Fallon Community Health Plan reports 2012 financial results

Worcester, Mass., March 1, 2013 ―Fallon Community Health Plan (FCHP) today reported net income of $15.3 million on revenue of $1.2 billion for the fiscal year that ended December 31, 2012. These results compare with net income of $38.5 million on revenue of $1.2 billion in 2011. Net income for 2012 included investment and other income of $21.7 million and an operating loss of $6.4 million. The operating loss includes a one-time charge of $7.2 million for the wind down and close out of the company’s pension plan, which was frozen in 2006. Membership was 223,235 as of December 31, 2012, compared with 213,537 ending December 31, 2011.

“Our significant progress in 2012 is the direct result of our highly engaged and committed employees, complimented with a disciplined and focused approach toward the continued execution of our multi-year strategic plan,” said President and CEO Patrick Hughes. “Consistent with our mission and our commitment to the markets and communities we serve, we have made, and will continue to make, meaningful investments in our business to deliver quality-based, affordable health care solutions to our customers. We enter 2013 with significant momentum to make the expanding markets and communities we serve healthier.”

“We recently completed the successful execution of the largest network expansion in the company’s history, which allows us to bring FCHP products and services to more individuals and families in the Commonwealth,” said R. Scott Walker, FCHP Executive Vice President and Chief Financial Officer. “Our continued investments in technology advancements and care management are making our core operations and business fundamentals more effective and efficient, providing us with greater flexibility to respond to the changing needs of our customers, and allowing us to create new business opportunities.”

Among FCHP’s technology investments are enhanced enterprise-wide reporting capabilities, a mobile ID card, and a new, improved member portal on fchp.org to be launched in early 2013, Walker added.

Walker said investments are also being made in support of Fallon Total Care, the integrated care organization FCHP created with Magellan Health Services. In November, Fallon Total Care was selected to participate in a new, three-year demonstration program to provide integrated health care to individuals aged 21 to 64 years who are eligible for both Medicare and Medicaid. Participation in the program will allow Fallon Total Care to serve dual-eligible residents in 10 counties across Massachusetts: Barnstable, Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester.

For the fourth quarter of 2012, FCHP posted net income of $2.3 million on revenue of $306 million, compared with net income of $2.4 million for the same quarter in 2011. Fourth quarter 2012 net income included investment and other income of $14.2 million and an operating loss of $11.9 million, which includes the one-time charge of $7.2 million incurred as a result of the close out of the company’s pension plan.

In addition to its partnership with Magellan Health Services to create Fallon Total Care, other major achievements for FCHP during 2012 included:

  • Partnering with Steward Health Care to launch FCHP Steward Community Care, a limited network product. The product was selected to be the primary offering through the Retailers Association of Massachusetts’ new group purchasing cooperative.
  • Achieving high rankings from the National Committee for Quality Assurance’s Health Insurance Plan Rankings, 2012-2013. For the fifth time in the past six years, FCHP was ranked the #1 Medicaid health plan in the country. FCHP’s Medicare HMO was ranked #8 in the country (out of 395 plans) and its private (commercial) HMO was ranked #33 (out of 474 plans).
  • Fallon Senior Plan and NaviCare HMO SNP both receiving a 4.5 star rating (out of a possible 5 stars) from the Centers for Medicare and Medicaid Services (CMS) for its 2013 Medicare Advantage and Medicare Part D Star Ratings program. CMS’ star rating system considers 50 quality measures, such as lowering hospital readmissions, ensuring members receive recommended cancer screenings, and providing an optimal member experience with the health plan. The measures cover clinical quality, patient satisfaction and compliance with regulatory requirements. CMS uses the 5-star rating system to monitor health plans to ensure that they meet Medicare’s quality standards.
  • The completion of the expansion of its Medicare Advantage Special Needs Plan, NaviCare® HMO SNP and NaviCare SCO, a Senior Care Options program. In addition to still being offered in Worcester County, NaviCare also is now available to eligible seniors in Hampden County and portions of Franklin, Hampshire, Middlesex and Norfolk counties. NaviCare is a unique product for seniors that combines in one package all Medicare and MassHealth Standard benefits, services and items, as well as needed community-based home and personal care services such as adult day health, home-delivered meals or help with bathing and dressing needs. NaviCare is available to those residing in the service area that are age 65 and over who are enrolled in MassHealth Standard. For those who qualify, NaviCare is available at a $0 premium with $0 copayments.
  • Hosting the second annual FCHP Coordinated Care and Coverage Conference, which featured keynote speaker Dr. Donald Berwick, Former Administrator of the Centers for Medicare & Medicaid Services, and Former President and CEO, Institute for Healthcare Institute.
  • As it does every year, FCHP invested more than $1 million in support of activities, events and initiatives consistent with its mission of “making our communities healthy.” Contributions included grants to non-profit, community-based organizations and $220,000 to food pantries and hunger relief programs throughout the Commonwealth.

NCQA is a private, non-profit organization dedicated to improving health care quality.

Fallon Community Health Plan
Carrie Wattu

About Fallon Community Health Plan
Founded in 1977, Fallon Community Health Plan is a nationally recognized, not-for-profit health care services organization. From innovative health insurance products available throughout Massachusetts for all populations, to unique health care programs and services for seniors, FCHP supports the diverse and changing needs of all those it serves. FCHP has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products.