Fallon Community Health Plan Inc

“Family or business relationship between officers, directors, and key employees. Fallon health & life assurance co., inc. (fhlac) is a wholly-owned subsidiary of fchp. The following fchp board members and officers served on the fhlac board directors in 2024. James r. Buonomo, b john dill, frederick misilo, esq., janet s. Rico, deborah c. Enos, joseph n. Stolberg, cpa, richard p. Burke (ex officio through 1/31/2024), todd bailey (ex officio 2/1/2024 through 6/30/2024), and manuel a lopes (ex officio effective 7/1/2024).”

“The process used by management and governing body to review form 990 a draft of the form 990 is prepared by fchp and reviewed by its tax consulting firm. The final version of the form 990 is provided to board members for review prior to filing with the irs.”

“The process used to monitor conflicts of interest fchp's bylaws require all directors and officers to disclose any actual or possible conflicts of interest, as defined in the organization's conflict of interest policy relating to directors, officers and members of a committee with board delegated powers. This is enforced by the requirement that such individuals annually complete a conflict of interest disclosure statement. Each year the completed conflict of interest disclosure statements are reviewed by the audit and compliance committee of the board which reports any actual or potential conflicts to the full board. Any board member or officer with a conflict of interest is prohibited from participating in any discussion of, or vote on, the transaction or arrangement that results in the conflict of interest. Two independent board members also conduct an annual review of any business transactions involving organizations that could potentially benefit a board member or officer, to ensure that the transactions do not involve any undue influence, are at fair market value, and are in the organization's best interest. The reviewing board members report their findings to the full board. Furthermore, at board meetings, individual board members are asked to identify, and recuse themselves from any discussion and vote on any matter before the board in which they may have a conflict. Fchp also requires all directors, officers, and key employees to complete a written disclosure statement designed to identify potential conflicts. Fchp also has general corporate-wide conflict of interest policies that require reporting of potential conflicts and management approval of certain transactions, and prohibits certain specific transactions. These policies are enforced by senior management, including the chief compliance officer.”

“Process of determining compensation for ceo, top management officials, officers, and key employees. Fchp has established an executive evaluation and compensation committee (the "committee") of the board of directors that establishes policies and the compensation structure of certain fchp executive officers. This committee is responsible for ensuring that the total compensation provided to these executive officers is determined by a fair and equitable process, informed by current and credible market practice information, and compliant with applicable legal and regulatory guidelines. In 2024, the committee consisted of three members of fchp's board of directors who are not employed by the organization. Fchp's ceo served as an ex officio member of the committee without a voting right. The executive officers over whose compensation the committee is responsible are comprised of the president and chief executive officer ("ceo"), and the executive vice president, and senior vice president positions that report directly to the ceo ("executive group"). In 2024, to determine the compensation structure of the executive group, the committee relied on a written compensation survey produced by an independent consulting firm that assesses executive compensation and benefits. The committee met to review the compensation structure of the executive group and reviewed the compensation survey prepared by the independent consulting firm. The committee then voted to approve the compensation of the executive group (other than the ceo). For the ceo's compensation the committee (meeting without the ceo) recommended a compensation structure that was presented to the fchp's board of directors. The board of directors (without the ceo present), voted to approve the committee's recommendation. All these deliberations were contemporaneously documented in the minutes of the committee and board of directors.”

“How documents are made available to public fchp's form 990 and annual audited financial statements are available to the general public on the massachusetts attorney general's website. Fchp's 990, financial statements, governing documents, conflict of interest policy, and annual report are also provided upon request.”

“Name and title: the following individuals' titles changed during the year: todd bailey: svp & chief financial officer throughout 2024 interim president & ceo effective 2/1/2024 through 6/30/2024 lora council, md: interim chief medical officer effective 2/23/2024 through 11/3/2024 svp & chief medical officer effective 11/4/2024 mary ritter: svp & chief strategy & government programs officer through 9/30/2024 david brumley, md: svp & chief medical officer through 2/23/2024”

“Form 990, part i line 1 organization mission and program activities founded in 1977, fallon community health plan, inc. ("fallon health") is a leading health care services organization with a mission to provide care, coverage and services designed to meet the unique and changing needs of the communities it serves. In addition to offering innovative health insurance solutions, fallon health excels at creating unique health care programs and services that provide coordinated, integrated care for older adults and individuals with complex health needs. With a predominant focus on government sponsored health insurance programs, fallon health's product portfolio includes a variety of medicaid and medicare advantage plans. As a provider of care, fallon offers a program of all-inclusive care for the elderly.”

