Brighton Health Plan Solutions Company Profile

Background

Brighton Health Plan Solutions (Brighton HPS) is a national healthcare enablement company and third-party administrator (TPA) dedicated to transforming the healthcare landscape by assisting self-funded organizations in delivering superior healthcare to their members. With over three decades of network administration experience, Brighton HPS offers unmatched administrative flexibility, customizable network solutions, comprehensive casualty solutions, and an award-winning technology platform adaptable to unique client needs. The company supports more than 1.6 million members and employs nearly 600 staff nationwide.

Key Strategic Focus

Brighton HPS focuses on providing innovative solutions for self-funded employers, health systems, TPAs, and insurance carriers. Their strategic initiatives include:

• Direct Provider Contracting: Facilitating direct contracts between self-insured employers and healthcare providers to bypass traditional insurance carriers, resulting in cost savings and enhanced care quality.

• Reference-Based Pricing Models: Implementing pricing models based on Medicare rates or custom fee schedules to manage healthcare costs effectively.

• Integrated Technology Solutions: Offering a modular and scalable technology platform that integrates with various provider networks, insurance carriers, and third-party vendors, enhancing administrative efficiency and member engagement.

Financials and Funding

Brighton Health Plan Solutions was launched in 2016 by Brighton Health Group, with investments from Goldman Sachs and Pamplona Capital Management, to pioneer new health plan management offerings. Specific financial details regarding total funds raised and recent funding rounds are not publicly disclosed.

Technological Platform and Innovation

Brighton HPS's proprietary Create® Technology platform is a state-of-the-art solution that combines a mobile app, enrollment portal, member portal, and administrator portal into a seamless system. This platform supports:

• Direct Contracting: Enabling health systems and provider groups to administer direct network contracts with self-insured employers.

• Reference-Based Pricing: Facilitating claims payment according to various reference-based pricing models.

• Modular Architecture: Allowing clients to select services tailored to their needs, with strong integration capabilities for external partner solutions.

Leadership Team

• Jim Cusumano, Chief Executive Officer: Oversees daily operations, financial planning, and risk management. Previously served as CFO at National Healthcare Resources.

• Michelle Zettergren, President of Labor and Chief Sales & Marketing Officer: Leads sales and marketing efforts, focusing on personalized service and custom-fit solutions. Formerly Chief Sales Officer at HPOne and Senior VP at ConnectiCare.

• Julie Bank, Chief People Officer: Manages human resources, emphasizing strategic approaches to recruiting, hiring, and employee retention.

• Arun Bhatia, Chief Information Officer: Directs technology operations and infrastructure management, introducing new technologies to enhance customer and member experiences.

• Dr. Nancy Klotz, Chief Medical Officer: Oversees medical affairs and clinical strategies, with extensive experience in managed care and internal medicine.

Additional leadership profiles are available on the company's website.

Leadership Changes

In 2024, Brighton HPS appointed Jeremy Schoettle as Chief Financial Officer. Schoettle brings extensive experience from his previous roles at Anthem and UnitedHealthcare.

Competitor Profile

Market Insights and Dynamics

The healthcare enablement and TPA industry is experiencing significant growth, driven by the increasing adoption of self-funded health plans by employers seeking cost-effective and customizable healthcare solutions. The market is characterized by technological advancements, regulatory changes, and a focus on value-based care.

Competitor Analysis

Key competitors in the healthcare enablement and TPA sector include:

• UnitedHealth Group's Optum: Offers a comprehensive suite of health services, including TPA solutions, with a strong emphasis on data analytics and technology integration.

• Aetna's Meritain Health: Provides TPA services with a focus on flexible plan designs and cost management strategies.

• Cigna's Allegiance Benefit Plan Management: Delivers customized TPA services, emphasizing personalized customer service and innovative health solutions.

These competitors leverage extensive networks, advanced technology platforms, and a broad range of services to cater to diverse client needs.

Strategic Collaborations and Partnerships

Brighton HPS has established significant collaborations to enhance its service offerings:

• Northwell Health: Administers health benefits for approximately 75,000 Northwell Health employees and dependents using the Northwell Direct network.

• SEIU 775 Benefits Group: Provides TPA services, including contribution accounting, financial administration, and eligibility determination.

Operational Insights

Brighton HPS differentiates itself through:

• Customizable Solutions: Offering tailored services that meet the unique needs of clients.

• Technological Innovation: Utilizing the Create® Technology platform to streamline administrative processes and enhance user experiences.

• Direct Contracting Expertise: Facilitating direct provider contracts to improve cost efficiency and care quality.

Strategic Opportunities and Future Directions

Brighton HPS is poised to capitalize on:

• National Expansion: Extending services across the United States to reach a broader client base.

• Enhanced Technology Integration: Continuing to develop and integrate advanced technologies to improve service delivery and client satisfaction.

• Value-Based Care Models: Embracing value-based care initiatives to align incentives with healthcare outcomes.

Contact Information

For more information, visit Brighton Health Plan Solutions' official website:

Social Media Profiles:

• LinkedIn: Brighton Health Plan Solutions on LinkedIn

• Twitter: Brighton Health Plan Solutions on Twitter

• Facebook: Brighton Health Plan Solutions on Facebook