Customize your network & health plan design
Groups are paying too much for their self funded health insurance.
What’s more, care is typically fragmented across disparate health systems. It’s difficult to navigate, and health plan members do not receive holistic care – adversely affecting health outcomes.
Brighton Health Plan Solutions enables self funded clients, health systems, and TPAs to solve the problems facing today’s healthcare. We offer highly customizable plan designs with ultimate flexibility and furnish our clients with tools that enhance the member experience. Our innovative and sustainable solutions encourage patient activation and improve the quality of care — all at lower cost.
Flexible plan design
No two clients are alike. We want you to have an exact fit for your population and budget. That’s why we work with you to customize your health plan design. We don’t limit you to a standard plan design. We analyze and model plans to determine the plan design changes that yield the most savings. You can determine copay amounts, deductibles, services requiring prior authorization, out-of-network reimbursement methodology, and more.
Non-traditional health plan options that save you money
Beyond plan design, we can assist in introducing new plans that support lower cost care.
Reference based pricing adds transparency to the cost of healthcare. It can be an excellent, low-cost, and flexible way to provide health coverage to your employees. With reference based pricing, you pay providers a “reasonable fee” based on a reference point, such as the Medicare price for the same service. It’s a concept that’s gaining traction, and we’ll work with you and your providers to set up a health plan using this reimbursement method.
Services that add value
We offer a wide range of health plan services that offer exceptional value to commercial and public sector employers, health systems, and other TPAs:
- Cost-effective TPA services
- In-house Medical Management programs such as utilization review and case management
- Create® Technology, our advanced healthcare technology platform that streamlines operations and engages members in their healthcare
Switch to self funding and save
Self funding your health plan is a great way to save money, gain total control over your plan, and realize immediate savings. Using a third party administrator (TPA) to administer the health plan removes the hassle of managing the plan.
The COVID-19 pandemic has illuminated the many advantages of a self funded health plan:
You pay only for the services your members use
Self funded groups benefited from lower health plan utilization during the COVID-19 crisis.
You can adjust your health plan design at any time
Self funded groups were able to add benefits such as telehealth and adjust covered services.
You have insight into your data
With self funded health plans, you own the data. We provide our clients with actionable insights so they can make informed decisions on plan design changes in real-time.
Learn about our Level-Funded program, which eases self funding through predictable monthly payments.
Need doctors? Choose our networks.
Brighton Health Plan Solutions’ proprietary MagnaCare provider networks and integrated delivery networks (IDNs) offer a wide range of network options:
Nationwide PPO network
Cover your health plan members with our affordable, comprehensive provider network in all 50 states and Puerto Rico.
Our leading PPO network in the New York tri-state area provides you with deep discounts.
Custom network
Do you want to cover only a specific region? Or exclude a certain type of provider? We will work with you to build your network, customized by any criteria – such as by zip codes, specialties, hospital-only, or provider-only.
You choose the types of providers you want, in the locations you need.
Narrow network
Choose our high-performing narrow networks that give your members exceptional healthcare at lower cost. You can offer the narrow network for people who prefer a lower cost health plan rather than a broader network.
Integrated delivery network
Save 10–25% on healthcare costs through an integrated delivery network (IDN) built around a single health system. IDNs offer the lowest rates in exchange for members who commit to using the health system's providers. Members benefit from coordinated care and stronger doctor-patient relationships.