GURULZ™

MYCOVERAGEPLAN

WHAT IS GURULZ?

GURULZ™ is an emerging Learning Management System (LMS) designed to educate learners to identify, secure and optimize health care coverage.

GURULZ is our mashup which combines GURU-like knowledge of healthcare coverage RULES.

WHAT WILL GURULZ DO?

Provide a simple, culturally competent, and cost effective way for providers, advocates and consumers to learn about public and private health coverage programs and health benefits counseling skills

Promote improved access to coverage and care for patients and greatly reduce uncompensated care for providers

Address community economic, cultural, and knowledge barriers that deter disparity patients from securing appropriate and needed health care coverage

"GURULZ delivers effective education strategies that promote improved access to health care coverage and services for disparity patients while also dramatically reducing uncompensated care."

-Bobby Peterson, Founder & President

GURULZ Learning Communities

Proposed Core Competencies

Public Healthcare Programs

Private Healthcare Coverage

Patient Advocacy Skills

Public Healthcare Programs

Complete Medicaid program applications
Understand eligibility options
Complete Social Security disability applications
Challenge or appeal benefits denials
Maintain eligibility
Navigate eligibility rules
Explain rule changes
Complete and track program applications
Transition coverage

Private Healthcare Coverage

Understand the basic terms and rules of private insurance
Challenge inappropriate insurance denials
Understand self-funded insurance or health plans
Secure public and private insurance benefits
Explain coverage and appeals available in the Health Care Marketplace
Understand primary and secondary coverage rules
Identify federal and state insurance law enforcement agencies

Patient Advocacy Skills

Engage families in a culturally and linguistically competent manner
Evaluate patient benefits needs in a family centered way
Investigate benefits denials or delays and engage in fact gathering
Communicate confidentially and effectively with disparity patients
Coach patients through complex benefits questions
Provide informed referrals for other community resources

PROVIDER STAFF
GURULZ will help Provider Staff:
- Connect to teaching, training and credentialing tools to successfully help disparity patients navigate complex health care coverage programs and services
- Help patients avoid medical debt and uncompensated care that hurts providers and drives up health care costs
- Improve staff morale through competent and effective services for patients seeking access to needed health coverage and services
- Promote continuity of care and services for patients that reduce reliance upon expensive and unproductive debt collection actions
PATIENT LEARNERS
GURULZ will help Patient Learners:
- Empower self-advocacy about their own medical care and coverage needs
- Reduce avoidable health disparities and related medical debt
- Help eliminate family stress over medical bills and collection actions
- Promote continuity of coverage for children and other family members
- Obtain needed teaching, training to successfully navigate complex programs to
- Improve access to coverage and care for themselves and their children
ADVOCACY STAFF
GURULZ will help Advocacy Staff:
- Secure the teaching, training, credentialing needed to help patients challenge inappropriate claim denials and successfully navigate complex health program rules and eligibility issues
- Reduce avoidable health disparities and limit uncompensated care by correctly helping patients obtain and maintain health care coverage
- Promote access to community services that lead to better health and improved health outcomes

ABOUT MY COVERAGE PLAN, INC.

TECHNOLOGY

Patented decision support tool

My Coverage Plan's patented technology solution provides a decision support tool that optimizes patient coverage, generates alerts, and creates a health care coverage record for patients.

Our suite of tools will interoperate with electronic medical records to promote efficiency and avoid duplicate date entry.

Our product development pipeline includes a variety of tools that enhance provider knowledge and skills to better support patient needs and services.

Finally, our suite of products under development include tools to verify the competency and certifications of provider staff to help patients and tools that promote compliance with federal charity care regulations.

My Coverage Plan, Inc. (MCP), is a subsidiary of ABC for Health, Inc. (ABC) a Wisconsin based nonprofit law firm. For the last 22 years, ABC has helped consumers obtain and maintain health coverage and trained health provider staff about coverage options. MCP is selling a web-based health benefits screening and counseling decision support tool to hospitals and other providers.

MCP products allow providers to help patients optimize health coverage programs and create a coverage roadmap that adjusts to changing life events. Patients optimize coverage and providers secure more revenue. MCP received patent protection for the software in February of 2012. MCP has three active provider customer partners. The NIH supports portions of the development work through SBIR funds to reduce health disparities.

CUSTOMERS

ABC & MCP Partnership + Healthcare Providers + Patients

With our partners at ABC for Health Inc., MCP works with urban and rural Wisconsin providers to help build the tools and technology solutions to help disparity patients. Currently our partnership includes St. Mary’s and SSM Wisconsin and Meriter Unity Point Health providers in south central Wisconsin. In Northwest Wisconsin MCP is under contract with ABC for Rural Health Inc., to help build a health benefits counseling network of a rural critical access hospitals, a local public health office, a county based behavioral health program and an advocacy organization. The SafetyWeb Network project is funded under a Rural Network Development initiative through federal Health Resources and Services Administration.

METHODS & APPROACH

Up front, Proactive, Patient-Centered

The MCP advantage includes a proactive patient-centered approach that helps patients optimize and maintain health coverage and helps providers increase revenues. MCP promotes up front revenue and reduces ineffective backend collection actions and costs. MCP tools inform a sophisticated understanding of both public and private payment options. MCP both secures and saves money for providers, and promotes positive community relations.

"The two products are based on...expertise in the intricacies of Medicaid and other programs. Even some financial counselors at hospitals...don't know all of the complex rules on eligibility for different programs."

Milwaukee Journal Sentinel

"The training would encompass a range of topics, from the Affordable Care Act to disability insurance and COBRA coverage."

The Cap Times

"Trying to decipher health care coverage programs is sure to trigger eyes-glazed-over moments. My Coverage Plan's mission is to make it all easier to understand."

Wisconsin State Bar

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