“Government programs from its very start in 1977, fallon health has always been committed to serving the health care needs of individuals enrolled in medicare and medicaid programs. It has worked to expand those offerings over the years, announcing in 2021 that it would primarily focus its resources on government-sponsored health insurance programs. Listed below is the complete list of the government-sponsored programs fallon health offered in 2024 in massachusetts. . Medicare advantage . Masshealth accountable care organization partnership plans . Medicare advantage special needs plan and senior care options . Program of all-inclusive care for the elderly (pace) . Limited-network plans via the health connector these programs enable fallon health to serve members of all ages, at all income levels and with all types of health needs. There are several notable facts when it comes to fallon health's history in government programs: . In 1979, fallon health received the first contract in massachusetts to cover medicaid beneficiaries. . In 1980, fallon health was the first health plan in the country to offer a medicare advantage plan. . In 1995, fallon health started its pace program in massachusetts, known today as summit eldercare. It is the largest pace program in new england and includes five pace centers in massachusetts. . In 2010, fallon health launched navicare, a medicare advantage special needs plan and senior care options program in massachusetts. . In 2017, fallon health was selected to participate in the redesign of massachusetts' medicaid program and formed three masshealth accountable care organization partnership plans. . In 2021, fallon health announced a primary focus on supporting the health care needs of individuals enrolled in government-sponsored health insurance programs, resulting in the near complete withdrawal from the commercial market by the end of august 2022. Fallon health continues to sell its community care product on the health connector. The product is available to individuals and small groups in the following massachusetts' counties: berkshire, bristol, hampden, middlesex, norfolk, plymouth, suffolk, middlesex and worcester. . In 2022, fallon health was selected to continue its participation in the masshealth accountable care partnership program, adding a new aco in partnership with atrius health. . In 2024, fallon health was selected by eohhs to recontract with the state and continue operating navicare, its senior care options program.”

“Community giving fallon health's mission, improving health and inspiring hope, isn't just a guiding principle but also the foundation of our community benefits program and strategy. Reinforced by a nearly 50-year commitment to caring for those who need us most, we're dedicated to addressing the needs of disadvantaged populations who live in the communities we serve. In pursuit of its community benefits mission, fallon health works cooperatively and collaboratively with health care and community-based organizations, as well as state and federal agencies to create innovative and equitable health care solutions, seek healthy outcomes, and improve access to health care services. Our strategy is designed with 5 specific goals in mind including: 1.improving health status. Develop, implement, and support programs that improve the health status of underserved or at-risk populations within our service area as determined by the needs of the communities we serve. 2.health education. Continue our role as a health educator by providing resources, hosting health and information programs, and by bringing general information to the public through speaking engagements, programs, and the use of our communication platforms. 3.community engagement. Convene key community stakeholders, providers, community-based organizations, and individuals to discuss escalating health issues that have a significant effect on the community's positive health outcomes, access to quality care, and overall cost of care. 4.partnership development. Develop partnerships that allow us to support and/or implement community health improvement plans and programs that are identified through local community health assessments and address the barriers that impact positive health outcomes. 5.culturally competent care. Continue to find ways to deliver or provide access to culturally competent, high-quality, low-cost health care coverage to people of any age, race, ethnicity, religion, ability, sexual orientation, gender identity, health status and income level. Fallon health is committed to making resources available to community organizations as appropriate in pursuit of these goals. To determine our community benefits program funding priorities and targeted populations, we use findings from the community health needs assessment in which we directly participate- the greater worcester chna- as well as those conducted in key geographies across the commonwealth by organizations including baystate medical center, the greater lowell health alliance, lawrence general hospital, berkshire health systems, and south shore health. As we develop our strategy, consideration is given to priority areas identified in the assessments, mission alignment, and community value including continuity with prior years' funding priorities and the populations we serve. Based on the above criteria, we identified the following 3 funding priorities and target populations for 2024 - 2026: 1.food and nutrition security. Priority will be given to programs that improve or expand access to healthy and culturally inclusive food sources with a focus on individuals and families with limited economic means. 2.older adults. Programs for older adults that support housing safety and stability, that mitigate isolation and loneliness, or that work to eliminate barriers to health care e.g.: technology, transportation, and health literacy. 3.early intervention programs for children and youth. Priority will be given to programs that focus on mental health, behavioral health, and/or substance use prevention, education, and awareness. In 2024, fallon health distributed approximately $1.5 million to support organizations and programs that met the goals of its community benefits program. Support for our funding priorities included grants, direct expenses, leveraged expenses, and contributions of staff and volunteer times. In addition, fallon supported other philanthropic initiatives through corporate sponsorships. In addition t”