Fallon Health reports year-end financial results

Financials reflect continued leadership in government programs, senior care

Worcester, Mass., March 1, 2018 — Fallon Health today reported net income of $7.9 million on revenue of $1.3 billion for the fiscal year that ended December 31, 2017. These results compare with a net loss of $20.1 million on revenue of $1.2 billion in 2016. Net income for 2017 included investment and other income of $15.5 million and an operating loss of $7.6 million. Membership was 219,112 as of December 31, 2017, compared with 227,461 ending December 31, 2016. 

For the fourth quarter of 2017, Fallon posted net income of $5.4 million on revenue of $335 million, compared with a net loss of $8.4 million on revenue of $311 million for the same quarter in 2016. The fourth quarter 2017 included investment and other income of $6.9 million and an operating loss of $1.5 million.

Kevin Grozio, Senior Vice President and Chief Financial Officer at Fallon Health, said, “Our year-end results are consistent with expectations, reflecting strategic decisions and investments that were made to provide high-quality products and services, achieve purposeful growth and turn around financial performance over the prior year. We finished the year strong, generating good momentum for 2018.”

For example, Fallon is participating in three Accountable Care Organizations (ACOs), a new MassHealth program designed to improve health outcomes and hold down costs by providing coordinated and patient-centered care in partnership with community providers. 

In addition to participating in the ACO program, Fallon has expanded into Berkshire County with its Medicare Advantage product, Fallon Senior Plan™; and its Senior Care Options/Special Needs Plan (SCO/SNP), NaviCare®. Fallon is the only SCO/SNP option in Berkshire County for adults age 65 and older who want to maintain their independence with comprehensive, coordinated, patient-centered care.

Fallon has also invested in the development of a new Summit ElderCare® site in Webster. Summit ElderCare is a Program of All-Inclusive Care for the Elderly (PACE) designed to ensure that seniors age in place at home by providing comprehensive, team-based care and support services.

“These strategic investments will maintain and enhance our expertise in care coordination, providing our members with better health outcomes while successfully managing costs,” said Richard Burke, President and CEO of Fallon Health.

Burke also noted the organization’s commitment to addressing key drivers of health care costs by implementing initiatives such as Safe Transitions, an in-home, post-discharge medication review program for Medicare members, and Teladoc, a telehealth service.

Other Fallon initiatives and accomplishments in 2017 include:

  • Being rated among the top health plans in America by the National Committee for Quality Assurance (NCQA)*. Fallon received 4.5 out of 5 stars for both Private (Commercial) and Medicare products and 4.0 out of 5 stars for its Medicaid products
  • Achieving a 4.5 star rating (out of a possible 5 stars) from the Centers for Medicare & Medicaid Services (CMS) for its 2017 Medicare Star Ratings programs
  • Maintaining its longtime commitment to community by distributing more than $1 million in grants, hunger relief, sponsorships, in-kind donations and volunteer hours
  • Being honored as a top workplace in five out of ten categories by Telegram & Gazette readers

*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 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.