that your PCP is in the Wellforce Care Plan network, you can call Fallon Health at 1-855-508-4715 (TRS 711) from 8 a.m to 6 p.m., Monday – Friday. Or, you can look up doctors online by visiting fallonhealth.org/wellforce.
Do I need to get a referral to see a Wellforce Care Plan specialist?
Yes. Because Wellforce is made up of many provider practices, you will have to get a referral from your PCP to see a Wellforce Care Plan specialist. You will also need to get a prior authorization from your PCP to see an out-of-network specialist.
Do I need to do anything to enroll in Wellforce Care Plan?
No. If you have a PCP in this office, then MassHealth will enroll you in Wellforce Care Plan for 3/1/2018. You don’t need to do anything else. If you’re not sure that you’re all set, or feeling confused? Call MassHealth. They can be reached at 1-800-841-2900 (TTY: 1-800-497-4648). They’re available 8 a.m. to 5 p.m., Monday through Friday. Or, visit MassHealthChoices.com.
Will my MassHealth benefits change with Wellforce Care Plan?
No. You’ll have the same benefits you’ve always had with MassHealth, including behavioral health services and free rides for emergencies. You’ll also get these healthy extras:
- $10 CVS Select gift card when you fill out your health survey
- Free prenatal vitamins, a free car seat, and other “little extras” for expectant parents through the Oh Baby! program
- A free online health resource with info on conditions, medicines and other health topics
- Free help for people with asthma, heart disease, diabetes or chronic obstructive pulmonary disease (COPD).
Wellforce Care Plan can also help you get behavioral health counseling services. They can teach you about children’s services. And they can show you how to apply for food stamps and other benefits.
Will I be able to continue to see my specialists?
If you have a Wellforce Care Plan PCP, and your specialists are part of the Wellforce Care Plan network, you will be able to continue to see your specialists with a referral from your PCP. To be sure that you can continue to see all of your doctors, you must make sure that they are in the Wellforce Care Plan network. You can do that by calling Fallon Health at 1-855-508-4715 (TRS 711) from 8 a.m to 6 p.m., Monday – Friday. Or, you can look up doctors online by visiting fallonhealth.org/wellforce.
If your specialist is not a part of the Wellforce Care Plan network, you will need to contact your PCP to determine if you can continue to see this specialist. You may need a referral or a Prior Authorization for some of your providers.
Questions about Wellforce Care Plan?
Call Fallon Health at 1-855-508-4715 (TRS 711) from 8 a.m. to 6 p.m., Monday – Friday. Or, visit fallonhealth.org/wellforce.
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