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.
From
Health Plan Weekly
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