Fallon Health reports third quarter financial results

Positive results driven by growth in revenue and membership.

Worcester, Mass., November 15, 2017―Fallon Health today reported a net income of $3.0 million on revenue of $335 million for the third quarter that ended September 30, 2017. Net income includes investment and other income of $2.5 million and an operating gain of $.5 million. For the same quarter last year, Fallon posted a net loss of $6.2 million on revenue of $304 million. Net loss included investment and other income of $2.4 million and an operating loss of $8.6 million. Membership was 223,733 as of September 30, 2017, compared with 220,487 ending September 30, 2016.

“Fallon’s steady financial improvement and membership growth in an ever-changing health care environment reflects our ability to innovate, the quality of our products and services, and our prudent management of costs, supported by revenue growth,” said Kevin Grozio, Senior Vice President and Chief Financial Officer.

Grozio also noted that Fallon continues to invest in infrastructure to lay the groundwork for growth. Several other accomplishments so far this year have also contributed to Fallon’s positive results:

  • Selected for three ACO Partnership Plans for MassHealth members. These plans are part of the state’s reform of MassHealth in which physicians, hospitals, insurers and other health care providers work together to provide integrated care with the goals of improving health outcomes and containing costs. Fallon’s ACO 
  • Partnership Plans are Berkshire Fallon Health Collaborative (with provider partners Berkshire Health Systems and Community Health Programs); Fallon 365 Care (with provider partners Reliant Medical Group and Southboro Medical Group); and Wellforce Care Plan (with provider partners Wellforce and Lowell Community Health Center).
  • Expanded into Berkshire County with Fallon’s Medicare Advantage product, Fallon Senior Plan™; and its Senior Care Options/Special Needs Plan (SCO/SNP), NaviCare®. Fallon is the only SCO/SNP option in Berkshire County for adults age 65 and older who are in need of comprehensive, integrated, patient-centered care.
  • Rated among the top health plans in America by the National Committee for Quality Assurance (NCQA)*. Fallon received 4.5 out of 5 stars for both Private (Commercial) and Medicare products and 4.0 out of 5 stars for its Medicaid products. 
  • Achieved 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.  
  • Broke ground on a state-of-the-art Summit ElderCare® PACE (Program for All-Inclusive Care for the Elderly) site in Webster, Mass. The move will consolidate two Fallon Summit ElderCare operations in Charlton and increase Fallon’s capacity to care for at least 250 participants at one location—a 50 percent increase.
  • Honored as a top workplace in five out of ten categories by Telegram & Gazette readers.

*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


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.