By Judy Packer-Tursman
Fallon Health in Massachusetts recently reported solid fourth quarter and full-year 2018 financial results, crediting its strategic investments in government programs and careful management of expenses as helping it continue to adapt and grow in its niche as a community health plan.
Fallon is experiencing growth in its Medicare Advantage (MA) line of business, and in Medicaid has enrolled nearly 100,000 members in its accountable care organizations under a reform initiative launched by MassHealth almost exactly a year ago.
“Strategically, that’s where we’re putting our focus as a company,” Richard Burke, Fallon’s president and CEO, says of government-sponsored programs, noting “demographic and public policy changes have…allowed us to grow in the government space.”
“It’s clear that there is and will continue to be significant growth in government health lines of business,” especially from baby boomers aging into MA and Medicaid expansion, says Ceci Connolly, president and CEO of the Alliance of Community Health Plans, of which Fallon is a member. “And while every health plan in America knows that, I think that community-based plans that have been mission-driven probably have a jump because it’s part of their portfolio and their commitment to the community.”
In Connolly’s view, community-based plans’ close collaboration with local providers results in “better outcomes, happier consumers and much better value for the health care dollar,” and such plans’ experience “puts them a little further ahead” on risk contracting with providers and drugmakers.