Fallon Health to offer coordinated care program for low-income seniors in Berkshire County

Fallon’s NaviCare®  program is the first and only program for Medicaid and Medicare dual eligibles in the Berkshires

Worcester, Mass., June 5, 2018
— Fallon Health, a nationally recognized, not-for-profit health care services organization, announced today that it is expanding its popular NaviCare HMO SNP and SCO program for low-income seniors to Berkshire County.  It is the first and only program in the Berkshires for seniors eligible for both Medicare and Medicaid.

“We’ve seen this program change lives,” said Richard Burke, President and CEO of Fallon Health. “Since we launched NaviCare in 2010, we’ve provided coordinated, team-based care to thousands of older adults in other parts of Massachusetts, and that’s helped them to live as independently as possible in their homes. Now we’re making that same level of care and personalized service available to older adults in Berkshire County.”

“While we’ve made progress, access to long-term services and supports remains an issue for older adults in Berkshire County for whom widely dispersed resources may present a barrier to care,” said John Lutz, Executive Director of the Elder Services of Berkshire County, Inc. “Fallon has been a great partner in helping us to address these issues. We’re pleased to have a program in the region that coordinates care for low-income seniors so that they can live as independently as possible in their own homes.”  

The NaviCare program, which includes a Medicare Advantage Special Needs Plan and a Senior Care Options program, provides adults age 65 and older, who qualify for MassHealth Standard, with comprehensive, integrated and patient-centered health care that includes all the services and benefits of MassHealth and Medicare—with many extras, at no additional cost to members. A health care team works with each member to develop a plan of care to meet his or her health goals. Members are also assigned a personal Navigator to ensure that they receive all the benefits and services to which they are entitled.

“Low-income older adults can get more benefits through NaviCare than they would otherwise receive through MassHealth and Medicare,” said Carolyn Langer, M.D., Senior Vice President and Chief Medical Officer. “Our program is based on the philosophy that people want to be healthy and live independently, especially as they get older, but that social barriers may prevent them from reaching their health goals. Fallon’s NaviCare program addresses issues such as health care access and affordability, and nutrition and food insecurity, through coordinated, wraparound services such as in-home visits and meal delivery programs.”

Fallon’s NaviCare program offers extras such as:

  • Preventive and comprehensive dental care
  • Coverage for eyewear
  • Rides to medical appointments, the gym and other destinations
  • Gym memberships
  • The Save Now card which is preloaded with money to help members pay for certain over-the-counter, health-related items

For more information about Fallon’s NaviCare program, senior care services, or Fallon’s new Accountable Care Organization (ACO), call 1-800-868-5200 (TRS 711) or visit fallonhealth.org/navicare.

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 rated among the nation’s top health plans by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products.