Quality at Fallon Health

NCQA "Excellent" accreditation

Fallon Health aims to assure that safe, effective, patient-centered, timely, efficient and equitable clinical care and services are provided to members. To ensure the quality and safety of clinical care and service, Fallon has established Quality Programs. In order to continually improve services to members in the community, Quality Programs aligns with Fallon Health's mission, values and vision statements.

For detailed Quality Programs information:
Download Fallon Health ’s Quality Programs brochure

Fallon Health is one of the highest-rated health plans in the nation

NCQA badges - FCHP is a top plan according to NCQAFallon Health is the #1 Medicaid health plan in the country according to the National Committee for Quality Assurance’s Medicaid Health Insurance Plan Rankings, 2013-2014. This is the sixth time in the past seven years that Fallon has achieved this distinction. 

Fallon's Medicare HMO was ranked 15th out of 405 plans. 

Fallon's commercial HMO was ranked 34th out of 484 plans.

Learn more about Fallon Health's rankings


National accreditation and Quality Plus distinction

Fallon maintains "Excellent" accreditation status for our commercial, Medicaid and Medicare Advantage products from the National Committee for Quality Assurance (NCQA,) an independent, not-for-profit organization dedicated to measuring the quality of America’s health care. "Excellent" accreditation is the NCQA's highest possible status and is reserved for the best health plans in the nation. Fallon Health is the only Massachusetts health plan to be accredited across all three product lines.

Fallon has also achieved Quality Plus Distinction for Physician and Hospital Quality from the National Committee for Quality Assurance—an independent, not-for-profit organization dedicated to measuring the quality of America’s health care. NCQA-accredited health plans can opt to achieve distinction in “Quality Plus” content areas in addition to their accreditation.

For details:
National accreditation and Quality Plus distinction
Download Fallon Health’s Quality Programs brochure 
Visit NCQA's Web site

HEDIS® is sponsored by NCQA. HEDIS® is a registered trademark of the National Committee for Quality Assurance.

Patient safety standards

Fallon Health collaborates with providers, hospitals and regional and national coalitions to improve health care delivery and minimize medical errors.

Activities associated with patient safety include the clinical peer review activities that identify case reviews related to clinical quality and the evaluation of possible errors of commission and omission. Corrective action plans are also carried out when areas of substandard care are identified, and follow-up is required that addresses practitioner-specific components as well as system issues identified through peer review committees.

Pharmaceutical patient safety is also monitored, with procedures in place for point-of-dispensing communications to identify drug-drug interactions and classify them by severity. Screening of new drugs and technologies occurs through Fallon's Pharmacy and Therapeutics Committee and Technology Assessment Committee, with input from national guidelines and research consortia.

For details on patient safety standards: 
Download Fallon Health’s Quality Programs brochure

Hospital patient safety standards

Fallon Health voluntarily participates in the activities of The Leapfrog Group, an initiative driven by organizations who are working to initiate breakthrough improvements in the safety, quality, and affordability of healthcare for Americans.

The Leapfrog Group has developed standards in several key areas:

  • Physician staffing in intensive care units
  • The use of computers in hospitals for ordering prescriptions
  • The number of certain high-risk treatments or procedures a hospital performs each year
  • A Leapfrog Quality Index summarizing performance on the 27 National Quality Forum procedures to reduce preventable medical mistakes.

For details on hospital patient safety standards: 
Download Fallon Health's Quality Programs brochure
Visit Leapfrog's hospital standards at www.leapfroggroup.org

* NCQA is a private, non-profit organization dedicated to improving health care quality.