Fallon Health

Fallon Health

Not-for-profit health plan for seniors.

Overview

Fallon Health is a not-for-profit health care organization that provides coordinated, integrated care for older adults and people with complex health needs. It offers Medicare Advantage, SCO, MassHealth ACO Partnership Plans, and Programs of All-Inclusive Care for the Elderly (PACE) in Massachusetts and New York, including Summit ElderCare and Fallon Health Weinberg–PACE. Its PACE programs deliver all-inclusive medical and social services as an alternative to nursing homes, funded through a mix of Medicare, Medicaid, and private coverage. The company differentiates itself by a not-for-profit mission, strong community engagement, and a focus on vulnerable populations, with top ratings for member experience and clinical quality; its goal is to improve health and quality of life while promoting equitable care.

About Fallon Health

Simplify's Rating
Why Fallon Health is rated
B-
Rated B on Competitive Edge
Rated B on Growth Potential
Rated C on Differentiation

Industries

Financial Services

Healthcare

Company Size

501-1,000

Company Stage

N/A

Total Funding

N/A

Headquarters

Worcester, Massachusetts

Founded

1977

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Simplify's Take

What believers are saying

  • Community Impact Grants deepen local nonprofit and municipal partnerships.
  • Removing prior authorization for psychological testing improves behavioral-health access.
  • SE Massachusetts expansion creates room for new enrollment and provider networks.

What critics are saying

  • CMS rate compression will pressure Medicare Advantage margins starting in 2026.
  • Blue Cross Blue Shield of Massachusetts is expanding direct competition in Worcester County.
  • NCQA and CMS quality requirements threaten rebate revenue if performance slips.

What makes Fallon Health unique

  • Fallon Health pairs Medicare Advantage with community-based health equity programs.
  • Its 2024 NCQA Health Equity Accreditation supports differentiated equity positioning.
  • Summit ElderCare expansion targets aging services across Southeastern Massachusetts.

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Benefits

Health Insurance

Paid Time Off

Paid Holidays

Vision Insurance

Life Insurance

Flexible Work Hours

Company News

Fallon Community Health Plan
Mar 3rd, 2022
Fallon Community Health Plan, Inc. hired Katie Acker as Health Equity Program Manager on Mar 3rd 22'.

Fallon Health, a nationally recognized not-for-profit health care services organization, today announced that Katie Acker, MPH, has been named to the newly created role of Health Equity Program Manager.

Fallon Community Health Plan
Jan 11th, 2022
Fallon Community Health Plan, Inc. partnered with Worcesterschools on Jan 11th 22'.

It is with great pride that Fallon Community Health Plan, Inc. partner with the City of Worcester to provide five years of fitness at the Senior Center.”

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