March 1, 2019

Fallon hits record membership and revenue totals

Photo/Grant Welker
Worcester's Fallon Health reported 271,369 members last year, a one-year rise of 24 percent. Revenue jumped accordingly, hitting $1.6 billion, a jump of 21 percent.

Worcester insurer Fallon Health reached the highest membership and revenue totals in 2018 in its 41-year history, the company reported Friday.

Fallon reported 271,369 members last year, a one-year rise of 24 percent. Revenue jumped accordingly, hitting $1.6 billion, a jump of 21 percent.

Those results come as Fallon has joined MassHealth's accountable care organizations, a new way of joining insurers and health providers for the state's Medicaid patients. In the last five years, government programs as a percentage of Fallon's total membership have increased from 20 percent to 50 percent, according to the company.

"Over the past several years, during a time of change and uncertainty in the health care industry, our strategic investments in government programs and careful attention to administrative expenses have put us on a path of long-term sustainability that will allow us to advance our mission of making our communities healthy," Richard Burke, the president and CEO at Fallon Health, said in a statement.

Profit for Fallon was $6.9 million, including an operating gain of $1.6 million and other income of $5.3 million. Profit the previous year was $7.9 million.

Other major Massachusetts health insurers also reported profitable years.

Harvard Pilgrim Health Care, which is based in Wellesley and until recently held a Worcester office before consolidating Central Massachusetts operations in Westborough, reported net income of $80.1 million for the year on revenue of $3.2 billion. That was a sharp turnaround for an insurer than reported a net loss of $8.7 million in the previous year.

Harvard Pilgrim also reported nearly 1.2 million members at the end of 2018.

Blue Cross Blue Shield of Massachusetts and Blue Cross Blue Shield of Massachusetts HMO Blue reported a combined net income of $159.6 million. Those results reflected an operating loss of $70.1 million for the Boston firm, with investment income of $69.6 million and what the company said was the benefit of federal tax law changes.

Tufts Health Plan, which is based in Watertown, reported a net income of $130.4 million, compared to $59.4 million in 2017. Revenue was $5.4 billion, up from $4.9 billion. Membership rose by nearly 5 percent to just under 1.2 million.

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