Fallon Health reports 2015 financial results

Worcester, Mass., March 1, 2016 ― Fallon Health today reported a net loss of $6.8 million on revenue of $1.2 billion for the fiscal year that ended December 31, 2015. These results compare with net income of $3.5 million on revenue of $1.3 billion in 2014. Net income for 2015 included investment and other income of $10.7 million and an operating loss of $17.5 million. Membership was 222,328 as of December 31, 2015, compared with 225,832 ending December 31, 2014.

For the fourth quarter of 2015, Fallon posted net income of $5.1 million on revenue of $297 million, compared with net income of $.9 million on revenue of $329 million for the same quarter in 2014. Fourth quarter 2015 net income included investment and other income of $3.8 million and operating income of $1.3 million.

“As the health care environment continues to evolve, Fallon is making important investments to benefit our members and to support strategic growth,” said R. Scott Walker, Fallon Executive Vice President and Chief Financial Officer. “At the same time, we faced external pressures that included the rising cost of specialty and generic drugs and the effects of the ACA’s risk adjustment program.”

Fallon Health’s initiatives and accomplishments in 2015 include:

  • Acquiring Group Insurance Service Center, Inc. (GISC) of Pembroke, MA, a third-party administrator. Through GISC, Fallon expands membership by 17,000 and increases its commitment to the self-insurance marketplace.
  • Celebrating the 20th anniversary of offering Summit ElderCare, a Program of all-Inclusive Care for the Elderly (PACE), now in seven locations in the Commonwealth and in New York: Worcester (two sites), Charlton, Leominster, Lowell (new), Springfield and Buffalo, NY (new).  With more than 1,000 participants, Summit ElderCare is the largest PACE provider in New England.
  • Launching Community Care, a limited network plan built in partnership with Reliant Medical Group and Harrington HealthCare, for individuals who qualify for extra help paying for their insurance
  • Introducing new hybrid plans to help people with chronic conditions like asthma, diabetes and coronary artery disease. These new hybrid plans offer low copays for doctor visits and prescriptions as well as lab services covered in full.
  • Launching $martFunding, a new product for companies with 25 to 200 employees who want to self-fund their employee health plan
  • Achieving high ratings from the National Committee for Quality Assurance Health Insurance Plan Ratings, 2015-2016 (NCQA*). Fallon is in the top 10% of health plans in America for all three of its insurance offerings: Medicaid, Medicare and commercial rankings.
  • 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. In addition, Fallon’s NaviCare program received a score of 100% for the model of care used to provide care for members.
  • Being recognized as the 2016 Corporate Citizen of the Year by the Worcester Business Journal. Fallon is honored for its ethics and integrity with all stakeholders, its family-friendly and supportive workplace environment and strong commitment to the community.

*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 accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.