August 15, 2018

Fallon Health hits new membership high and $2.8M profit

Photo/Grant Welker
Fallon Health of Worcester saw a spike in revenue of 27 percent over the same period last year, with revenue hitting $422 million in the quarter ending June 30.

Fallon Health of Worcester hit a new high of more than 277,000 members in the second quarter, a period in which it also reported a $2.8 million net profit, it announced Wednesday.

The health insurer saw a spike in revenue of 27 percent over the same period last year, with revenue hitting $422 million in the quarter ending June 30.

Fallon's membership rose by more than 50,000, or more than 20 percent, from the same period last year.

Kevin Grozio, Fallon's CFO, said in a statement the company continues to invest in technology driving data analysis and enhancing provider collaboration.

Health insurers statewide announced their quarterly results on Wednesday.

Blue Cross Blue Shield of Massachusetts reported a net loss of $2 million on $2 billion in revenue. The insurer is the largest private health plan in the state with 2.8 million members. It said its finances for the second quarter were in line with what was expected and its administrative spending was below state and federal requirements for the seventh straight year.

Revenue at Boston-based Blue Cross Blue Shield of Massachusetts was up 9 percent from the prior year.

Tufts Health Plan, which is based in Watertown, reported a net profit of $60.1 million and a membership of nearly 1.2 million. Revenue at Tufts hit $1.4 billion, up 17 percent from the prior year. Profit was up more than threefold compared to the second quarter of 2017, and membership rose by just over 4 percent.

Harvard Pilgrim Health Care, which is based in Wellesley and has offices in Worcester, said it had a net profit of $63.6 million in the quarter on revenue of $831.5 million. Membership fell slightly, by nearly 2 percent, to 1.2 million from the prior year.

Harvard Pilgrim's revenues jumped by more than 9 percent from the second quarter of 2017.

The second quarter marked a turnaround for Fallon and Tufts, which both lost money in the first quarter of the year as they and others began operating as accountable care organizations treating MassHealth patients.

The so-called ACOs started operating in January as networks of physicians, hospitals and other health care providers treating more than 900,000 MassHealth members, who are Medicaid and the Children's Health Insurance Program recipients.

Fallon is involved in three Massachusetts care organizations: with Reliant Medical Group, Berkshire Health Systems/Community Health Programs and Wellforce, the parent company of Lowell General Hospital and Tufts Medical Center.

Tufts Health Plan is in organizations with Beth Israel Deaconess, Atrius Health, Cambridge Health Alliance and Boston Children's Hospital. Blue Cross Blue Shield of Massachusetts and Harvard Pilgrim Health Care are not involved in any of the accountable care organizations.

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