Fallon Health reports 2013 financial results

Worcester, Mass., Feb. 28, 2014 - Fallon Health today reported net income of $13.2 million on revenue of $1.3 billion for the fiscal year that ended December 31, 2013. These results compare with net income of $15.3 million on revenue of $1.2 billion in 2012. Net income for 2013 included investment and other income of $15.7 million and an operating loss of $2.5 million. Membership was 228,809 as of December 31, 2013, compared with 223,235 ending December 31, 2012.

“In a constantly evolving, dynamic market, Fallon Health continues to make progress and achieve results. We focus on our customers, providing solutions that meet their unique and changing needs, helping them to be as healthy as possible,” said Fallon President and CEO Patrick Hughes. “Our competitive advantage remains our compassionate, engaged employees who work to fulfill our mission of making our communities healthy. Through their efforts, we’ve achieved very good results and made steady progress.”

“First and foremost, our objective and responsibility is to prudently manage our business fundamentals to ensure that our members receive affordable, quality-based health care and coverage,” said R. Scott Walker, Fallon Executive Vice President and Chief Financial Officer. “Our results reflect that commitment, as well as our continued investment in expanding our provider networks, and in advancing our care management expertise and technological capabilities. These investments provide the solid foundation to support our continued growth and business diversification.”

Additionally, Walker continued, the financial results also reflect the significant one-time investment in Fallon Total Care, a wholly-owned subsidiary of Fallon Health and a Massachusetts One Care demonstration plan which began providing services at the end of 2013. Fallon Total Care provides integrated care and services to individuals between the ages of 21 and 64 who receive both MassHealth and Medicare benefits in Hampden, Hampshire and Worcester counties.

Other major achievements for Fallon Health during 2013 included:

  • Achieving high rankings from the National Committee for Quality Assurance’s Health Insurance Plan Rankings, 2013-2014. For the sixth time in the past seven years, Fallon Health was ranked the #1 Medicaid health plan in the country. Fallon’s Medicare HMO was ranked #15 in the country (out of 405 plans) and its private (commercial) HMO was ranked 34 (out of 484 plans).
  • Receiving a 4.5 star rating (out of a possible 5 stars) from the Centers for Medicare and Medicaid Services (CMS) for Fallon Senior Plan and NaviCare HMO SNP.
  • Opening its sixth Program of All-inclusive Care, or PACE center in Western Massachusetts.
  • Implementing the “Healthy Health Plan,” which made Fallon the first plan in Massachusetts to include a wellness incentive as part of a standard benefit package. 
  • Expanding its Select Care HMO network to include Mass. General Hospital and Brigham & Women’s Hospital and their respective physicians, and also the renowned providers of the Dana-Farber Cancer Institute.
  • Launching an enhanced member portal, myFallon, on www.fallonhealth.org.
  • Implementing a broker quoting tool, Quote Now, and becoming the first health plan in the state to quote for merged market plans effective January 1, 2014, as required by the ACA. 
  • Implementing a mobile ID card, becoming the first health insurer in the state to offer this convenience to our members.
  • Being named the Top Workplace by the Worcester Business Journal in the category of Education, Training and Career Development.

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

Carrie Wattu

About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon 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.