Media Kit

Fallon at a glance………………………1
Highlights from our history…………….3
Product overview………………………6
Recent press releases………….……11
Executive bios and photos…….….....16

Prepared by
Melissa Cordial
Director of Corporate Communication
April 2019
 MISSION Making our
Fallon Health is a leading
communities healthy.
not-for-profit health care services
organization based in Massachusetts. VISION A vibrant health care services
We offer innovative health insurance organization that exceeds our
solutions and a variety of Medicaid members' expectations
and Medicare products to meet the
VALUES Accountability • Collaboration •
health care needs of people of all
ages, health statuses and income Compassion • Excellence •
levels. Innovation

Products Membership
Commercial HMO
• Broad network TPA
19.1%
• Limited networks
Commercial
Commercial PPO PACE 34.4%
0.5%
Medicare Advantage
Medicare Supplement
Senior Care Options
Program of All-Inclusive Care MassHealth Medicare
37.3% 8.6%
for the Elderly (PACE)
MassHealth ACO
Third Party Administrator

Nationally Recognized for Quality A Program of All-Inclusive

Care for the Elderly (PACE)

As a provider of care, Fallon Health offers

Consistently ranked as one
of the nation’s highest-rated
health plans according to
the National Committee for
Quality Assurance (NCQA),
a private, non-profit
organization dedicated to
improving health care
quality.
Fallon Senior Plan and NaviCare
plans received 4 stars out of 5
possible stars from the Centers for
Medicare and Medicaid Services
for 2019.
Summit ElderCare® and Fallon Health
Weinberg-PACE, an innovative and
completely integrated home- and
community-based nursing home
alternative for older adults.
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 Our commitment to community
Community focus is core to who we are and something our employees enthusiastically support.
Each year, Fallon fulfills its mission by contributing more than $1 million in grants,
sponsorships, in-kind donations, hunger relief funding, advocacy and volunteering efforts
throughout the Commonwealth.
$1.4 million donated Employees
Our focus areas include: to 60 organizations volunteer over
Senior Health Initiatives – Programs that support fighting hunger in 6,500 hours each
seniors in their homes and communities providing Massachusetts year to serve their
access to care, safety in their homes and since 2008 communities
communities, behavioral health resources and Recognition:
access to food and utilities. · 2016 Worcester Business Journal’s “Corporate
Citizen of the Year.”
Children and Youth Health Initiatives – Fallon · 2017 Telegram & Gazette’sBest place to work for
community presence.
supports community based programs and
· 2018 Associated Industries of Massachusetts’
organizations that provide access to programs Sustainability Award for our longtime commitment to
that wrap services and resources around children addressing basic barriers of health, such as
and youth. transportation, education, housing and access to food.

Workforce at a glance Locations

1,230 90% 80%
Corporate offices:
Worcester, MA
number of employees who Pembroke, MA
employees said they will go the extra
mile to help Fallon succeed female Amherst, NY
in carrying out its mission.
PACE centers:
Summit ElderCare:
Lowell, MA
Executive Leadership Leominster, MA
Springfield, MA
Webster, MA
Richard P. Burke | President and CEO
Worcester, MA
Christine Cassidy | Senior Vice President and Chief Communications Officer
Fallon Health Weinberg:
James Gentile | Senior Vice President and Chief Compliance Officer
Amherst, NY
Kevin Grozio | Senior Vice President and Chief Financial Officer
Carolyn Langer, M.D. | Senior Vice President and Chief Medical Officer
Connect with us
Jill Lebow | Senior Vice President and Chief Human Resources Officer
Phone: 1-800-333-2535
Mark Mosby | Chief Legal Counsel (Epstein Becker & Green, P.C.) Web: fallonhealth.org
David Przesiek | Senior Vice President and Chief Sales Officer
Mary Ritter | Senior Vice President of Strategy and Business Development
Emily West | Senior Vice President and Chief Operating Officer 2
 Highlights from our history
1977

 Fallon Community Health Plan is launched.

1978

 Becomes first federally qualified HMO in central Massachusetts, fourth in Massachusetts and
75th in the U.S.

1979

 Wins first Massachusetts contract to cover Medicaid beneficiaries

1980

 Begins Fallon Senior PlanTM Medicare demonstration project and has first Medicare risk
contract in the country

1984

 Covers Worcester’s first heart transplant recipient, a Fallon Senior Plan member

1994

 Applies voluntarily for accreditation from the National Committee for Quality Assurance
(NCQA) and receives a three-year accreditation—the first in state to do so

1995

 Starts Elder Service Plan, a Program of All-Inclusive Care for the Elderly (PACE), in
Worcester—renamed Summit ElderCare® in 2005. Now in six Massachusetts locations.

