Clinically Integrated Network Briefing

Update: Tufts Children’s Collaboration
A message for all members of the Wellforce Clinically Integrated Network, including physicians, advanced practice clinicians, administrators and the team in Braintree and Lowell
February 11, 2022

Dear Colleagues:
I’m pleased to update you on the work that is underway to advance our pediatric services in collaboration with Boston Children’s Hospital.
As you’ll read below, many of your important questions have been answered since the news was shared three weeks ago.
The relationship with Boston Children’s Hospital presents a unique opportunity for our Network to shape the delivery of pediatric care.
The Wellforce CIN Board is chartering a Network Pediatric Council to address the needs of the pediatric population in the communities we serve.
Please be on the lookout for more information about this important forum and how you can get involved.
As always, please reach out at any time with questions.
Warm regards,
Emily Young
Wellforce Clinically Integrated Network
Dear Community:
It's been three weeks since we announced our planned changes to inpatient pediatric care at Tufts Children’s Hospital and our new relationship with Boston Children’s Hospital (BCH).
We are in the midst of important conversations with our pediatric faculty, our nurses, our ambulatory staff, our pharmacists, our child life specialists, our medical students and residents and others all of whom play a vital role in helping us think through the best path forward in pediatrics on our campus and throughout Wellforce.
We wanted to provide an update on our progress:
  • We will close our pediatric inpatient units (PICU, FL7, Pedi BMT, PPU) on or around July 1, 2022. BCH will collaborate with us and our faculty immediately on any child who needs inpatient services or other services we cannot provide.
  • We will maintain the dedicated space for our Pediatric ED. This is a change from our original announcement and reflects updated thinking.
  • We are committed to continue uninterrupted and extensive services for children on the Tufts Medical Center campus. This includes:
  • Outpatient (ambulatory) pediatric primary care and sub-specialty clinics with trusted Tufts faculty, nurses, medical assistants and staff. This also includes our Center for Children with Special Needs, general pediatric clinic and our highly respected Asian and Adolescent Medicine clinics.
  • Outpatient (ambulatory) procedures and surgery
  • Level 3 neonatal intensive care unit services with on-site coverage by vital sub- specialists
  • We are committed to uninterrupted and extensive outpatient (ambulatory) services in the community at our current sites in Brockton, Woburn, Lawrence and Chelmsford.
  • We are committed to continuing our extensive hospitalist services at Lowell General, Signature Brockton, MelroseWakefield, MetroWest and Lawrence General hospitals.
Our plan and the new collaboration with BCH requires long term employment of our pediatric faculty, nurses and staff and a never ending commitment to our teaching and learning environment. We are confident that we have identified or will identify employment opportunities for all impacted staff either within the Wellforce system or at BCH. 
  • We have offered full salary and benefits to all pediatric faculty effectively immediately and for 18-months (through June 30, 2023) to allow sufficient time to work through and implement these changes together.
  • We are meeting again with pediatric division leadership and faculty next week to work through and implement additional details to maintain robust pediatric programs and faculty on our campus. Some of the things we are addressing include: 
  • BCH is establishing a structure similar to our Tufts Medical Center Physicians Organization to serve as a long-term employment vehicle for our faculty or others interested in joining this innovative collaboration. This model is complete with its own physician board structure, BCH medical staff participation privileges consistent with each physician’s primary site of clinical practice and access to BCH’s broad network of physicians and services. Faculty who become employed in this model will carry the BCH name.
  • Faculty in this model will maintain their Tufts University School of Medicine (TUSM) academic appointments and will be promoted through the TUSM promotions process.
  • Faculty in this model will be “leased” back (paid by Wellforce) to Tufts MC and Wellforce sites to provide the level of outpatient (ambulatory) services, procedures and surgery they perform today. While employment arrangements will be with BCH in the model, these leased back contracts are structured at the request of and benefit for Tufts MC, Wellforce and Tufts University School of Medicine. This is no different than current employment arrangements between pediatric faculty who work for the Tufts PO today at both Tufts Children’s Hospital and our other sites like LGH or Brockton, etc.
