The hospital is
the health plan

A hospital has an unusual advantage as an employer. The people on its payroll work beside the people who could provide their healthcare. Yet connecting those two facts requires a surprising amount of machinery. Someone must decide which doctors participate, keep enrollment records straight, process claims and explain a bill. Brighton Health Plan Solutions has made that gap its business.

A hospital with two jobs

Consider Northwell. In October 2021, the New York health system selected Brighton to administer its employee health benefit plans using the Northwell Direct network. Northwell was buying care for its workforce while also organizing the providers who could deliver it. Brighton supplied the administrative connection between those roles.

The arrangement makes the company easier to understand than its broad description of “healthcare enablement.” A self-funded employer pays for covered claims under its plan. A third-party administrator handles agreed functions. The provider network determines where members can obtain participating care. Those pieces can be chosen separately, even when employees experience them as a single benefit.

Northwell supplied a substantial test. Its workforce numbered more than 75,000 when HealthLeaders examined the implementation in March 2022. Executives described moving quickly over a few months, addressing employee issues and recruiting providers. The detail that matters is the recruiting: an attractive network on paper still has to accommodate the people using it.

“Frequent, multi-channel communication is key.”

Nick Stefanizzi · Northwell Direct · 2022

The pandemic helped make such relationships less abstract. In the HealthLeaders interview, Brighton’s Michelle Zettergren pointed to employers approaching local health systems for testing, vaccinations and safety guidance. Those practical collaborations accelerated interest in broader partnerships. The question became whether an existing connection could support more of an employer’s healthcare needs.

Brighton’s customers extend beyond hospitals. Self-funded businesses, labor and Taft-Hartley funds, other administrators and health-plan organizations buy its services. Its MagnaCare brand brings a history that reaches back to 1990, when physician Anthony Bacchi established a diagnostic network after questioning what unions paid for laboratory and radiology services. Benefits administration followed in 1999.

The work after the handshake

That history helps explain Brighton’s position. It comes to direct contracting with existing experience in networks and administration. A hospital can negotiate with an employer, but the agreement still needs eligibility files, claims rules, member assistance and a way to cover missing specialties. Brighton offers to assemble those working parts.

The company also works within a familiar carrier arrangement. Blue Cross NC announced that Brighton would administer claims and member and provider services for two selected self-insured employer groups beginning in January 2023. Blue Cross NC retained the group contracts and network role. Members kept Blue Cross-branded cards while using Brighton’s Create platform for claims and provider searches.

That is a useful correction to the idea that every Brighton engagement removes an insurer. Its business is selling administration, network capabilities and technology to organizations with different needs. A direct provider arrangement is one application. A carrier partnership is another. The customer buys a working configuration.

The app meets the appointment

Create is the digital layer: a configurable platform for enrollment, benefits administration and member access. Employers can apply their branding, rules and processes. Members can look up participating providers, inspect claims and explanations of benefits, and review coverage. Brighton says the platform integrates with third-party vendors and can support plans beyond its own networks.

Then there is the problem a screen cannot finish. A provider search produces names; a patient needs an appointment. Brighton’s concierge service can check participation, arrange visits, confirm benefits and help untangle explanations of benefits afterward. This pairing of software with human assistance gives the product a practical purpose: shorten the distance between having coverage and using it.

Clinical administration adds another layer. Brighton describes utilization review, nurse case management and care coordination among its services. These address how care is used, alongside the contracted price. Buying a lower rate and helping someone navigate a complex treatment are different tasks; a health plan may need both.

A discount needs somewhere to go

The economics depend on a bargain. A provider accepts negotiated terms in exchange for the prospect of more patients. The employer encourages members to use those providers. Geography immediately becomes consequential. Brighton’s hospital-employee offering explicitly includes supplemental networks for people outside the service area and help filling specialty gaps.

Its 2024 research with HR Dive’s studioID surveyed 150 benefits leaders, all representing organizations with at least 1,000 benefit-eligible employees. Seventy-five percent reported some direct provider arrangement. That is an interesting signal from this sample, rather than a census of American employers.

Price deserves the same care. The survey found that 76% expected savings in that range. Evaluating an offer still means accounting for administration, network fit and care use. Brighton directs prospective customers toward a tailored proposal; the useful buying question is what the complete arrangement costs for a particular population.

Start with the map

In a 2025 Leader’s Edge interview, Brighton executive Tom Malczewski emphasized local competition and employer scale. He described large groups as better placed to attract provider interest, while acknowledging smaller experiments. His practical advice began with understanding where members already receive care and using benefit design to encourage preferred providers.

That is the part a reader can copy. Map the workforce. Find the gaps. Compare the full costs. Give people a reason to choose a provider they can reach. A contract cannot do that persuasion alone.

There is a people business inside the administrative one. Brighton received a third consecutive USA Today Top Workplace award in 2025, based on employee feedback. City & State’s October profile reported that 39% of the company’s 144 roles filled that year came through internal promotions. Keeping experienced people matters in a business built around interpreting rules and resolving exceptions.

Brighton continues to sell the operational work behind such choices. WakeMed announced it as the administrator for its 2026 medical plan. For an employee, that change arrives as something wonderfully ordinary: a new card, an answered question, a claim that makes sense. Those small encounters are where the larger arrangement earns its keep.