1996

 Ranks as #1 HMO in the U.S. by both Newsweek and U.S. News & World Report—Fallon’s
commercial, Medicare and Medicaid plans are consistently ranked in the top 10% through the
years and maintain a high NCQA accreditation status and Centers for Medicare & Medicaid
Services (CMS) star rating

2002

 Starts Direct Care, the first limited network in the state, and Select Care, an expanded network
in central and eastern Massachusetts

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2004

 Introduces the first $0 premium Medicare Advantage plan in the state

 Launches It Fits!—making Fallon the only plan in the state to reimburse for youth sports fees—
and starts Oh Baby!
 Eliminates copays for routine physicals, annual gynecological exams and well-child visits—the
first health plan in Massachusetts to do so, years before it was federally mandated

2006

 Acquires UltraBenefits Inc., a third-party administrator that manages health benefits for
members nationally
 Holds the first Golf & Gather FORE a Cause, an annual event that raised more than $1.8
million for hunger relief in Massachusetts

2009

 Becomes first in the state to offer health insurance through eHealthInsurance.com

2010

 Launches NaviCare® HMO SNP/SCO in Worcester County, which is now available throughout
most of Massachusetts

2013

 Launches The Healthy Health Plan, making Fallon the first plan in Massachusetts to include a
wellness incentive as part of its standard benefit package
 Offers an ID card app for mobile devices—the first insurer in the state to have one
 Opens a Summit ElderCare program in Springfield, making Fallon the first to bring PACE to
western Massachusetts
 Implements QuoteNow, a broker quoting tool, becoming the first health plan in the state to
quote for merged market plans as required by the Affordable Care Act

2014

 Brings all products and services together with a new name—Fallon Health—to emphasize that
we are a health care services organization, the only health plan in the state that is also a
provider of care
 Forms Fallon Health Weinberg, a joint venture with the Weinberg Campus in New York, to
develop a PACE and Managed Long Term Care plan in Erie and Niagara counties
 Introduces Community Care, a health plan for the subsidized market

2015

 Acquires third-party administrator Group Insurance Service Center, Inc., strengthening its
position in the self-insurance marketplace and expanding membership by 17,000

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2016

 Selected as Corporate Citizen of the Year by the Worcester Business Journal

 Introduces new, specialized plans to offer extra support for people with chronic conditions like
asthma, diabetes and coronary artery disease
 Reaches target of 1,000 Summit ElderCare participants

2017

 Expands Summit ElderCare to Lowell and becomes the fifth-largest PACE in the nation
 Forms MassHealth Accountable Care Organizations (ACO) with the following provider groups:
o Berkshire Health Systems and Community Health Programs
o Reliant Medical Group, including Southboro Medical Group
o Wellforce, and its provider partners, and Lowell Community Health Center
 Wins Best Place to Work in Worcester Telegram & Gazette competition

2018

 Reaches highest membership milestone in its history

 Begins serving MassHealth Accountable Care Organization members in Fallon 365 Care,
Berkshire Fallon Health Collaborative and Wellforce Care Plan
 Expands into Berkshire County with Fallon’s Medicare Advantage product, Fallon Senior
Plan™, and its Senior Care Options/Special Needs Plan (SCO/SNP), NaviCare® and becomes
the only SCO/SNP option available in Berkshire County
 Expands Summit ElderCare® with a new state-of-the-art site in Webster, MA
 Received Associated Industries of Massachusetts’ 2018 Sustainability Award for its longtime
commitment to addressing some of the most basic barriers of health, such as transportation,
education, housing and access to food

*NCQA is a private, nonprofit organization dedicated to improving health care quality

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 Fallon Health Product Overview

Fallon Health both an insurer and provider of care. As an insurer, products filed under Fallon are
subject to HMO regulations and mandates. Fallon is a provider of care through its Programs of
All-Inclusive Care for the Elderly, also called PACE programs. Descriptions of Fallon’s products
and programs are summarized in this document.

Direct Care, Select Care and Fallon Steward Community Care (HMO plans)
Direct Care, Select Care and Fallon Steward Community Care are traditional health
maintenance organization (HMO) products. With our HMO plans, Fallon members choose a
primary care physician (PCP). Their PCP helps manage their care and arranges for all of their
health care needs, including referrals to specialists. The only difference between Direct Care,
Select Care and Steward Community Care is the choice of physicians and hospitals. Both have
a rich core of benefits and include extra benefits such as It Fits!, Oh Baby! and Naturally Well.
 Select Care provides access to an extensive network of doctors and community-based
hospitals throughout Massachusetts and in southern New Hampshire. Members can be
seen at physician practices, community and teaching hospitals and medical facilities
across the Select Care service area, providing a wide choice of health care providers.
 Direct Care is a high-performing limited network of providers at medical centers within
our licensed service area. Direct Care network providers are carefully chosen for their
medical excellence, patient access and innovation. Members have access at physician
practices, community hospitals and medical facilities across the Direct Care service
area.
 Fallon Steward Community Care is a limited network plan that provides world-class
health care at an affordable cost. Built in partnership by Fallon Health and Steward
Health Care System, Fallon Steward Community Care is available throughout Eastern
Massachusetts and includes all of the Steward Health Care System community doctors
and hospitals.

