Fallon Health reports 2016 financial results

Worcester, Mass., March 1, 2017 — Fallon Health today reported a net loss of $20.1 million on revenue of $1.2 billion for the fiscal year that ended December 31, 2016. These results compare with a net loss of $6.8 million on revenue of $1.2 billion in 2015. Net income for 2016 included investment and other income of $8.5 million and an operating loss of $28.6 million. Membership was 227,461 as of December 31, 2016, compared with 222,328 ending December 31, 2015.

For the fourth quarter of 2016, Fallon posted a net loss of $8.4 million on revenue of $311 million, compared with net income of $5.1 million on revenue of $297 million for the same quarter in 2015. The fourth quarter 2016 net income included investment and other income of $2.6 million and an operating loss of $11 million.

“Our results continue to reflect higher-than-expected claim activity within several of our product lines,” said R. Scott Walker, Executive Vice President and Chief Financial Officer at Fallon. “We are responding to this trend with programs that focus on appropriate utilization and improvements in the coordination of care. We are also working to aggressively manage administrative expenses.”

Richard Burke, President and Chief Executive Officer at Fallon, said the health plan is also making strategic investments that will position it for long-term growth.

“We continue to invest heavily in Medicare and Medicaid programs ahead of the industry, making us well-positioned to capitalize on the growing senior care and government program marketplace,” said Burke. “We are also expanding our partnerships with health care providers to better integrate care in a way that improves quality and controls costs. With our dedicated and engaged employees, we are confident that we will execute on our strategic vision.”

Fallon Health’s initiatives and accomplishments in 2016 include:

  • Becoming the fifth largest PACE (Program of All-inclusive Care for the Elderly) in the nation and the largest in New England with its Summit ElderCare program
  • Opening a Summit ElderCare site on the D’Youville Campus in Lowell, its sixth PACE in Massachusetts
  • Establishing a PACE program at Fallon Health Weinberg in western New York
  • Achieving high performance ratings from the National Committee for Quality Assurance Health Insurance Plan Ratings, 2016-2017 (NCQA*). Fallon is in the top 10 percent of health plans in America for its Medicaid and commercial offerings.
  • Receiving a 4.5 star rating (out of a possible 5 stars) from the Centers for Medicare & Medicaid Services (CMS) for Fallon Senior Plan™ and NaviCare® HMO SNP, which are health plans for people eligible for both Medicare and Medicaid.  In addition, Fallon’s NaviCare program received a score of 100 percent from CMS for its model of care.
  • Maintaining its longtime commitment to community by distributing $1.6 million in grants, hunger relief, sponsorships, in-kind donations and volunteer hours

* National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA's HEDIS® is the most widely used performance measurement tool in health care. NCQA's website (www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.

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. For more information, visit www.fallonhealth.org.