The teaching environment of any academic program and the care provided is continuously linked to the footprint of the clinical services available. Academic medical centers and community teaching programs face this dynamic day in and day out as services change and as physicians evolve in their careers. We have stated very clearly our intent to continue to provide robust clinical services in pediatrics at all sites and are going to great lengths to retain our existing faculty, many of whom can continue to provide the services they provide in an uninterrupted fashion. Should any change arise with the availability of these services we are prepared to provide equal access to care and teaching either through new hiring, through affiliation agreements that already exist with our vast network or through the new collaboration we have announced with Boston Children’s Hospital.
Teaching is core to our mission and will continue uninterrupted by our TUSM faculty. Tufts University School of Medicine students will continue to rotate at Tufts MC for pediatric rotations, including clerkships, acting internships and electives. When the inpatient services move, Tufts students will rotate at both Tufts Medical Center and at Boston Children’s Hospital and its affiliates. We have been reassured by the Boston Children’s team that they will continue to work with us through the transition to ensure that we will be able to continue to deliver high quality education.
  • We are working to provide options for each RN and have created additional nursing positions forecasting future staffing needs and in areas of future growth (ex. OB), offering extensive training opportunities to other areas of the Medical Center for those interested.
  • We are offering retirement/voluntary early exit program for those impacted and in related areas-potentially creating more open, available opportunities.
  • BCH hosted meetings to discuss nursing open positions and other opportunities.
  • Many of our pediatric staff will be able to continue working in their current practices given our commitment to maintain robust services on our campus.
  • We are offering support and training to team members in other areas of the Medical Center and are making alternative choices available.
  • All affected staff members have had and will continue to have opportunities to meet with BCH to discuss open positions.
Questions have been raised that some of our patients may have insurance plans that are not accepted by BCH. The majority of the care we provide is through our outpatient services which is care that will continue and be covered under current insurance contracts. Our analysis shows that of the more than 100 commercial health insurance products that Tufts MC accepts, BCH currently takes nearly all. In 2021, we identified 13 pediatric patients discharged from our care who would have fallen into a coverage gap. We are committed to addressing these gaps as is BCH. Going forward, we will work with each individual family to understand and minimize any financial impact. BCH concurs that there should not be significant issues around insurance coverage and notes that processes are in place to work with payers when BCH is out of network for patients who require access to their services. BCH takes care of more Medicaid patients than Tufts Children’s Hospital.
Pediatric care is changing. We are now in a position to help lead that change through an innovative approach with BCH. While change is stressful and at times feels impossible, we strongly believe that this can only happen through careful dialogue with each and every one of our experts in pediatric care. These amazing teams are best positioned to work alongside us and with BCH to thoughtfully design and implement this plan.
Many have questioned the nature of this broad decision and the health of our organization. We want to clearly state that our organization and our financial standing are strong. Our entire community helped to achieve this in the face of every possible challenge providing world-class care to each and every patient, young and old. We are a great organization and great organizations have to make difficult if not agonizing decisions from time to time. We ask for your help, support and guidance in making these important changes and helping us build a bright future. It truly is up to us.
We will keep you updated on our progress.
With humility, we truly remain honored to work beside you all.
The Wellforce Clinically Integrated Network
The Wellforce Clinically Integrated Network is a distinctively different population health enterprise and value-based care contracting entity. It comprises 2,300 primary care and specialist physicians and advanced practice clinicians, in private and employed practices, working in community and hospital settings. The Network’s purpose is to build healthier communities and to create healthy, rewarding experiences for our participating physicians and care teams. The Network was launched in July 2021 by building upon the legacies of two long-standing, high-performing organizations – Lowell General Physician Hospital Organization and New England Quality Care Alliance (NEQCA).