Community Care
Community Care is a plan for those who qualify for a subsidy from the government based on
income to pay for health insurance. Members get reduced premiums, low co-payments, and no
deductibles plus extra features like a fitness reimbursement.

Community Care is available in central Massachusetts and parts of Middlesex County. Members
can see health care providers at Reliant Medical Group (including Southboro Medical Group),
Harrington HealthCare, select PCPs and specialists affiliated with MetroWest HealthCare
Alliance and other local providers.

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Summit ElderCare®
Summit ElderCare, a Program of All-inclusive Care for the Elderly (PACE), is an innovative
approach to elder care. The only program of its kind in central Massachusetts, it allows older
adults to maintain their independence while providing necessary support for both the program
participants and their caregivers.

Summit ElderCare offers the convenience and security of coordinated care. Most medical
services are provided at a Summit ElderCare site by an interdisciplinary team of medical
professionals who know participants’ medical history. Participants do not have to be a member
of Fallon Senior Plan™ to join. Any person age 55 and older who is able to live safely at home,
who lives in the service area, and who is certified by the Divisions of Medical Assistance’s
screening agent as meeting Medicaid nursing facility clinical criteria is eligible for the program.

An individualized care plan of services is developed and approved by the interdisciplinary team
and may include the following:
 Primary medical and nursing care
 Full prescription drug coverage
 Medical supplies and equipment
 Physical, occupational and recreational therapies
 In-home care
 Day Health Center with a specialized unit for the memory impaired
 Specialty care including podiatry, optometry and audiology
 Transportation to the Summit ElderCare site as needed
 Family caregiver support
 100% hospitalization coverage

Summit ElderCare is covered by Medicare and Medicaid (MassHealth). Participants who are
eligible for MassHealth may have a monthly deductible based on their income. If a participant is
not eligible for Medicare or MassHealth, they may enroll and pay a monthly premium that is
equivalent to the Medicaid payment to Summit ElderCare.

Medicare beneficiaries not on Medicaid must continue to pay the Part B premium after
enrollment in Summit ElderCare, along with the monthly premium. Participants in Summit
ElderCare pay no additional co-payments or deductible for covered services.

Fallon Health currently operates five PACE sites in Massachusetts–Leominster, Lowell,

Springfield, Webster and Worcester. Additional sites are planned as we continue our Summit
ElderCare expansion. Fallon also operates a PACE site in Amherst, NY called Fallon Health
Weinberg-PACE.

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Fallon Senior Plan™ and Fallon Companion Care
One of the first Medicare HMO’s in the country, Fallon Health has offered choices to Medicare-
eligible members for over 30 years. Today, we offer several Medicare Advantage HMO plans for
individuals throughout Massachusetts. The key differences between the plan choices are the
monthly premium amounts and the levels of coverage that seniors are interested in, need or
qualify for.

All of our HMO plans include a choice of Medicare Part D prescription drug coverage, and they
all provide benefits above and beyond Original Medicare alone, like:
 Preventive & comprehensive dental coverage for certain plans
 The SilverSneakers Fitness Program: a health and fitness program that provides a free
fitness membership with access to amenities and fitness classes including the signature
SilverSneakers classes
 Weight Watchers membership
®

 Routine annual physical exam at no cost

 Routine eye exam & eyewear
 Nationwide travel coverage for doctor visits outside of the Northeastern states

Our Medicare Advantage plans have been given four out of five stars from the Centers for
Medicare and Medicaid Services for 2019.

Fallon offers a Medicare Supplement (Medigap) insurance option for individual consumers in
Massachusetts. Our Medicare Supplement plans, “Core” and “1” further diversify our non-group
senior-product portfolio. Members pay a higher premium than our very popular Medicare
Advantage HMO plans. However, they pay little to nothing on health care expenses, such as
deductibles, coinsurance and other gaps in Original Medicare coverage that remain after
Medicare has covered its portion of the costs.

Fallon also offers Medicare Group plans for Medicare-eligible retirees/employees and their
spouses. Our dedicated team works with each employer group to develop plan designs that
best fit their groups' needs.
Our Medicare Group plans are:
 Fallon Senior Plan Premier HMO (Medicare Advantage HMO)
 Fallon Companion Care (Medicare Supplement) - a Medicare Part A and B Wrap Plan
which is available to retirees and their spouses living anywhere in the United States.

NaviCare®
NaviCare is the product name for Fallon’s Senior Care Options program and Medicare
Advantage Special Needs Plan. It is designed for Massachusetts residents age 65 or older who
are on MassHealth Standard and may also be on Medicare. This program provides coordinated
care and coverage for all Medicare and Medicaid covered benefits plus member specific health
services not traditionally covered by Medicare and Medicaid such as coverage for dentures.

