How Fallon Health Has Coped With COVID-19


In this part one of two series, Carolyn Langer, M.D., the chief medical officer, says the Massachusetts health plan mounted a big push on telehealth that includes in-person visit payment levels.

Like many health plans, Fallon Health in Worcester, Massachusetts, saw a drop in utilization because of COVID-19 and therefore a decrease in medical expenditures during the second quarter.

But Carolyn Langer, M.D., senior vice president and the health plan’s chief medical officer, said in a video interview with Managed Healthcare Executive that the plan has had to make directed provider payments to provider in some of its state-funded program and has taken steps to support provider financially. 

“We had a big push on telehealth. We currently reimburse (a telehealth visit) at 100% of in-person visit. We also cover telephonic encounters. All of this has really helped sustain the practices during this pandemic,” said Langer, who has been in her current position since 2018.

Langer said that Medicaid ACOs are Fallon’s largest product line and that value-based arrangements such as ACOs have helped providers cope with the drop in utilization, which, of course in fee-for-service arrangements means less revenue. “I think value-based payment has provided a cushion (to providers),” she said.

Fallon is a not-for-profit health plan that covers about 253,000 people. It operates several Programs of All-inclusive Care for the Elderly (PACE) programs for people who are dually eligible for Medicare and Medicaid. Langer said the organization has plans and programs that include people from throughout Massachusetts, and it has a PACE program in western New York. Still, most of the people it covers live in the western part of the state. 

Fallon tends to get high quality ratings. One of its plans, Fallon Community Health Plan, received a 4.5 rating for 2019-2010 from the National Committee for Quality Assurance.

For the first quarter of this year, Fallon reported adjust net income of $2.3 million on revenues of $441 million.