About Fallon Health

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care and services they need and deserve. We partner with them to understand what they want and need, and we work to address disparities in care created by social determinants of health. Ensuring high quality and excellence is the basis of everything we do, and our mission—improving health and inspiring hope—guides every decision we make.

As a not-for-profit health care services organization that is both an insurer and provider of care, we also work closely with providers, community leaders, government organizations, and others to enhance care and services. We deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

With Fallon Health, our members and participants can expect care and coverage that goes further—and everything we do is centered around the people we serve. We take the extra step when it’s needed, and we lend a hand whenever we can. Being there for our members is what makes Fallon Health stand out.

Our history

Fallon Health’s founders had a vision to combine all components of the health care system into one. Committed to providing high-quality care at an affordable cost, they fulfilled that vision in 1977 with the launch of Fallon Community Health Plan.

Fallon Health has been committed to government-sponsored programs from its start. We were the first health plan in Massachusetts to cover Medicaid recipients (in 1979), the first health plan in the country to offer a Medicare Advantage Plan (in 1980), and the first and only health plan in Massachusetts to operate a Program of All-Inclusive Care for the Elderly (in 1995).

Our focus today

Throughout our history, we’ve learned much about the needs of our members and our communities. In 2021, we decided to enhance our focus on serving those who need us most. During one of the most tumultuous times in health care history—the COVID-19 pandemic—we proudly forged a path to use our expertise, capabilities, and experience to expand the impact of the integrated care programs we offer, partnering throughout our communities to coordinate and deliver high quality care and exceptional service to more individuals—particularly those enrolled in Medicaid and Medicare.

This focus aligns with Fallon Health’s mission, vision, and values. And it supports the needs of the communities we serve while filling an important need in the Commonwealth. We believe Fallon Health is well-positioned to address barriers to health care access and equity that are creating disparities in society.

Products we are focused on today include:

• Medicare Advantage
• Medicare Advantage Special Needs Plan (SNP)/Senior Care Options Program (SCO)
• MassHealth Accountable Care Organization (ACO) Partnership Plans
• Program of All-Inclusive Care for the Elderly (PACE)
• And a limited number of offerings on the Massachusetts Health Connector

Our vision for the future

Continuing along a strategic path that is unique among independent health plans in Massachusetts, Fallon Health has set its sights on becoming the leading provider of government-sponsored health care and coverage programs in the region. This vision is consistent with our history and mission, and leverages our brand, expertise, and experience to provide integrated and coordinated care, coverage, and services to the communities we serve.