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NaviCare provides a comprehensive package of medical, social and long-term care services
with the goal of maintaining the member in the least restrictive setting, functioning at the highest
level possible. With NaviCare, there are no premiums and no co-payments or coinsurance for
the member. The member’s health care is coordinated by a team of doctors, nurses, social
workers and a personal Navigator, who serves as a resource to both the member and the
caregivers to provide support, guidance and information and assists with things like scheduling
doctor visits and transportation needs. NaviCare is available throughout Massachusetts except
in Dukes County.

Fallon MassHealth ACO Programs (Medicaid)

Fallon Health offers three Accountable Care Organization (ACO) partnership plans with local
providers as part of the MassHealth Program. Fallon Health works closely with each provider
group to provide care to members.

 Berkshire Fallon Health Collaborative is made up of Berkshire Health Systems,

Community Health Programs, several Berkshire County community physician practices
and Fallon Health. It is available to individuals with MassHealth in Berkshire county.

 Fallon 365 Care includes doctors and health care providers from Reliant Medical Group
and Southboro Medical Group. This plan is available to individuals with MassHealth in
central Massachusetts.

 Wellforce Care Plan, available to individuals with MassHealth in eastern

Massachusetts, is made up of doctors and other health care providers from, or affiliated
with:
o Circle Health
o Floating Hospital for Children at Tufts Medical Center
o Lawrence Memorial Hospital (Hallmark Health System)
o Lowell Community Health Center
o Lowell General Hospital
o Lowell General Physician Hospital Organization
o Melrose-Wakefield Hospital (Hallmark Health System)
o New England Quality Care Alliance (NEQCA)
o Tufts Medical Center

Members who enroll in one of Fallon Health’s plans through the MassHealth Program have a
contractually defined set of benefits, in addition to, some nonstandard benefits/services that
provide additional coverage through Fallon.

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Fallon Health and Life Assurance Company (FHLAC) Products
FHLAC is a wholly owned, for profit subsidiary of Fallon. Products filed under the FHLAC line of
business include Fallon Preferred Care (PPO), and Administrative Services Only (ASO)
contracts. FHLAC products are not marketed under the Fallon HMO license and regulations are
less strict.

Fallon Preferred Care (PPO plan)

Fallon Preferred Care is FCHP’s PPO, or preferred provider organization, product. The Fallon
Preferred Care network is a combination of a wholly owned network, made up of direct
agreements with Fallon Preferred Care providers and facilities, and a leased PPO network
through Private Health Care Systems (PHCS) from Multiplan, Inc. The PHCS nationwide PPO
network offers members access to almost 600,000 providers and 4,000 health care facilities
nationwide. This network provides members with more flexibility than a traditional HMO plan
design but comes at a higher price point. Members are not required to choose a PCP and there
are no referral requirements. All plan designs include co-payments, coinsurance and
deductibles. Members may also seek services outside of the Fallon Preferred Care network at
a reduced benefit level. Fallon Preferred Care Members are eligible to participate in It Fits!, Oh
Baby!, and $0 wellness visits.

Administrative Services (ASO)

Administrative Services Only (ASO) business is administered by Fallon Health and Life
Assurance Company. Services include medical management, claims processing, enrollment,
check issuance, reporting, member handbooks and other administrative functions. Our ASO
model provides employers with a flexible, full-service contract which means that all of the
administrative and medical management services provided under a fully-insured arrangement
are also provided under a self-insured arrangement. In addition to receiving a full complement of
medical management services, employers can choose to leverage Fallon’s programs and
wellness incentives – including, It Fits!, Oh Baby! and Nurse Connect. The employer is
responsible for funding all of their medical claims.

UltraBenefits Products
UltraBenefits is a wholly owned, for profit subsidiary of Fallon Health and Life Assurance
Company (FHLAC). UltraBenefits is a third-party administrator that manages group benefit
plans by providing consultative and administrative services such as claims processing, claims
management services, premium and fee billing, and eligibility verification in addition to COBRA,
flex spending and health reimbursement account administration. UltraBenefits is not an
insurance company. All of the group benefit plans they manage are self-insured. UltraBenefits
utilizes rental networks of providers to meet the needs of employer groups around the country
but has the ability to utilize the Fallon provider network to employers in our service area.

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 For immediate release
For more information, contact:
Melissa Cordial
Director, Corporate Communications
melissa.cordial@fallonhealth.org
508-368-9616

Fallon Health reports record year for membership

and financial performance
Results driven by strategic investments in government market, effective
management of administrative expenses

