Fallon Community Health Plan reports third quarter financial results

Worcester, Mass., November 15, 2013Fallon Community Health Plan (FCHP) today reported net income of $5.4 million on revenue of $316 million for the third quarter that ended September 30, 2013. Net income includes investment and other income of $3.8 million and operating income of $1.6 million. For the same quarter last year, FCHP posted net income of $4.4 million on revenue of $289 million. Net income included investment and other income of $3 million and operating income of $1.4 million. Membership was 227,624 as of September 30, 2013, compared with 219,351 ending September 30, 2012.

“Results for the third quarter are consistent with our expectations and reflect the steady progress FCHP has made in advancing our high quality and affordable network, care management and technology so that we can better meet the needs of the communities we serve,” said R. Scott Walker, FCHP Executive Vice President and Chief Financial Officer. “As we continue to advance our strategic plan, we do so by taking disciplined steps to manage our administrative expenses. These steps enable us to best support our mission, our business goals and the high level of quality care and services for which FCHP is known.”  
Highlights from the third quarter include:

  • Fallon Total CareSM, a Massachusetts One Care plan, finalized preparations and began accepting enrollments for an October 1, 2013, effective date. Participation in the One Care program will allow Fallon Total Care to provide access to and support for integrated care to residents under the age of 65 that are eligible for both Medicare and Medicaid in Worcester, Hampden and Hampshire counties.

  • FCHP was named the highest-ranked Medicaid health plan in America, according to National Committee for Quality Assurance’s Health Insurance Plan Rankings 2013 – 14 (NCQA)*. This is the sixth time in the last seven years that FCHP achieved this honor. Additionally, FCHP was ranked as the number two Medicare health plan in Massachusetts (and the 15th highest-ranked Medicare health plan in the country).

  • To meet the demands of the ever-changing market, FCHP invested in new technology through Pegasystems®, which enabled FCHP to be the first Massachusetts health insurer to quote for merged market plans effective Jan. 1, 2014, as required by the ACA. This platform also enables FCHP to develop flexible products and networks, to effectively conduct Health Insurance Exchange activity and, overall, to become a part of the solution when it comes to health care reform.

*NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measure tool in health care.

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 independent 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.