Fallon Health membership hits record high

Membership growth, financials reflect strategic investment in state’s new ACO program

Worcester, Mass., May 15, 2018 — Fallon Health today reported that its participation in the state’s new Accountable Care Organization (ACO) program helped increase membership by 21 percent over the past year to a record high of more than 270,000 members. Membership was 270,055 as of March 31, 2018, compared to 222,920 as of March 31, 2017.

“Growth in several product lines contributed to Fallon’s record-high membership, including the strategic partnerships we’ve made to launch a first-in-the-nation Medicaid program as part of the state’s MassHealth reform,” said Richard Burke, President and CEO of Fallon Health. “Through our ACOs, we’re working closely with state leaders, providers and community organizations to deliver integrated services to reduce fragmented care, increase value and improve health outcomes for more than 90,000 people.”

Fallon’s first-quarter financial results reflect strategic investments made to prepare for its participation in the ACO, said Kevin Grozio, Senior Vice President and Chief Financial Officer at Fallon Health. Fallon reported a net loss of $4.4 million on revenue of $354 million on a GAAP basis for the first quarter that ended March 31, 2018. Net loss includes investment and other income of $1.5 million and an operating loss of $5.9 million. For the same quarter last year, Fallon posted a net loss of $444,000 on revenue of $319 million. The net loss included investment income of $3.2 million and an operating loss of $3.6 million. The financial results also reflect the Affordable Care Act fee, Grozio added.

“Fallon is ahead of expectations for the first quarter, and we are on track to meet our year-end targets,” Grozio said.

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.