Is Your Health System Leaving Money On the Table?

As healthcare systems continue to have margins squeezed and pressure on the bottom line intensifies, many are wondering: Are there places where I’m leaving money on the table? If your health system is still working under the traditional insurance model, the answer is a resounding yes! Luckily, there’s an alternative to the traditional model—one that eliminates expensive administrative costs, delivers more patients to you, and increases services per patient. It’s direct contracting—and if you’re a health system looking for stronger financials and better patient relationships, it’s a model worth exploring.

Direct contracting is a fast-growing healthcare trend, and understandably so. Rather than working through traditional insurance companies, under direct contracting, health systems provide their services directly to self-funded employers, thereby driving revenue and increasing utilization of services. What’s more, by working with a third-party administrator (TPA), health systems can implement and manage direct contracting without taking on extra administrative work.

Here are three ways your health system can increase profitability by offering direct contracting:

1. Eliminate the high admin fees of traditional insurance carriers.

Who loves high admin fees? Absolutely no one. Well, no one aside from traditional insurance carriers. Eliminating these carriers by going direct-to-employer makes your health system a more attractive option to employers who would gladly give up paying the carrier’s steep admin fees.

That said, health systems may wonder: Will eliminating traditional insurance carriers create an influx of new administrative tasks (and costs)? The answer: No. A TPA can take on all the administrative tasks that a traditional insurance company would usually carry out, such as determining eligibility, processing claims, generating EOBs, billing clients, and more—at a lower cost. There’s no added administrative burden on your health system.

Plus, your TPA can take on the bulk of the customer service work your health system’s staff currently handles. Brighton’s Concierge Customer Service enables plan members to speak directly with a TPA-employed customer service representative to find a provider and book an appointment, reducing the administrative burden for you and your individual providers’ offices.

In deciding which TPA can serve you best for direct contracting, look for a partner with a forward-leaning tech solution, including an easy-to-use intuitive patient portal for plan members. A well-designed patient portal can reduce your health system’s overall administrative effort, saving time and money. Plus, you gain the ability to run reports for at-a-glance information on key demographic and utilization metrics that help you identify trends and control costs.

Brighton’s Create Technology platform integrates easily with any health plan on the market. There’s no steep learning curve: Brighton handles all setup and customizes the platform to your rules and processes, including onboarding options.


2. Gain more patients.

When health systems work directly with plan sponsors, they instantly gain large rosters of new patients because each employee becomes a patient.

Many health systems have a wide reach over concentrated areas. For example, Northwell Health has nearly 20,000 providers throughout New York and New Jersey, so many employees of locally based organizations are likely already using providers within the system.

With direct contracting, companies leverage your health system’s reach to provide quality care at a lower-cost  to their employees, who probably have already had a positive experience with your system. And instead of wondering if they need to add a new provider or specialist, plan members have the built-in access and assurance that a qualified professional can help them get the medical care they need—which brings us to the third point.


3. Provide more services to each patient.

A TPA isn’t just a benefits processor; it’s also a utilization maximizer that delivers expert and friendly customer service to answer questions, provide guidance on using the system, and more. The TPA should help members understand their coverage and feel confident scheduling appointments with your providers. Your partner should create a directory where members can easily find eligible providers according to their conditions and view their expected copay.

An experienced TPA will look at every opportunity to foster regular interaction between plan members and their providers, keeping more revenue within your system and allowing you to provide your patients with comprehensive care. Direct contracting can encompass your entire breadth of healthcare offerings, from medical to behavioral health to wellness program partnerships, including education programs and chronic condition management. A nimble TPA can work with your system to customize coverage offerings, differentiating your system from more rigid ones on the market.


Maximize your system’s revenue potential with direct contracting.

A tech-forward TPA with more than 30 years of experience designing health plans, Brighton Health Plan Solutions is bringing health systems and employers together to revolutionize patient care. We work with health systems to design custom direct contracting plans that bring in more patients, increase services, and minimize administrative workload. Brighton Health Plan Solutions handles all enrollment, administration, customer service, and more. Don’t leave money on the table. Are you ready to go direct? Let’s talk.

Contact Brighton Health Plan Solutions

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