Fallon Health reports 2014 financial results

Worcester, Mass., February 27, 2015 ― Fallon Health today reported net income of $3.5 million on revenue of $1.3 billion for the fiscal year that ended December 31, 2014. These results compare with net income of $13.2 million on revenue of $1.3 billion in 2013. Net income for 2014 included investment and other income of $15 million and an operating loss of $11.5 million. Membership was 225,832 as of December 31, 2014, compared with 228,809 ending December 31, 2013.

“Fallon made steady progress in 2014, entering new markets and lines of business and offering solutions to a diverse population of ages, income levels and health statuses,” said Fallon President and CEO Patrick Hughes. ”Our results demonstrate a commitment to continued investments in the communities we serve.”

For the fourth quarter of 2014, Fallon posted net income of $0.9 million on revenue of $329.5 million, compared with net income of $0.7 million on revenue of $318 million for the same quarter in 2013. Fourth quarter 2014 net income included investment and other income of $4.6 million and an operating loss of $3.7 million.

“Our results show the fundamental resilience of our organization,” said R. Scott Walker, Fallon Executive Vice President and Chief Financial Officer. “We’ve balanced challenges that exist in this evolving health care environment by investing in technology infrastructure, care management, new product development, network development and geographic expansion. We’ve made disciplined and responsible decisions that ultimately result in giving consumers more choice and control over their health care costs.”

Additionally, Walker continued, the financial results reflect the significant cost of hepatitis C medications and fees required by the Affordable Care Act (ACA). The results also reflect the one-time investment in Fallon Health Weinberg, a joint venture with Weinberg Campus, the largest aging health campus in Western New York (Erie County).

Other major achievements for Fallon Health during 2014 include:

  • Achieving high rankings from the National Committee for Quality Assurance Health Insurance Plan Rankings, 2014-2015. Fallon is in the top 10% of health plans in America for all three of its insurance offerings: Medicaid, Medicare and commercial rankings. Fallon is the #2 Medicaid plan in America out of 136 plans ranked. Fallon is ranked #22 for Medicare out of 408 plans and #34 for commercial out of 507 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
  • Creating Community Care, a new limited network plan, built in partnership with Reliant Medical Group and Harrington HealthCare, and targeted toward individuals who qualify for extra help paying for their insurance
  • Developing and implementing Smart Shopper—Fallon’s transparency tool that also offers a financial incentive to members of up to $500 for making informed choices about the care they receive. This is unique in the Mass. market.
  • Introducing a new line of business, Plan Innovations, to serve organizations looking to improve the way health care is managed and delivered. The goal is to help partners to better coordinate care and reduce medical expenses. Plan Innovations offers consulting, administrative services, health plan business process outsourcing and joint venture partnerships.
  • Being named the winner of the Worcester Business Journal’s Best of Business awards in the category of Best Health Insurance Provider (HMO/PPO) in Central Mass.

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, non-profit health care services organization that supports the diverse and changing needs of those it serves. In addition to providing innovative health insurance solutions and a variety of Medicaid and Medicare products, Fallon excels in unique health care programs and services that coordinate 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.