Joint Agreement Doubles Market Coverage For Two Health Plans

The new year brings a significant change to two Massachusetts health maintenance organizations, which have teamed up to market each other’s products.

The net result, the presidents of both plans claim, will not only help employers offer more complete coverage to their workers but also give the two HMOs an edge in competing against larger, regional plans.

Effective Jan. 1, Health New England, which is based in Springfield, is teaming with Worcester-based Fallon Community Health Plans in serving employers that have employees living in both Western and Central Mass.

cause we share a mutual respect for each other and serve adjoining markets, by working together, we can make our plans more easily available to consumers,” said Peter Straley, Health New England’s president and chief executive officer. “Through this arrangement, we can enhance the service we provide our members and double our sales capabilities without any added expenses.”

Previously, Straley explained, if a company had 100 employees in Greater Springfield and five or 10 near Worcester, for example, Health New England would have a harder time giving them a product that meets all their needs than would a competitor with a statewide reach.

ow, that 100 people who live here in Springfield would buy Health New England; that’s the product they want. And for the people living in Worcester, give them the Fallon HMO. This allows us to offer another high-quality product so employers can get it all at once instead of having to piece it together.”

Employers that offer the plans jointly to their employees can choose to have one point of contact, but the two plans will continue to bill separately, operate separately, and provide separate identification cards to employees.

“This marketing agreement creates new, added value for our customers,” said Eric Schultz, president and chief executive officer of Fallon. “By sharing information and working cooperatively, we will both serve our customers better.”

Clearly, Straley said, employers and their workers aren’t the only ones who will benefit.

“This allows us to compete with some health plans, like Blue Cross, that have a statewide network and give employees a plan that’s geared toward where they live and get their health care,” he said. “By putting the two together, they’ll get a better product than they might get from a regional or national firm.”

Besides its Springfield headquarters, Health New England has a sales and service office in Pittsfield. The health plan serves nearly 100,000 members in Western Mass. and Northern Conn. through a variety of health coverage plans.

Fallon Community Health Plan, which has more than 190,000 members, boasts a network that includes thousands of private practice physicians, as well as its founding medical group, Fallon Clinic. The plan offers a choice of targeted products, including HMO plans, a point-of-service plan, an out-of-area indemnity product, and a Medicare + Choice plan.

Both HMOs have an accreditation status of ‘Excellent’ for their commercial plans from the National Committee for Quality Assurance (NCQA). This accreditation status, the highest level achievable, is based on a voluntary review of how a health plan ensures that its members are receiving quality care.

Health New England was recently named one of the top 15 accredited plans in the country based on member satisfaction, according to the Consumer Assessment of Health Plans, a nationwide survey conducted on behalf of the NCQA. In addition, Fallon was named the number one health plan in the country twice each by Newsweek and U.S. News and World Report.