Brighton Health Plan Solutions, the medical plan management division of Brighton Health Group that provides private-labeled benefit plans to clients and their employees, launched an open enrollment platform that creates a marketplace for workers to find a hospital system at a lower cost than an open-access health plan.

The platform, called Create, allows client employees in the New York, New Jersey and Connecticut area to exclusively obtain their care from one of three hospital systems — Englewood Hospital and Medical Center in Englewood, N.J., the Mount Sinai Health System in New York, N.Y., and Long Island Health Network in Melville, N.Y. Brighton Health Plan Solutions plans to add more hospital systems.

An employee choosing a hospital system trades open access and selected a specific healthcare system, says Simeon Schindelman, CEO at Brighton Health Plans Solutions.

“That healthcare system is now going to see you and your family on a much more consistent basis. Those doctors and other healthcare providers are going to know you and your family better, and as they understand your needs, preferences and background history, they’ll be able to treat you better,” he says.

Employees use the Create platform to enroll in one of the three hospital systems or choose the more expensive open-access plan. “If you’re willing to and want to choose one of our healthcare systems, your payroll deduction will drop immediately,” he adds.

Although Brighton Health Plan Solutions declined to share the average cost savings, Schindelman says the cost structure is per employee per month. “The range depends on the array of services that employers get from us,” he says, noting self-insured employers could buy stop-loss or other services from them, which would alter the open enrollment platform cost. In a demo of the technology, the prices ranged from about $80 to more than $300 per paycheck, although the cost depends on the type of plan — individual or family — and how often employees and their dependents access care.

Employees then become “members” of the health system and receive a branded card of the hospital system, not unlike a healthcare administrator card. “Part of the approach we’re taking is the total focus on the patient-provider relationship,” Schindelman says.

Reaching transparency

The goal is to prepare hospitals for the upcoming year, where Brighton Health Plan Solutions can send the participating health system’s information on newly enrolled employees and their communication preferences. It also shows the health systems how competitive their services and rate are in comparison to the other participating hospitals.

“As we grow [employee] participation, every hospital system will stand on its own,” he says. “They’ll know how much market share they’ve won and their positioning.”

The transparency also forces health systems to be competitive just as the services need to be good to keep patients in the system.

In the case that a hospital system cannot provide adequate services, an employee can file an appeal to get care outside of the health system for a service that the health system cannot provide, says Carmilla Tan, senior vice president of analytics at Brighton Health Plan Solutions. For example, the healthcare company’s chief medical officer will review the case and determine whether there is a medical necessity to do so. Because the platform just launched, she says Brighton Health Plan Solutions has not been in that situation before.

Within the platform, employees can compare plan costs, manage spouses and dependents, view their company-paid contribution, and purchase and view voluntary benefits like short- and long-term disability. Employees can also toy with a map function that shows them where the nearest hospital, facility or clinic is from their home or office. “All of those include the hospitals, ambulatory care centers, labs, affiliated physicians and imaging centers,” says Schindelman.

The company expects to expand its geographic coverage to include more health systems in northern New Jersey, the Bronx, Westchester County and Fairfield County in Connecticut in the next six months.

Employees can access the platform on mobile, tablet or desktop, and Brighton Health Plan Solutions plans to roll out its iOS- and Android-capable app in several more weeks.

“Once it’s released, it will be ready for full use,” claims Schindelman. “You’ll be able to go to the App Store.”

Although Schindelman declined to name the companies currently using Create, he says two middle-market, self-insured companies have signed on to use the platform and about two to three dozen companies are in the request for proposal stage. He says he expects to have between 3,000 and 10,000 employees on the platform for January 2019.

“We believe that a point of enrollment decision is a better way to ask consumers how to differentiate between healthcare servicers,” he says. “We built an enrollment platform that’s dedicated to helping their employees engage with their options.”

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