Case Study: Fallon Health achieves 75% faster quote generation and rapid broker portal launch with Pegasystems

How Fallon streamlined quote to card

Fallon Health, a Massachusetts not‑for‑profit insurer serving commercial, Medicaid and Medicare members, needed to quickly modernize broker sales amid fragmented IT systems, tight regulatory deadlines and growing product complexity. With over 4,000 brokers and 1,600 products across multiple programs, Fallon sought to simplify broker interactions, meet state exchange and ACA mandates, and prevent loss of market share by making quoting and sales faster and more compliant.

Fallon implemented Pega’s sales and enrollment platform using an Agile, integrated delivery team to build QuoteNow, a broker portal that automated quote-to-card workflows, document generation and EDI exchange with the state. Delivered in four months, the solution produced a 75% reduction in quote generation time, enabled one‑stop shopping across plans, met exchange compliance, improved broker experience and was named a “benchmark” by the state of Massachusetts.

Fallon

David Przesiek

Senior Vice-President and Chief Sales Officer