Fallon Health Recognized by NCQA for Excellence

Earns Highest Accreditation Status Offered 

Worcester, Mass., December 21, 2021— Fallon Health announced today the not-for-profit health care organization has earned Accreditation from the National Committee for Quality Assurance (NCQA)* for its clinical quality, member experience and performance against operational standards for its commercial, Medicaid and Exchange plans. NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers.

“As a mission driven organization, Fallon Health is committed to caring for those who need us most,” said Richard Burke, President and CEO of Fallon Health. “This external benchmark speaks to the quality of the products and services we offer—and the work we do—to best serve our members. We are extremely proud to have maintained NCQA accreditation and will continue our work to provide them with access to high quality health care services.” 

NCQA reviews approximately 1,100 health plans for accreditation every three years. The compressive assessment is based on operational categories including: 

  • Quality Management & Improvement
  • Network Management
  • Utilization Management
  • Credentialing & Recredentialing
  • Population Health Management
  • Member Experience

NCQA also evaluates health plans on the quality-of-care patients receive, how happy patients are with their care and health plans' efforts to keep improving. For 2022, Fallon was rated among the highest commercial and Medicaid health insurance carriers in Massachusetts, receiving 4.5 stars out of a possible 5 in NCQA’s Health Plan Ratings. 

The plans are rated based on their combined performance in three areas:

  • HEDIS®-- the Healthcare Effectiveness Data and Information Set is one of health care’s most widely used performance improvement tools.
  • CAHPS®-- the Consumer Assessment of Healthcare Providers and Systems aims to advance the understanding of patient experience with health care.
  • NCQA Accreditation 

* NCQA Health Plan Report Cards

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)

About Fallon Health

Founded in 1977, Fallon Health is a community-focused not-for-profit health care services organization based in Worcester, Massachusetts. Committed to caring for those who need us most, we pride ourselves on providing coordinated, integrated care for older adults and for individuals with complex health needs. We serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.


About NCQA
NCQA is a private, nonprofit 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 measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more-informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, on Facebook at facebook.com/NCQA.org/ and on LinkedIn at linkedin.com/company/ncqa