History of Fallon Health

Here's a timeline of events in the history of Fallon Health.


  • Fallon Community Health Plan is founded.


  • Receives first state contract to cover Medicaid recipients.


  • Becomes one of the first HMOs in the country to receive a special contract for Medicare recipients through the U.S. Health Care Financing Administration.


  • First HMO in state to receive accreditation from National Committee for Quality Assurance (NCQA)*.


  • Establishes Elder Service Plan, the region’s first comprehensive health care program for the elderly in Worcester, Mass.


  • Launches the first commercial product with a limited network in the Commonwealth of Massachusetts.


  • Eliminates copays for routine physicals, annual gynecological exams and well-child visits—the first health plan in Massachusetts to do so, years before it was federally mandated.


  • Elder Service Plan is rebranded as Summit ElderCare.


  • Summit ElderCare expands with the opening of a new site in Charlton.
  • Becomes one of four managed care organizations to participate in Massachusetts' new Commonwealth Care health insurance program.
  • Acquires UltraBenefits Inc., a third-party administrator that manages health benefits for members nationally.


  • Summit ElderCare expansion continues with the opening of a new site in Leominster.


  • Summit ElderCare opens a second facility in Charlton, Mass., and a second facility in Worcester, on Grafton Street.


  • Expands service area to Southern New Hampshire to provide greater access for Massachusetts-based companies that have employees living in New Hampshire.
  • Introduces NaviCare HMO, a Senior Care Options/Medicare Advantage Special Needs program.


  • Summit ElderCare becomes largest PACE program New England.
  • Introduces Medicare Supplement health insurance options.


  • Announces the expansion of NaviCare to MetroWest, Middlesex County and western Mass.


  • Announces expansion of the Fallon Senior Plan and NaviCare service areas—the largest service area expansion in FCHP history. As of January 2013, both are available to eligible residents in Barnstable, Bristol, Essex, Hamden, Hampshire, Middlesex, Norfolk, Plymouth, Suffix and Worcester counties, and portions of Franklin County.


  • First health insurer in the state to offer the convenience of a mobile ID card to members.
  • Opens its fifth Summit ElderCare in Springfield. The western Mass. service area includes Hampden County and the towns of Granby, Easthampton, Southampton and South Hadley.
  • Opens a faculty and student wellness center on the College of the Holy Cross campus that is staffed daily by a Fallon Health Educator.


  • Fallon Community Health Plan rebrands as Fallon Health to reflect its evolving business in the rapidly changing health care industry.
  • Fallon announces a joint venture with Weinberg Campus, the largest aging health campus in western New York (Erie County), to create Fallon Health Weinberg. Together, the company reaches many of the most vulnerable residents in western New York with a holistic, person-centered, integrated approach to care.
  • Introduces Community Care, a health plan for the subsidized market in Massachusetts.


  • Announces that UltraBenefits Inc. acquires third-party administrator Group Insurance Center Inc., (GISC) of Pembroke, Mass. expanding membership by 17,000.
  • Fallon Senior Plan and NaviCare both receive 4.5 star ratings (out of a possible 5 stars) from CMS for its 2015 Medicare Advantage and Medicare Part D Star Ratings program.
  • Named in the top 10% of health plans in America for 2015 - 2016. Based on ratings by NCQA, Fallon's commercial (private) and Medicaid plans receive a 4.5 rating (out of 5) and Medicare a 4.0.


  • Expands Summit ElderCare, opening a Program of All-inclusive Care for the Elderly (PACE), on D'Youville Campus in Lowell.
  • Opens a PACE program at Fallon Health Weinberg in western New York.
  • Fallon Senior Plan and NaviCare both receive 4.5 star ratings (out of a possible 5 stars) from the Centers for Medicare and Medicaid Services (CMS) for its 2015 Medicare Advantage and Medicare Part D Star Ratings program.  
  • Once again rated as one of America's top health plans. Based on ratings by NCQA, Fallon's commercial (private) and Medicaid plans receive a 4.5 rating (out of 5) and Medicare a 4.0. 


  • Forms MassHealth Accountable Care Partnership Plans with the following provider groups:
  • Berkshire Health Systems and Community Health Programs
  • Reliant Medical Group
  • Wellforce, and its provider partners, and Lowell Community Health Center


  • Reaches highest membership milestone in its history.
  • Expands Summit ElderCare with a new site in Webster.


  • Opens newest Summit ElderCare PACE site on Grove Street in Worcester. This state-of-the-art site has upgrades and advanced features that will allow Fallon to provide the best care for participants for years to come.
  • Introduces new, member-focused improvements in its Medicare Advantage plan, now called Fallon Medicare Plus, including new network choices, simplified plan options, and plans that offer access to a card-based solution that can be used for certain wellness-related expenses.


  • Quickly responds to the COVID-19 pandemic, putting in place new policies, procedures, programs and services to support employees, members, employers and providers. Additionally, transforms Grove Street into a temporary infirmary for participants, and provides funding to the Worcester Together Fund as well as through Fallon’s own grant program to support community-based COVID-19 relief efforts.
  • Celebrates 25 years of experience as one of the country’s largest PACE organizations.


  • Launches Rx Savings Solution, a prescription savings program for its Medicare Advantage members.
  • In response to the high demand for COVID recovery sites, opens a COVID Recovery Center at the Briarwood Continuing Care Community in Worcester for Summit ElderCare participants who are recovering from the virus and live alone or need skilled care.

* NCQA is a private, non-profit organization dedicated to improving health care quality.

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