Brighton Health Plan Solutions

What Brighton Health Plan Solutions does

Brighton Health Plan Solutions (Brighton HPS) is a New York-based healthcare enablement company that has operated as a third-party administrator for over 35 years, serving self-insured employers, health systems, and labor unions across the United States. The company's core function is administering self-funded health plans — handling enrollment, eligibility, claims adjudication, and medical management on behalf of employers and providers that assume their own insurance risk. Brighton HPS also acts as a back-office administrator for other TPAs and as a contracting enabler that helps health systems build direct relationships with employer groups. Named clients and partners include Northwell Health, Atlantic Health System, Waterbury HEALTH, and Eastern Connecticut Health Network.

The company is built around its proprietary Create® Technology Platform, which integrates enrollment, benefits administration, member engagement, provider search, claims viewing, EOB tracking, and HR/payroll system integration into a single configurable system. Complementing the platform are three proprietary network and care assets: the MagnaCare PPO network (nationwide coverage in all 50 states and Puerto Rico with deep discounts in the New York tri-state area), Integrated Delivery Networks built around specific health systems under the Create® Health Systems brand, and the MagnaCareRx pharmacy benefits management service. The platform processes more than 10.1 million claims annually at a stated 99% accuracy rate. Brighton HPS holds five consecutive URAC accreditations in Health Utilization Management, providing independent validation of its quality infrastructure.

Brighton HPS generates revenue primarily through administrative fees structured on a per-member-per-month basis or as a percentage of claims processed, with pricing customized by plan size, services selected, and network configuration. The company distributes through a hybrid go-to-market model: a direct enterprise field sales force targets large self-funded employers and health systems, while broker and benefits consultant partnerships extend reach into the mid-market. The firm employs 251–500 people and is headquartered at One Penn Plaza in Manhattan. Ownership is private, with no institutional funding rounds, parent entities, or M&A transactions disclosed in the source material, indicating an organically grown or management-held business.

Name

Brighton Health Plan Solutions

Legal name

Brighton Health Plan Solutions, LLC

Website

https://brightonhps.com

Company type

Private

Founded year

1990

Operating status

Operating

Headcount range

251–500 employees

Short description

Brighton Health Plan Solutions is a healthcare enablement company providing third-party administration, direct contracting, and its proprietary Create® Technology platform for self-insured employers, health systems, and labor unions nationwide.

Ownership category

akta.pro rank

Product category

Third Party Administration (Health Plan Management)

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health and Welfare Funds (525120)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

MA Care Coordination & Utilization Management (UM) Programs (HLAEACAK)

Keywords

• Third party administration
• Health plan management
• Claims administration
• PPO provider network
• Direct provider contracting

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Others

Revenue model

1. Third Party Administrator (TPA) Services: Comprehensive TPA services including claims administration, enrollment, eligibility management, and plan administration for self-insured employers and health systems. Revenue is generated through administrative fees, typically on a per-member-per-month (PMPM) basis or as a percentage of claims processed.
2. Direct Contracting Services: Facilitates direct relationships between health systems and employers, providing administrative expertise, network contracting, and benefit design services. Generates revenue through administrative fees for managing health plans and provider relationships.
3. Retirement Plan Administration: 401(k) defined-contribution and defined-benefit pension plan administration services including plan design, recordkeeping, compliance testing, and reporting.
4. Technology Platform Licensing: Create® Technology platform offered to TPAs and health systems for health plan management, member engagement, and claims administration.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

Brighton Health Plan Solutions is a healthcare enablement company and third-party administrator (TPA) serving self-insured employers, health systems, and TPAs. It administers self-funded health plans (claims adjudication, enrollment, eligibility, network access, medical management) via its proprietary Create Technology platform and MagnaCare PPO network, and enables direct provider-to-employer contracting.

Product overview

Brighton Health Plan Solutions is a healthcare enablement company offering a comprehensive suite of products and services centered around its proprietary Create® Technology Platform. The core offering includes Third Party Administrator (TPA) Services processing over 10.1 million claims annually. Their network portfolio includes the MagnaCare PPO Network (nationwide), Integrated Delivery Networks (IDNs), and Direct Contracting solutions for employers and health systems. They offer integrated pharmacy benefit management through MagnaCareRx, along with Concierge Customer Service, Medical Management, Wellness programs, Reference Based Pricing, Retirement Administrative Services, and COBRA Administration. The Create® Technology Platform integrates with their proprietary networks and third-party vendors (PBMs, payroll systems) to provide a unified health plan management solution.

