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.
Personal Health Information was Released in Change Healthcare Hack
April 23rd 2024UnitedHealth has found 22 screenshots, allegedly from Change Healthcare files, that were posted for about a week on the dark web. Some of these contained personal health information. The extent of data release is not yet known.
Read More
DC Roundtable: Patrick Cooney of The Federal Group Drops the Latest on PBM Legislation in Washington
April 11th 2024In this episode of "DC Roundtable," Peter Wehrwein, managing editor of Managed Healthcare Executive, spoke with Patrick Cooney, president of The Federal Group, a lobbying and strategic planning firm in Washington, D.C., about recent developments in Washington concerning PBMs.
Listen
Drug Discount Programs Poised to Change with New Tech, Pharma Execs Survey Finds
April 22nd 2024It is somewhat mind-boggling in 2024 that more than one-third of pharma organizations still rely on manual entry of data into Excel spreadsheets to track duplicate discounts that can cost millions of dollars a year in lost revenue
Read More
2024 Emerging Leaders in Healthcare — Submit For a Chance to Be Featured in MHE's August Issue
April 22nd 2024MHE Editors are seeking diverse healthcare professionals from different backgrounds and healthcare sectors, with individual interests. Eligible candidates are early or mid-career leaders with less than 10 years of experience. Award winners will enjoy complimentary passes to the PBMI Annual National Meeting in Orlando, Florida, from Sept. 4-6. Additional perks include a feature in our August issue, a subscription to MHE and more!
Read More