Worcester, Mass., March 1, 2019 ― Fallon Health today reported membership and
revenue totals for 2018 that are the highest in the 41-year-old history of the company. The
results were driven by strategic investments in government programs and effective
management of administrative expenses.
For 2018, Fallon Health had 271,369 members – an increase of nearly 24 percent over
219,112 members in 2017, and revenue of $1.6 billion – a 21 percent increase over revenue of
$1.3 billion in 2017. Fallon’s net income of $6.9 million consisted of an operating gain of $1.6
million and investment and other income of $5.3 million. For 2017, Fallon’s net income of $7.9
million consisted of an operating loss of $7.6 million and investment and other income of $15.5
million.
“Over the past several years, during a time of change and uncertainty in the health care
industry, our strategic investments in government programs and careful attention to
administrative expenses have put us on a path of long-term sustainability that will allow us to
advance our mission of making our communities healthy,” said Richard Burke, President and
CEO at Fallon Health. “I am grateful for the hard and sustained work of our employees in getting
us to this place. We will continue this momentum in 2019.”
For the fourth quarter of 2018, Fallon Health posted net income of $2.9 million on
revenue of $414 million, which included an operating gain of $2.8 million and investment and
other income of $.1 million. For the fourth quarter of 2017, Fallon posted an operating loss of
$1.5 million, investment and other income of $6.9 million, revenue of $335 million, and net
income of $5.4 million.

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 “Investments in government programs, including our MassHealth ACOs, have resulted
in Fallon Health’s deliberate growth in the government market. In the past five years,
government programs as a percentage of Fallon’s total membership have increased from 20
percent to nearly 50 percent. With a growing reliance on government programs among state
residents, we see this market continuing to provide opportunities that Fallon is well positioned to
support,” said Kevin Grozio, Senior Vice President and Chief Financial Officer at Fallon Health.

Investments made by Fallon Health include:

 Launching three MassHealth Accountable Care Organizations (ACOs) to improve
health outcomes by providing coordinated and patient-centered care in
partnership with community providers.
 The expansion into Berkshire County of Fallon’s Medicare Advantage product,
Fallon Senior Plan™, and its Senior Care Options/Special Needs Plan
(SCO/SNP), NaviCare®. Fallon is the only SCO/SNP option in Berkshire County
for adults age 65 and older who want to maintain their independence with
comprehensive, coordinated, patient-centered care.
 Continued expansion of Summit ElderCare®, including a new site in Webster,
MA. Summit ElderCare is a Program of All-Inclusive Care for the Elderly (PACE)
designed to allow seniors to age in place at home by providing comprehensive,
team-based care and support services.
 Technology investments that have driven data analysis and enhanced provider
collaboration, strengthening quality and value for members while efficiently
overseeing administrative and medical costs.
 The distribution of $1.4 million in grants, sponsorships, in-kind contributions and
volunteer hours to fight hunger and support other causes addressing social
determinants of health.
* * *
About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports
the diverse and changing needs of those we serve. In addition to offering innovative health
insurance solutions and a variety of Medicaid and Medicare products, we excel in creating
unique health care programs and services that provide coordinated, integrated care for
seniors and individuals with complex health needs. Fallon has consistently ranked among the
nation’s top health plans and is accredited by the National Committee for Quality Assurance
for its HMO, Medicare Advantage and Medicaid products. For more information, visit
fallonhealth.org.
# # #

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 For immediate release
For more information, contact:
Melissa Cordial
Director, Corporate Communications
1-508-368-9616
melissa.cordial@fallonhealth.org

Fallon Health awards grants to 10 community-based

organizations in Massachusetts

Worcester, Mass., Feb 6, 2019 — Fallon Health, a mission-focused, community-based

not-for-profit health care services organization, today announced $10,000 grants to each of 10
community-based organizations addressing health care barriers in underserved communities
from Lowell to Worcester to the Berkshires.
The grants were provided through Fallon Health’s Community Benefits Grants Program.
As a Massachusetts’ non-profit Health Maintenance Organization (HMO), Fallon Health commits
to provide support to address unmet health needs and improve the health of disadvantaged
populations through its grant program. Grant recipients were selected based on their ability to
achieve positive health outcomes in two critical focus areas: senior health initiatives that support
older adults living independently or provide access to care, behavioral health resources, or food
and utilities; and health initiatives supporting wrap-around services and resources for children
and youth.
Organizations selected for their senior health initiatives:
 Genesis Club House for its Worcester County Older Adults Committee, which
visits inactive older members and those isolated in their homes due to physical or
mental health issues, with the goal of reducing isolation and loneliness.

 Merrimack Valley Food Bank for its Mobile Pantry Program, a home grocery
delivery service helping elderly and disabled Greater Lowell residents.

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  Quaboag Valley Community Development Corp. to expand its senior
transportation services in the Quaboag Region to include North Brookfield, MA.

 St. Paul’s Elder Outreach to reduce falls among Worcester’s older adults by
promoting healthy behaviors related to fall prevention.

 Volunteers in Medicine Berkshires to assist seniors with social determinants of

health, including food security, assistance with heating costs and weatherization,
housing and other factors.

Organizations selected for their child and youth health initiatives:

 Berkshire Health Systems’ Operation Better Start for its Berkshire Healthy
Students Program to increase knowledge of healthy eating, physical activity and
parent/community engagement.

 Boys & Girls Club of Worcester for its Family Support Program, which provides
counseling for children and families, referrals, service plans and case
management.

 Girls Inc. of Lowell to provide community-based enrichment and educational

activities for girls in grades K-12.