Differentiator

Problem solved

Functional benefit

Brands

• Create® Technology: Advanced technology platform for health plan administration including online open enrollment, benefits administration, and member engagement tools.
• MagnaCare
• Create® Health Systems
• MagnaCareRx

Products and services

• Third Party Administrator (TPA) Services Comprehensive TPA services for self-funded employers, health systems, and other TPAs including claims adjudication and processing, claims repricing, custom plan design, high-touch account management, enrollment/eligibility management, and data transparency. Processes over 10.1 million claims annually with 99% accuracy.
• Create Technology Platform Award-winning proprietary healthcare technology platform enabling online open enrollment, benefits administration, and member activation/engagement. Integrates with any health plan, PBMs, payroll vendors, and HR applications, and includes provider directory, custom ID cards, claims/EOB viewing, and mobile app.
• MagnaCare PPO Network Proprietary nationwide PPO provider network offering coverage in all 50 states and Puerto Rico, with deep discounts in the New York tri-state area. Available for network rental to plans and TPAs.
• Integrated Delivery Networks (IDNs) / Create Health Systems Networks built around single health systems offering 10-25% savings through coordinated care and stronger doctor-patient relationships. Includes Create Atlantic Health System and Waterbury HEALTH/ECHN networks.
• MagnaCareRx Integrated pharmacy benefit management (PBM) offering competitive pricing, with pharmacy data feeding the care management engine. Integrates with clients' preferred PBMs.
• Direct Contracting for Employers Enables employers to contract directly with health systems, achieving 10-25% savings over traditional insurance. Brighton assists with network creation, claims processing, and medical management.
• Direct Contracting for Health System Employees Self-funded health plans based on health system networks for health system employees, providing access to high-quality providers while lowering healthcare costs.
• Health System Custom Program Development Custom healthcare program development for health systems including benefit tiering, center of excellence programs, custom reimbursement models, and on-site clinic administration.
• Concierge Customer Service Personalized member service helping members understand benefits, navigate care, find and book providers, manage appointments, and clarify EOBs and follow-ups.
• Reference Based Pricing Cost-containment program enabling employers to lower healthcare costs by 25-30% by pricing claims against a reference benchmark rather than negotiated network rates.
• Medical Management Cost-containment and clinical programs (utilization management, disease management, wellness) that reduce clients' medical spend while improving member health outcomes. URAC accredited in Health Utilization Management.
• Retirement Administrative Services 401(k) defined-contribution and defined-benefit pension plan administration including plan design, enrollment, payroll deductions, plan document creation, benefit statements, compliance testing, recordkeeping, and IRS/DOL reporting.
• COBRA Administration COBRA benefit administration including preparing and distributing documentation, monitoring election periods, and collecting monthly premiums to ensure compliance.

Quantifiable outcome

• 10.1 million claims processed annually with 99% accuracy
• +5 more outcomes

Named customers4 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

Feature4 records

Partnerships

Seven partnerships are on record, tiered core and secondary.

• Northwell HealthcoreStrategic or Co-development Partner · 1 January 2021Northwell Health partnered with Brighton HPS to form Northwell Direct, enabling direct-to-employer health care contracting. Brighton administers health benefits for approximately 75,000 Northwell employees and dependents using the Northwell Direct network. This partnership allows Northwell to offer innovative health plans based on its own provider network.
• Atlantic Health SystemcoreStrategic or Co-development PartnerAtlantic Health System joined the Create® Network, enabling the health system to offer integrated delivery network options to self-insured employers. This expands access to affordable, quality care in New Jersey's Morris, Sussex, Union and Warren Counties.
• Waterbury HEALTHsecondaryStrategic or Co-development PartnerWaterbury HEALTH joined the Create® Network expanding innovative benefits options for Connecticut employees through an integrated delivery network.
• Eastern Connecticut Health Network (ECHN)secondaryStrategic or Co-development PartnerECHN partnered with Brighton to offer integrated delivery network options to self-insured employers in Connecticut.
• MagnaCarecoreTechnology or IntegrationBrighton HPS operates MagnaCare PPO network (nationwide in all 50 states and Puerto Rico) and integrates with MagnaCareRx pharmacy benefits management (PBM). MagnaCare is a related entity within the Brighton organization providing proprietary networks and pharmacy services.
• Create Health PlanscoreTechnology or IntegrationCreate Health Plans operates integrated delivery networks (IDNs) built around major hospital systems. Brighton HPS integrates with these networks for direct contracting health plan offerings.
• Stop Loss CarrierssecondaryStrategic or Co-development PartnerBrighton maintains strong relationships with Stop Loss partners to help clients achieve competitive stop loss insurance coverage. Can also integrate with client's preferred stop loss vendor.

Scale indicators9 records

Recent moves7 records

Expansion highlights6 records

Market position

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/brighton-health-plans-solutions

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

Funding overview

Funding rounds1 record

Investors1 record

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Brighton Health Plan Solutions