Fallon Health reports third quarter financial results
Worcester, Mass., November 15, 2019 ― Fallon Health today announced its financial results through the third quarter. Year-to-date results for the nine months ending September 30, 2019 include net income of $2.2 million on revenue of $1.2 billion. Net income included investment and other income of $19.7 million and an operating loss of $17.5 million. For the same period in 2018, Fallon reported net income of $4 million on revenue of $1.2 billion.
Third quarter results include a net loss of $4.4 million on revenue of $429 million. Net income included investment and other income of $15.8 million and an operating loss of $20.2 million. For the same quarter last year, Fallon posted net income of $5.6 million on revenue of $411 million, which included investment and other income of $2.4 million and operating income of $3.2 million.
Membership was at 264,889 at the end of the third quarter of 2019.
“Our results reflect ongoing investments in the State’s new Medicaid Accountable Care Organization program,” said Todd Bailey, Senior Vice President and Chief Financial Officer. “We are working closely with our ACO provider partners and the State to make improvements to this program, which is bringing high-quality, effective care to the most vulnerable in the communities we serve.”
"We also continue to make strategic investments to enhance our members’ experiences, including new technology that streamlines member transactions, enhanced plan options for our Fallon Medicare Plus members, and also recently opened a new Summit ElderCare® Program of All-Inclusive Care for the Elderly center in Worcester,” Bailey said.
Continued investments like these, Bailey noted, contribute to the high quality ratings Fallon receives from federal government and national non-profit agencies:
- Fallon Health’s Medicare Advantage plans received a 4-star rating (out of a possible 5 stars) in the 2020 Medicare Star Ratings program of the Centers for Medicare & Medicaid Services (CMS).
- Fallon Health’s commercial Marketplace plans received a 5-star rating (out of a possible 5 stars) from CMS.
- The National Committee for Quality Assurance (NCQA) recognized Fallon as one of the highest-rated health plans in the nation. Fallon’s Commercial HMO/POS rated 4.5 out of 5 in NCQA’s Private Health Insurance Plan Ratings 2019–2020. Its Medicaid plan received a 4.5 out of 5 in NCQA’s Medicaid Health Insurance Plan Ratings 2019–2020.
*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.
Melissa Randall
Corporate Communications Manager, Fallon Health
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.