 Girls Inc. of Worcester for its After School and Summer Camp Program to
serve the “whole girl” in safe, gender-specific environments.

 The SHINE Initiative for its Swatting the Stigma of Mental Illness Program,
which combats and de-stigmatizes mental health conditions in children, teens
and young adults.

“Making our communities healthy is Fallon’s mission, and we value the power of
community partnerships in addressing interrelated health care barriers,” said Richard Burke,
President and CEO of Fallon Health. “We’ve seen first-hand the difference our grant recipients
are making across the state, and we’re gratified to be able to help them expand their reach and
advance our shared mission of improving the health and well-being of our community.”

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 Through its Community Benefits Grants Program, Fallon Health has distributed more
than $1.4 million to local organizations with initiatives that address health care barriers.
In addition to its Community Benefits Grants Program, Fallon Health offers robust
community support through monthly mini-grants, annual hunger relief funding, corporate
sponsorships, in-kind donations, wellness programs and volunteer opportunities for employees.

For more information, visit fallonhealth.org/community.

* * *

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports
the diverse and changing needs of those we serve. In addition to offering innovative health
insurance solutions and a variety of Medicaid and Medicare products, we excel in creating
unique health care programs and services that provide coordinated, integrated care for
seniors and individuals with complex health needs. Fallon has consistently ranked among the
nation’s top health plans and is accredited by the National Committee for Quality Assurance
for its HMO, Medicare Advantage and Medicaid products. For more information, visit
fallonhealth.org.

15
 Fallon Health Executive Team

Richard P. Burke
President and CEO

Throughout Richard Burke’s 20 years at Fallon Health, he has demonstrated

a strong commitment to both Fallon and to the communities it serves.

Prior to his appointment as President and CEO, Burke held the position of
President of Senior Care Services and Government Programs. His
responsibilities included overseeing Fallon’s government product lines
serving both aging populations and high-risk populations of all ages,
including Fallon Senior Plan (Medicare Advantage), Summit ElderCare (a
Program of All-inclusive Care for the Elderly), NaviCare (Special Needs
Plan/Senior Care Options), Fallon Health Weinberg (a joint venture in New
York State) and Home Staff, LLC (a private duty home health agency).
Under his leadership, Fallon Senior Plan and NaviCare had the largest
statewide expansion in the company’s history and Summit ElderCare grew
to six locations, achieving a membership milestone of 1,000 participants.

Burke has served on numerous boards including the Central Massachusetts Agency on Aging, for
which he was Board President from 2009 to 2011. He has also served on the boards of Fitchburg State
University, Worcester Regional Chamber of Commerce, for which he served as Chairman in 2012 and
2013 and the Worcester Economic Club. Burke is currently a board member of the Massachusetts
Association of Health Plans, Assumption College and the Worcester Business Development
Corporation.

A graduate of Assumption College, Burke holds a master’s degree in political science from Boston
College and a master’s in business administration from the Johnson School of Management at Cornell
University.

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Christine Cassidy
Senior Vice President and Chief Communications Officer

In her role at Fallon Health, Christine Cassidy is responsible for all of the
company’s communications and corporate relations functions, including
corporate and marketing communications; advertising; brand management
and promotion; public, community and government relations; digital
communications; and internal communications.

Cassidy joined Fallon in 2002 and has held various communications-related

roles, including Vice President of Corporate Communications. In her most
recent position as Chief Communications Officer, Cassidy led Fallon’s 2014
rebrand campaign.

Prior to joining Fallon, Cassidy was the Editor of The Lancaster Times and North County Family &
Health. She also spent 15 years at the John Hancock Mutual Life Insurance Company in Boston
working in a variety of roles including leading a multi-million-dollar project to optimize the automatic
adjudication of group health claims.

Cassidy is Chair of the Becker College Board of Trustees, Vice Chair of the Worcester Regional
Chamber of Commerce Board of Directors, and a member of the Leadership Council for the United
Way of Central Massachusetts’ Women’s Initiative. Additionally, she was the Chair of the 2015 and
2016 Worcester Women’s Leadership Conferences and selected by the YWCA of Central
Massachusetts as its 2017 recipient of the Katharine F. Erskine Award in Business and Law.

Cassidy graduated summa cum laude from Becker College where she received a Bachelor of Science
in Business Administration.

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James Gentile
Senior Vice President and Chief Compliance Officer

James Gentile has over 20 years of experience in health care compliance,

regulatory oversight, management and operations. As Fallon’s Senior Vice
President and Chief Compliance Officer, Gentile oversees all regulatory,
privacy and compliance matters as well as internal audit for the
organization.

Previously, Gentile served as Fallon’s Vice President of Regulatory Affairs

& Compliance and played a significant role in helping to guide Fallon’s
commercial program through unprecedented regulatory changes, including
Mass. Health Care Reform and the Affordable Care Act.

