Fallon Health reports third quarter financial results

Worcester, Mass., November 15, 2016 ― Fallon Health today reported a net loss of $6.2 million on revenue of $304 million for the third quarter that ended September 30, 2016. Net income includes investment and other income of $2.4 million and an operating loss of $8.6 million. For the same quarter last year, Fallon posted a net loss of $5.1 million on revenue of $311 million. Net income included investment and other income of $2.0 million and an operating loss of $7.1 million. Membership was 220,487 as of September 30, 2016, compared with 228,420 ending September 30, 2015.

“Results for the third quarter are consistent with our strategic decision to reposition our commercial business and strengthen our focus on senior care and government product lines where Fallon has long held leadership roles,” said R. Scott Walker, Fallon Executive Vice President and Chief Financial Officer. “Our results also reflect a higher-than-expected level of claims specific to a few products in our overall portfolio. We continue to work to hold down costs by developing programs that ensure access to high quality health care while focusing on appropriate utilization and managing overall administrative expenses.” 

Also in the third quarter, Fallon was once again rated among the top health plans in America by the National Committee for Quality Assurance (NCQA)*. Fallon received a 4.5 out of 5 stars for both Private (Commercial) and Medicaid products and a 4.0 out of 5 stars for its Medicare products. Fallon also earned NCQA accreditation for its HMO, Medicare Advantage and Medicaid products. Fallon continues to advance its leadership position in senior care services, receiving 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 program.  The National PACE Association recently named Fallon the fifth largest provider of PACE (Program of All-inclusive Care for the Elderly) in the nation.

*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
508-368-9345

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.