Prior to his role at Fallon, Gentile was with the Massachusetts Office of the
Attorney General. He also was Chief Claims Administrator at Allmerica
Financial.

Gentile graduated magna cum laude with a bachelor of arts in economics from Saint Anselm College
and earned a Juris Doctor at Massachusetts School of Law. He serves on the Board of Directors for
Court Appointed Special Advocates (CASA) Project of Worcester.

Gentile resides in Holden, Massachusetts.

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Kevin Grozio
Senior Vice President and Chief Financial Officer

Kevin Grozio has more than 20 years’ experience in actuarial services within
the health insurance industry. As Fallon’s Senior Vice President and Chief
Financial Officer, Grozio is responsible for accounting, financial planning and
analysis, strategic cost analysis, actuarial and underwriting, medical
economics, and risk adjustment and analytics.

Prior to his current role, Grozio served as Vice President, Underwriting and
Actuarial Services, responsible for all underwriting and actuarial services
within Fallon. In addition, he was an active member of the finance leadership
team, working closely with Fallon senior management on key strategic
initiatives.

Prior to joining Fallon, Grozio served as Vice President, Actuarial Services at

ConnectiCare, Inc. & Affiliates. In his role at ConnectiCare, he led the rate review process and rating
factor studies as well as worked closely with providers and external vendors to provide actuarial
expertise during negotiations.

Grozio is an Associate in the Society of Actuaries, a member of the American Academy of Actuaries
and possesses the Qualifications Standards of the American Academy of Actuaries to Render
Statements of Actuarial Opinion. Grozio graduated summa cum laude with a Bachelor of Science in
business administration in actuarial science from the University of Hartford.

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Carolyn Langer, M.D.
Senior Vice President and Chief Medical Officer

Carolyn Langer, M.D., J.D., M.P.H., returned to Fallon Health in 2018 as

Senior Vice President and Chief Medical Officer after previously serving as the
company’s Medical Director from 2005 to 2008.

In this role, Dr. Langer is responsible for ensuring the quality and cost-
effectiveness of health care services to Fallon members, overseeing all
activities and operations within Fallon Health’s Care Services department. She
also fosters strong relationships with Fallon’s provider partners.

Prior to Fallon, Dr. Langer served as Chief Medical Officer at MassHealth and
the Director of the Office of Clinical Affairs. In these roles, Dr. Langer provided
leadership and oversight of medical policy, pharmacy, quality, utilization
management, care management and clinical analytics teams, while serving as a MassHealth
representative to several local, state and national committees on clinical, quality and policy initiatives.

In addition, Dr. Langer previously held health care leadership roles with Harvard Pilgrim Health Care,
Tufts Health Care Institute and Blue Cross Blue Shield of Massachusetts. She is also a retired Colonel
and former flight surgeon in the Army National Guard. Dr. Langer earned her Doctor of Medicine at
Jefferson Medical College in Philadelphia and a Master of Public Health and a law degree from Harvard
University.

In 2016, Dr. Langer received the Harvard T.H. Chan School of Public Health's Leadership in Public
Health Practice Award. She holds an appointment as an associate professor in the Department of
Family Medicine and Community Health at UMass Medical School and as an instructor at the Harvard
T.H. Chan School of Public Health where she sits on the Occupational Medicine Residency Advisory
Committee. She also serves as the Board Chair of the Meyers Primary Care Institute.

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Jill Lebow
Senior Vice President and Chief Human Resources Officer

As Fallon Health’s Senior Vice President and Chief Human Resources Officer,
Jill Lebow is responsible for the functional areas of Talent Acquisition, Talent
Management and Total Rewards. She ensures that Fallon’s human resources
systems, functions and services are aligned to attract, engage and develop
the talent necessary for Fallon to meet its growing and evolving organizational
and business needs.

Lebow joined Fallon in 2008 as a Human Resources Business Partner. In this

consultative and proactive role, Lebow advised senior leaders, managers and
employees in areas such as organizational effectiveness, talent acquisition,
retention and employee development. She also served as Fallon’s Director of
Employee Relations and Staffing.

In addition to her contributions to Fallon, Lebow was a Human Resources Business Partner at the
Hanover Insurance and worked in employee relations at Abbvie.

Lebow has a Bachelor’s of Arts degree in English literature from the University of Connecticut and her
Juris Doctorate from University of Connecticut School of Law. She is member of the Worcester Boys
and Girls Club Human Resources Committee. She also sits on the advisory board for Bottom Line to
help low-income and first-generation-to-college students get to and through college.

In 2017, Lebow was honored as one of The Worcester Business Journal’s six Outstanding Women in
Business.

Lebow resides in Worcester, Massachusetts with her family.

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Mark Mosby
Chief Legal Counsel (Epstein, Becker & Green P.C.)

With more than 25 years of health law experience in support of health plans
and health benefit organizations, Mark Mosby serves as Fallon Health’s Chief
Legal Counsel. A member of the law firm of Epstein Becker & Green, P.C.
(EBG), Mosby provides comprehensive on-site legal services to Fallon and its
affiliated companies. His practice focuses primarily on transactional, regulatory,
compliance, litigation management and corporate governance issues in his
management of EBG’s legal work for Fallon.

Before joining EBG, Mosby served as Deputy General Counsel for a large
provider-owned health plan, where he was responsible for the day-to-day
oversight of a 14-member legal department and for providing legal support to
the company's compliance, Medicare and Medicaid programs, health
management, provider contracting, special investigations unit and pharmacy
programs. Before that, he served as the attorney with a large multi-state BlueCross and BlueShield
organization providing legal counsel to its national group life and disability insurance company and its
dental plan administrator and network. Mosby also served for more than ten years as director and
associate counsel, overseeing the regulatory division of a national health benefits management
company and national provider network. Early in his legal career, Mosby was in a commercial litigation
practice and also served as an attorney for the Illinois Supreme Court’s administrative office.

Mosby is a member of the American Health Lawyers Association, the Chicago Bar Association, and a
former officer of the Health Care Section Council of the Illinois State Bar Association. He has presented
on health law topics for a number of organizations.

Mosby received a bachelor’s degree from the University of Virginia and his Juris Doctorate from the
Washington University in St. Louis School of Law.

He lives in Worcester, Massachusetts with his family.

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David T. Przesiek
Senior Vice President and Chief Sales Officer

David Przesiek is a 25-year veteran of the health insurance industry.

Przesiek’s many accomplishments reflect his passion of driving innovation
in health care while creating a positive member experience.

As Fallon Health’s Senior Vice President and Chief Sales Officer, Przesiek
is responsible for commercial products including Fallon’s third-party
administrator (TPA) business, Medicare and Senior Care Options (SCO)
products, Fallon’s Medicaid line of business as well as Fallon’s Managed
Long-term Care and Program of All-Inclusive Care for the Elderly (PACE)
programs in New York. In his role at Fallon, he has overseen the
introduction of limited networks, the rollout of Fallon’s Medicaid ACO line of
business, and a strategic acquisition to increase Fallon’s self-funded
business.

Prior to joining Fallon, he held several leadership positions in health care organizations across the
country. Przesiek holds a master of business administration in health care management from Canisius
College and an undergraduate degree in marketing and management from Saint Bonaventure
University.

He is a member of the Society of Professional Benefits Administrators, the Self-Insurance Institute of

America and the New England Employee Benefits Council. In addition, Przesiek is the Chairman of
One Sky, a human service organization based in Worcester, Massachusetts. He also sits on the board
of the Worcester Research Bureau and the Worcester Economic Club; and is a past board member of
the March of Dimes and The Lowell Plan.

Przesiek lives in Manchester, Massachusetts.

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Mary Ritter
Senior Vice President of Strategy and Business Development

Mary Ritter is Fallon Health’s Senior Vice President of Strategy and Business
Development, responsible for strategy development and execution, provider
contracting, provider relations, and Summit ElderCare®, Fallon Health’s
Program of All-Inclusive Care for the Elderly (PACE).

Ritter rejoined Fallon in June 2018 after previously serving the company for
11 years. During her first tenure, Ritter was a dynamic leader, holding
positions that included Executive Vice President and Chief Operating Officer;
Senior Vice President and Chief Strategy Officer; and Senior Vice President
of Corporate Strategy and Communications.

Prior to returning to Fallon, Ritter owned and operated Worcester-based

Maywood Consulting, LLC—a niche consulting practice that provided
strategic planning and advisory services to health care, human services and cultural organizations.

Ritter earned her Bachelor of Business Administration degree in finance and operations from the
University of Massachusetts Amherst.

She is a past recipient of Worcester Business Journal’s “Outstanding Women in Business” and “40
Under 40” distinctions, past chair of the Worcester Women’s Leadership Conference and is currently a
trustee at The Hanover Theatre and Worcester State Foundation.

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Emily West
Senior Vice President and Chief Operating Officer

As Senior Vice President and Chief Operating Officer, Emily West is

responsible for overseeing all operational areas for Fallon Health, including
Enrollment & Billing, Claims & Configuration, Customer Service, Operations
System Support and Information Technology.

Since joining Fallon in 1989, West has held various leadership roles. Her
accomplishments over the last 30 years include developing and
implementing a customer service department from the ground up; assisting
in the launch of two core system replacements; managing several large
vendor solutions; implementing various components of the Affordable Care
Act (ACA) and Massachusetts health care reform and the implementation of
three ACO partnerships.

West holds a bachelor’s degree in business administration from Assumption College and certificates in
health care management and human resources. In 2014, West was selected for the American Health
Insurance Plans (AHIP) Executive Leadership Program (ELP) and received her Certified Health
Insurance Executives (CHIEs) designation in June 2015. Limited to 50 candidates nationwide, West
was chosen based on her high level of professionalism, excellent performance in her position and a
commitment to the health insurance industry.

West lives in Sterling, Massachusetts.

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